腹腔镜下疝囊高位结扎术治疗小儿腹股沟斜疝的临床分析(附962例报告)
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摘要
目的:探讨腹腔镜小儿腹股沟斜疝疝囊高位结扎术的临床治疗效果。方法:选取2012年2月至2016年2月行腹腔镜疝囊高位结扎术的962例腹股沟斜疝患儿作为研究对象,回顾分析其年龄、性别、疝类型、手术时间、并发症等临床资料。结果:962例均在腹腔镜下完成手术,采用自制带丝线克氏穿刺针经皮内环口结扎法施术,无中转开放病例,其中7例患儿加用辅助钳辅助手术,3例为大网膜粘连于疝囊,4例为疝囊巨大,输精管处折叠借助辅助钳分离输精管。手术时间6～18min,平均(14.3±4.2)min。术后3例复发,行二次手术治愈;术中对侧探查无异常,但术后再次出现腹股沟斜疝4例,接受二次手术治愈。无副损伤、切口感染等并发症发生,效果满意。结论:腹腔镜小儿腹股沟斜疝疝囊高位结扎术临床效果显著,不解剖腹股沟管,损伤小,并发症少,操作简单,术后康复快,是治疗小儿腹股沟斜疝的可靠选择。
Objective:To explore the clinical value of laparoscopic high ligation of hernia sac in the treatment of pediatric indirect inguinal hernia.Methods: A retrospective analysis was made on the clinicaldata,such as age,sex,hernia type,operation time and complications,of the 962 children who suffered from indirect inguinal hernia and were treated with laparoscopic high ligation of hernia sac from Feb.2012 to Feb.2016. Results: All the 962 patients successfully underwent laparoscopic high ligation of hernia sac without conversion to open surgery.A self-made Kirschner wire was used to ligate the hernia sac through the abdominal wall.An assistant forceps was insertedduring operation in 7 cases to assist separation,including 3 cases of adhesion between the hernia sac and omentum majus and 4 cases of huge hernial sac with fold atdeferens.The operating time was 6.0-18.0 min with a mean of (14.3±4.2)min.3 cases of inguinal hernia recurred and 4 cases of contralateral inguinal hernia were found after surgery which seemed normal under first laparoscopy.These 7 cases were cured after a second surgery.All operations obtained good effect without subsidiary-injury,incision infection or other serious complications.Conclusions: The laparoscopic high ligation of hernia sac avoids the anatomy of inguinal canal,is an effective and reliable operation in the treatment of pediatric indirect inguinal hernia because of its advantages such asmini-invasion,few complications,simple operation and quick recovery.
Objective:To explore the clinical value of laparoscopic high ligation of hernia sac in the treatment of pediatric indirect inguinal hernia.Methods: A retrospective analysis was made on the clinicaldata,such as age,sex,hernia type,operation time and complications,of the 962 children who suffered from indirect inguinal hernia and were treated with laparoscopic high ligation of hernia sac from Feb.2012 to Feb.2016. Results: All the 962 patients successfully underwent laparoscopic high ligation of hernia sac without conversion to open surgery.A self-made Kirschner wire was used to ligate the hernia sac through the abdominal wall.An assistant forceps was insertedduring operation in 7 cases to assist separation,including 3 cases of adhesion between the hernia sac and omentum majus and 4 cases of huge hernial sac with fold atdeferens.The operating time was 6.0-18.0 min with a mean of (14.3±4.2)min.3 cases of inguinal hernia recurred and 4 cases of contralateral inguinal hernia were found after surgery which seemed normal under first laparoscopy.These 7 cases were cured after a second surgery.All operations obtained good effect without subsidiary-injury,incision infection or other serious complications.Conclusions: The laparoscopic high ligation of hernia sac avoids the anatomy of inguinal canal,is an effective and reliable operation in the treatment of pediatric indirect inguinal hernia because of its advantages such asmini-invasion,few complications,simple operation and quick recovery.
引文
[1] Easter DW.Inguinal hernia in pediatrics:initial experience with laparoscopic inguinal exploration of the asymptomatic contralateral side[J].J Laparoendosc Surg,1992,2(6):361-362.
[2]刘琳,李索林.腹腔镜技术诊治小儿腹股沟疝的演化[J].中华小儿外科杂志,2016,37(10):796-800.
[3]李索林,刘琳,杨晓锋.腹腔镜技术诊治小儿腹股沟斜疝的现状与评价[J].中华小儿外科杂志,2014,35(6):406-409.
[4]吕晓菲,张黎,张庭澍,等.腹腔镜治疗小儿腹股沟斜疝“一日病房”护理模式的探讨[J].内蒙古中医药,2010,29(19):75-76.
