腹腔镜带线直针单隧道疝囊高位结扎治疗小儿腹股沟斜疝427例
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摘要
目的探讨腹腔镜带线直针单隧道疝囊高位结扎治疗小儿腹股沟斜疝的价值。方法脐下脐上分别切5 mm及3 mm切口,建立气腹后置入5 mm及3 mm trocar,在疝囊颈投影的皮肤位置切1 mm切口,自该切口刺入带线疝针,疝针在腹膜外沿疝囊颈后方走行,疝针通过精索血管后针尖即可穿过腹膜进入腹腔,用腹腔镜钳将疝针上的线牵拉进入腹腔足够长。将疝针沿原隧道缓慢退出,至退到腹膜外原进针垂直位置后将疝针沿疝囊颈的外侧走行,于疝囊颈后方出线处出针,将腹腔内留的线穿过疝针上方的线与疝针之间的间隙,腹腔外轻拉疝针与缝线,将腹腔内的线带出,并剪断,并分别打结,完成疝囊单隧道双线高位结扎。结果 427例中术中发现对侧鞘状突未闭218例,占单侧腹股沟斜疝患者的51.2%。单侧手术平均时间约8.5分钟,术后脐部少量渗血5例,无阴囊、腹股沟血肿等其他并发症。平均住院时间3.1天,术后312例随访3月~24月,无复发病例,未出现线结反应,术后内环处未扪及线结。结论腹腔镜带线直针疝囊单隧道高位结扎治疗小儿腹股沟斜疝疗效满意。
Objective To investigate the value of laparoscopic high ligation of hernia sac withstraight threaded needle via single tunnel in treating pediatric inguinal hernia. Methods Set up a 3 mmsupraumbilical incision and a 5 mm subumbilical incision,place 5 mm and 3 mm Trocars were placedafter the artificial pneumoperitoneum. Set up a 1 mm in surface projection of the hernia sac,then thethreaded needle was pierced through this incision,and make the needle stealthed along the backside ofhernia sec extraperitoneally. After crossing the spermatic vessels tip,the hernia needle pierced perito-neum into the abdominal cavity. Pull the thread into the abdominal cavity from the needle with laparo-scopic clamp till it was long enough. Pull the needle back along the tunnel slowly till it reach the originalvertical extraperitoneal entrance,then let the needle stealth along the outside of hernia sec extraperitone-ally and pierce into abdominal cavity at the place of previous piercing into abdominal cavity. Put thethread in abdominal cavity into the gap between the thread on needle and the hernia needle,and pulledthe thread and the needle from extraperitone gently. The thread in abdominal cavity was taken outside,then cut and knot it. So the hernial sac were ligated twice. Results There were 218 contralateral vestigi-um proceseus vaginalis cases out of 427 cases,accounting for 51.2% of the patients with unilateral ingui-nal hernia. The average time of one side operation was about 8.5 minutes. There were 5 cases of umbilicalhemorrhage,and no scrotum,groin hematoma or other complications occurred after operation. The aver-age hospital stay was 3.1 days. 312 cases were followed up from 3 months to 24 months after operation.No recurrence or surgical knots reaction were found. Conclusion Laparoscopic high ligation of herniasac with straight threaded needle via single tunnel is satisfactory and worthy of promotion.
Objective To investigate the value of laparoscopic high ligation of hernia sac withstraight threaded needle via single tunnel in treating pediatric inguinal hernia. Methods Set up a 3 mmsupraumbilical incision and a 5 mm subumbilical incision,place 5 mm and 3 mm Trocars were placedafter the artificial pneumoperitoneum. Set up a 1 mm in surface projection of the hernia sac,then thethreaded needle was pierced through this incision,and make the needle stealthed along the backside ofhernia sec extraperitoneally. After crossing the spermatic vessels tip,the hernia needle pierced perito-neum into the abdominal cavity. Pull the thread into the abdominal cavity from the needle with laparo-scopic clamp till it was long enough. Pull the needle back along the tunnel slowly till it reach the originalvertical extraperitoneal entrance,then let the needle stealth along the outside of hernia sec extraperitone-ally and pierce into abdominal cavity at the place of previous piercing into abdominal cavity. Put thethread in abdominal cavity into the gap between the thread on needle and the hernia needle,and pulledthe thread and the needle from extraperitone gently. The thread in abdominal cavity was taken outside,then cut and knot it. So the hernial sac were ligated twice. Results There were 218 contralateral vestigi-um proceseus vaginalis cases out of 427 cases,accounting for 51.2% of the patients with unilateral ingui-nal hernia. The average time of one side operation was about 8.5 minutes. There were 5 cases of umbilicalhemorrhage,and no scrotum,groin hematoma or other complications occurred after operation. The aver-age hospital stay was 3.1 days. 312 cases were followed up from 3 months to 24 months after operation.No recurrence or surgical knots reaction were found. Conclusion Laparoscopic high ligation of herniasac with straight threaded needle via single tunnel is satisfactory and worthy of promotion.
引文
[1]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(4):406-409.
[2]Bruzoni M,Jaramillo JD,Kastenberg ZJ,et al.Long-term follow-up of laparoscopic transcutaneous inguinal herniorraphy with high transfixation suture ligature of the hernia sac[J].J Pediatr Surg,2015,50(10):1767-1771.
[3]Kim S,Hui T.Laparoscopically assisted repair of inguinal hernia through a micro-incision and extra-peritoneal division and ligation of the hernia sac[J].Pediatr Surg Int,2013,29(4):331-334.
[4]姚干.国内腹腔镜治疗小儿腹股沟斜疝的进展及展望[J].岭南现代临床外科,2009,9(6):414-416.
[5]陈子民,叶明,王斌.微型腹腔镜治疗小儿腹股沟斜疝并发症的原因分析及预防[J].腹腔镜外科杂志,2012,17(3):212-213.
[2]Bruzoni M,Jaramillo JD,Kastenberg ZJ,et al.Long-term follow-up of laparoscopic transcutaneous inguinal herniorraphy with high transfixation suture ligature of the hernia sac[J].J Pediatr Surg,2015,50(10):1767-1771.
[3]Kim S,Hui T.Laparoscopically assisted repair of inguinal hernia through a micro-incision and extra-peritoneal division and ligation of the hernia sac[J].Pediatr Surg Int,2013,29(4):331-334.
[4]姚干.国内腹腔镜治疗小儿腹股沟斜疝的进展及展望[J].岭南现代临床外科,2009,9(6):414-416.
[5]陈子民,叶明,王斌.微型腹腔镜治疗小儿腹股沟斜疝并发症的原因分析及预防[J].腹腔镜外科杂志,2012,17(3):212-213.