单孔腹腔镜治疗小儿腹股沟嵌顿斜疝的探讨

目的：探讨单孔腹腔镜治疗小儿腹股沟嵌顿斜疝的疗效。方法2013年3-9月，单孔腹腔镜治疗小儿腹股沟嵌顿斜疝48例。术前诊断右侧嵌顿疝32例，左侧嵌顿疝16例。经脐切口置入trocar建立气腹，置入Z形腹腔镜，经探查孔置入无损伤钳，探查患侧疝内容物类型、嵌顿程度。腹腔镜下辅以体外手法复位将嵌顿疝复位，观察嵌顿脏器损伤情况。如嵌顿脏器无损伤，行腹腔镜下疝囊高位结扎术。探查对侧如存在隐匿疝则同时处理。结果48例均顺利完成单孔腹腔镜手术。术中探查合并对侧隐匿疝10例。嵌顿疝内容物36例为肠管，8例为卵巢，4例为网膜。手法协助复位均顺利还纳，镜下观察5 min，48例嵌顿脏器均血运良好。单侧疝（38例）手术时间10-18 min，平均15 min；双侧疝（10例）手术时间16-30 min，平均24 min。麻醉清醒后进食，疼痛均能耐受。术后10-15 h（平均12 h）出院。随访3-13个月，无切口感染，无阴囊水肿、血肿等并发症，无复发。结论单孔腹腔镜治疗小儿腹股沟嵌顿斜疝不破坏腹股沟管解剖结构，可高位结扎，直视下探查嵌顿疝内容物损伤情况，探查对侧有无隐匿疝。该技术安全、有效、微创，值得推广。

Single-port Laparoscopic Surgery for Incarcerated Indirect Inguinal Hernia in Children

Objective To explore the value of single-port laparoscopic surgery in the treatment of incarcerated indirect inguinal hernia in children . Methods From March to September 2013, a total of 48 cases of incarcerated indirect inguinal hernia were treated by single-hole laparoscopic surgery .Preoperative diagnosis of hernia was right sided in 32 cases and left sided in 16 cases. Via an umbilical incision , one trocar was inserted to establish the pneumoperitoneum .A Z-shaped laparoscope was introduced from the umbilicus, accompanying with a no-damage clamp to explore the lesion and extend of incarceration .If the incarcerated organs were not necrosed , the high ligation of hernial sac was performed .Intraoperatively , contralateral side was explored for finding concealed hernia . Results The single-hole laparoscopic surgery was successfully completed in all the cases .Intraoperative exploration found 10 cases of concealed contralateral hernia .Incarcerated hernia contents included bowel in 36 cases, ovaries in 8 cases, and omentum in 4 cases. All the incarcerations were successfully restored by manual reduction assistance .After observation for 5 minutes, the incarcerated organ had good blood flow in all the 48 cases.The operation time was 10-18 minutes （mean, 15 minutes） for unilateral hernia （in 38 cases） and 16-30 minutes （mean, 24 minutes） for bilateral hernia（in 10 cases）.All the children began to diet after awake from anesthesia.No postoperative pain was observed .The patients were discharged from hospital at 10-15 postoperative hours （mean, 12 hours）.The follow-up time was 3 -13 months.There were no postoperative wound infection , scrotal edema, or hematoma.No recurrence or other complications occurred . Conclusions Single-port laparoscopy for incarcerated inguinal hernia in children has advantages of preservation of anatomy of the inguinal canal , easy to perform high ligation of hernial sac , and simultaneous reduction under direct visual control .It is a safe, effective, and minimally inv