[5] El-Gohary MA.Laparoscopic ligation of inguinal hernia in girls[J].Pediatr Endo Innov Tech,1997,1(3):185-188.
[6] Schier F.Laparoscopic surgery of inguinal hernias in children--initial experience[J].J Pediatr Surg,2000,35(9):1331-1335.
[7] Takehara H,Yakabe S,Kameoka K.Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children:clinical outcome of 972 repairs done in 3 pediatric surgical institutions[J].J Pediatr Surg,2006,41(12):1999-2003.
[8] Li S,Liu L,Li M.Single-port laparoscopic percutaneous extraperitoneal closure using an innovative apparatus for pediatric inguinal hernia[J].J Laparoendosc Adv Surg Tech A,2014,24(3):188-193.
[9]李俊江,王坤,穆速,等.“穿针引线”法在腹腔镜小儿腹股沟疝手术中的应用体会[J].腹腔镜外科杂志,2018,23(5):381-384.
[10]高军平,梁万强,陈宇.改良式单孔腹腔镜带线法治疗90例小儿腹股沟斜疝临床疗效分析[J/CD].中华疝和腹壁外科杂志(电子版),2017,11(3):181-184.
[11]Tatekawa Y.Laparoscopic extracorporeal ligation of hernia defects using an epidural needle and preperitoneal hydrodissection[J].J Endourol,2012,26(5):474-477.
[12] Wenk K,Sick B,Sasse T,et al.Incidence of metachronous contralateral inguinal hernias in children following unilateral repair-A meta-analysis of prospective studies[J].J Pediatr Surg,2015,50(12):2147-2154.
[13] Hoshino M,Sugito K,Kawashima H,et al.Prediction of contralateral inguinal hernias in children:a prospective study of 357 unilateral inguinal hernias[J].Hernia,2014,18(3):333-337.
[14]宋国鑫,李洁,张青松,等.腹腔镜下小儿腹股沟隐匿性疝的临床特点分析[J].腹腔镜外科杂志,2017,22(10):785-788.
[2]刘琳,李索林.腹腔镜技术诊治小儿腹股沟疝的演化[J].中华小儿外科杂志,2016,37(10):796-800.
[3]李索林,刘琳,杨晓锋.腹腔镜技术诊治小儿腹股沟斜疝的现状与评价[J].中华小儿外科杂志,2014,35(6):406-409.
[4]吕晓菲,张黎,张庭澍,等.腹腔镜治疗小儿腹股沟斜疝“一日病房”护理模式的探讨[J].内蒙古中医药,2010,29(19):75-76.
[5] El-Gohary MA.Laparoscopic ligation of inguinal hernia in girls[J].Pediatr Endo Innov Tech,1997,1(3):185-188.
[6] Schier F.Laparoscopic surgery of inguinal hernias in children--initial experience[J].J Pediatr Surg,2000,35(9):1331-1335.
[7] Takehara H,Yakabe S,Kameoka K.Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children:clinical outcome of 972 repairs done in 3 pediatric surgical institutions[J].J Pediatr Surg,2006,41(12):1999-2003.
[8] Li S,Liu L,Li M.Single-port laparoscopic percutaneous extraperitoneal closure using an innovative apparatus for pediatric inguinal hernia[J].J Laparoendosc Adv Surg Tech A,2014,24(3):188-193.
[9]李俊江,王坤,穆速,等.“穿针引线”法在腹腔镜小儿腹股沟疝手术中的应用体会[J].腹腔镜外科杂志,2018,23(5):381-384.
[10]高军平,梁万强,陈宇.改良式单孔腹腔镜带线法治疗90例小儿腹股沟斜疝临床疗效分析[J/CD].中华疝和腹壁外科杂志(电子版),2017,11(3):181-184.
[11]Tatekawa Y.Laparoscopic extracorporeal ligation of hernia defects using an epidural needle and preperitoneal hydrodissection[J].J Endourol,2012,26(5):474-477.
[12] Wenk K,Sick B,Sasse T,et al.Incidence of metachronous contralateral inguinal hernias in children following unilateral repair-A meta-analysis of prospective studies[J].J Pediatr Surg,2015,50(12):2147-2154.
[13] Hoshino M,Sugito K,Kawashima H,et al.Prediction of contralateral inguinal hernias in children:a prospective study of 357 unilateral inguinal hernias[J].Hernia,2014,18(3):333-337.
[14]宋国鑫,李洁,张青松,等.腹腔镜下小儿腹股沟隐匿性疝的临床特点分析[J].腹腔镜外科杂志,2017,22(10):785-788.