腹腔镜下疝气针无损伤腹膜疝囊高位结扎术治疗小儿腹股沟斜疝1 411例手术技巧探讨

西安市儿童医院,西安交通大学附属儿童医院普外一科(陕西省西安市,710002)

腹腔镜; 疝, 腹股沟; 疝气针; 无损伤腹膜; 儿童

Operative techniques of laparoscopic hernia sac high-ligation for pediatric inguinal hernia:a report of 1 411 cases.
Bian Jun,Wei Qiang,Shi Weidong,Zhang Sheng,Zhang Aihui,Zhang Xiangning.

Department I of General Surgery,Affiliated Children's Hospital,Xi'an Jiaotong University,Xi'an 710003,China.Corresponding author:Bian Jun,Email:blandbird@126.com

Laparoscopes; Hernia, Inguinal; Hernia Needle; Non-invasive Peritoneum; Child

DOI: 10.3969/j.issn.1671— 6353.2018.09.015

备注

目的 初步探讨腹腔镜下疝气针单通道无损伤腹膜疝囊高位结扎术治疗小儿腹股沟斜疝的手术技巧。方法 回顾性分析2014年8月30日至2015年8月29日我们收治的腹股沟斜疝患儿1 411例(男1 233例,女178例),平均年龄3岁2个月(6个月至15岁2个月); 病灶位置:左侧505例,右侧779例,双侧127例; 术中采用腹腔镜下疝气针单通道无损伤腹膜疝囊高位结扎术(手术中疝气针通过输精管或者精索时穿破腹膜的发生率为10%~15%,此种情况下先退针,重新选择潜行位置顺利通过输精管和精索)。结果 单患侧女童手术平均耗时约3 min,双患侧约5 min; 单患侧男童手术平均耗时约5 min,双患侧约8 min; 患儿手术当日进食流质饮食,次日出院,门诊复查1个月,电话随访1年,复发2例,其余患儿均未出现术后不良反应。结论 腹腔镜下疝气针单通道无损伤腹膜疝囊高位结扎术治疗小儿腹股沟斜疝具有操作简单、手术时间短、微创安全等优势,值得临床推广。
Objective To explore the operative techniques of laparoscopic hernia sac high-ligation for pediatric inguinal hernia. Methods Retrospective statistical analyses were performed for a total of 1411 hospitalized cases of pediatric oblique inguinal hernia from August 30,2014 to August 29,2015.The involved side was left,right and bilateral.The operative approach was laparoscopic hernia sac high-ligation.During surgery,hernia needle had an incidence of 10%-15% guiding through spermatic cord or vas deferens piercing peritoneum.Such an event required re-selecting stealth position and passing smoothly through vas deferens and spermatic cord. Results For girls,the average operative duration was 3 min in unifeteral hernia and 5 min in bilateral hernia; For boys,the average time was 5 min in unifeteral hernia and 8 min in bilateral hernia.They resumed a liquid diet the same day and were discharged the next day.Follow-ups were conducted by clinic visits at 1 month and telephone at 1 year.Two cases recurred and the remainder showed no major postoperative discomforts. Conclusion Laparoscopic hernia sac high-ligation offers the advantages of simple handling,short operative duration and minimal trauma.It is quite worthy of clinical popularization.