水分离腹壁缝合器辅助单孔腹腔镜腹股沟斜疝内环结扎术
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摘要
目的介绍一种腹壁缝合器实施腹膜外斜疝内环结扎术的方法,并评价该方法的可行性及疗效。方法 2017年11月～2018年3月,使用专利产品腹壁缝合器,行经脐单孔腹腔镜监视下小儿腹股沟斜疝内环结扎术37例,将腹壁缝合器挂结扎线经腹股沟内环体表穿刺,一次穿刺腹壁保持进出线在同一路径,采用水分离技术环绕疝缺损腹膜外套扎内环。结果单孔腹腔镜经皮穿刺腹膜外内环结扎术均顺利完成,其中单侧21例,双侧16例,手术时间分别为(8. 5±1. 8) min和(15. 8±1. 6) min,术中无精索、输精管损伤。术后随访6～11个月,平均8. 3月,未见伤口感染、医源性隐睾、睾丸萎缩、复发疝、鞘膜积液和线结肉芽肿形成等并发症发生。结论采用腹壁缝合器辅助单孔腹腔镜完全腹膜外腹股沟疝内环结扎术是一种安全有效的简便方法,保持脐窝瘢痕隐蔽、美观的优势,腹腔内预置和钩挂丝线轻松流畅,可避免传统双钩套扎针钩挂肠壁或腹膜组织的风险,是治疗小儿腹股沟疝值得选择的器械和操作技术。
Objective To introduce a modified single-port laparoscopic internal inguinal ring ligation by using an endo mini-grappler with hydrodissection and to assess its feasibility and safety. Methods From November 2017 to March 2018,37 children with inguinal hernia underwent our previously reported single-port laparoscopic percutaneous extraperitoneal closure( LPEC) by using an endo mini-grappler with hydrodissection. Under laparoscopic visualization through a single umbilical port,an endo mini-grappler with a non-absorbable suture was introduced into the extraperitoneal space at the corresponding point of the internal inguinal ring,where it could be readily kept as in an identical subcutaneous path. The internal ring orifice was absolutely lassoed extraperitoneally by the suture under the assistance of hydrodissection. Results The inguinal hernia was ligated successfully via single-port LPEC. A total of21 patients underwent unilateral internal inguinal ring ligation and 16 patients were found to be complicated with contralateral hernia and underwent bilateral internal inguinal ring ligation. The operating time for unilateral and bilateral inguinal hernia repairs were( 8. 5 ± 1. 8) min and( 15. 8 ± 1. 6) min,respectively. There were no intra-operative complications and no wound infection,iatrogenic cryptorchidism,testicular atrophy,recurrence,hydroceles,or suture granuloma formations were postoperatively seen during follow-ups for 6-11 months( mean,8. 3 months). Conclusions The single-port LPEC by using an endo mini-grappler with hydrodissection is a simple and feasible technique,with characteristics of safety,effectiveness and invisible scarring,as well as satisfactory cosmetic results. In addition,the intraperitoneal prepositioning and thread hooking are easy and smooth,which avoid the risk of injuring intestinal duct or peritoneum during hooking suture. It is a valuable instrument and operation technology for the treatment of inguinal hernia in children.
Objective To introduce a modified single-port laparoscopic internal inguinal ring ligation by using an endo mini-grappler with hydrodissection and to assess its feasibility and safety. Methods From November 2017 to March 2018,37 children with inguinal hernia underwent our previously reported single-port laparoscopic percutaneous extraperitoneal closure( LPEC) by using an endo mini-grappler with hydrodissection. Under laparoscopic visualization through a single umbilical port,an endo mini-grappler with a non-absorbable suture was introduced into the extraperitoneal space at the corresponding point of the internal inguinal ring,where it could be readily kept as in an identical subcutaneous path. The internal ring orifice was absolutely lassoed extraperitoneally by the suture under the assistance of hydrodissection. Results The inguinal hernia was ligated successfully via single-port LPEC. A total of21 patients underwent unilateral internal inguinal ring ligation and 16 patients were found to be complicated with contralateral hernia and underwent bilateral internal inguinal ring ligation. The operating time for unilateral and bilateral inguinal hernia repairs were( 8. 5 ± 1. 8) min and( 15. 8 ± 1. 6) min,respectively. There were no intra-operative complications and no wound infection,iatrogenic cryptorchidism,testicular atrophy,recurrence,hydroceles,or suture granuloma formations were postoperatively seen during follow-ups for 6-11 months( mean,8. 3 months). Conclusions The single-port LPEC by using an endo mini-grappler with hydrodissection is a simple and feasible technique,with characteristics of safety,effectiveness and invisible scarring,as well as satisfactory cosmetic results. In addition,the intraperitoneal prepositioning and thread hooking are easy and smooth,which avoid the risk of injuring intestinal duct or peritoneum during hooking suture. It is a valuable instrument and operation technology for the treatment of inguinal hernia in children.
引文
1刘雪来,费川,张永婷,等.双钩套扎针辅助小儿单孔腹腔镜阑尾切除术.中华小儿外科杂志,2016,37(10):762-766.
2刘琳,李索林.腹腔镜技术诊治小儿腹股沟疝的演化.中华小儿外科杂志,2016,37(10):796-800.
3 Li S,Liu L,Li M.Single-port laparoscopic percutaneous extraperitoneal closure using an innovative apparatus for pediatric inguinal hernia.J Laparoendosc Adv Surg Tech A,2014,24(3):188-193.
4费川,张永婷,李索林,等.单孔腹腔镜双钩疝针内环结扎术并脐内侧襞遮盖术.中华腔镜外科杂志(电子版),2016,9(5):257-260.
5李索林,费川,张永婷,等.水分离双钩套扎针辅助单孔腹腔镜腹股沟疝腹膜外结扎术.中国微创外科杂志,2017,17(1):42-50.
6 Chang YT,Lee JY,Tsai CJ,et al.Preliminary experience of one-trocar laparoscopic herniorrhaphy in infants and children.J Laparoendosc Adv Surg Tech A,2011,21(3):277-282.
7 Xu Q,Liu SQ,Niu JH,et al.A new technique for extraperitoneal repair of inguinal hernia.J Surg Res,2016,204(2):452-459.
8 Thomas DT,G9cmen KB,Tulgar S,et al.Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia:experience with 250 cases.JPediatr Surg,2016,51(8):1330-1335.
2刘琳,李索林.腹腔镜技术诊治小儿腹股沟疝的演化.中华小儿外科杂志,2016,37(10):796-800.
3 Li S,Liu L,Li M.Single-port laparoscopic percutaneous extraperitoneal closure using an innovative apparatus for pediatric inguinal hernia.J Laparoendosc Adv Surg Tech A,2014,24(3):188-193.
4费川,张永婷,李索林,等.单孔腹腔镜双钩疝针内环结扎术并脐内侧襞遮盖术.中华腔镜外科杂志(电子版),2016,9(5):257-260.
5李索林,费川,张永婷,等.水分离双钩套扎针辅助单孔腹腔镜腹股沟疝腹膜外结扎术.中国微创外科杂志,2017,17(1):42-50.
6 Chang YT,Lee JY,Tsai CJ,et al.Preliminary experience of one-trocar laparoscopic herniorrhaphy in infants and children.J Laparoendosc Adv Surg Tech A,2011,21(3):277-282.
7 Xu Q,Liu SQ,Niu JH,et al.A new technique for extraperitoneal repair of inguinal hernia.J Surg Res,2016,204(2):452-459.
8 Thomas DT,G9cmen KB,Tulgar S,et al.Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia:experience with 250 cases.JPediatr Surg,2016,51(8):1330-1335.