改良单孔疝针经皮腹膜外结扎术治疗小儿腹股沟疝

目的 探讨单孔腹腔镜下改良单孔疝针经皮腹膜外结扎术治疗小儿腹股沟斜疝的手术效果.方法 回顾性分析我科2013年6月至2015年6月,在单孔腹腔镜辅助下,应用改良单孔疝针内环腹壁投影处经皮穿刺腹膜外结扎关闭内环手术治疗腹股沟疝病例312例(459侧)的临床资料.经脐部5 mm Trocar置入30°观察镜,内环投影处以带双股闭合2-0慕丝线疝针先沿内环口内侧紧贴腹膜外分离潜行,于贴近精索血管处穿透腹膜进入腹腔,牵拉体外双股线,闭合端双线自疝针孔退出,将疝针缓慢回撤至针孔露出皮肤平面时停止,以一根单股1-0慕丝线穿过疝针针孔,再将疝针沿内环口外侧腹膜外潜行,从同一腹膜穿刺点进入腹腔,将带单线疝针穿过预置于腹腔内的圈套内,牵拉1-0慕丝线使其与疝针分离,牵拉双股2-0慕丝线,将后置入的单股1-0慕丝线线尾牵拉出体外,挤压排出阴囊内气体,收紧1-0慕丝线,体外打结埋置于腹膜外.结果 298例442侧通过此法完成手术;所有病例无手术中并发症发生,术后穿刺点无明显疼痛,术后3d出院.术后随访5～29个月,尚未见疝复发或鞘膜积液病例,无穿刺点缝线反应及异物感.结论 单孔腹腔镜下改良单孔疝针经皮腹膜外结扎术经腹壁穿刺导入和牵出结扎线可保持在同一穿刺隧道,避免了因两次穿刺造成的较多结扎组织引起的术后疼痛和线结变松的情况发生.

Modified single-site laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia

Objective To evaluate the feasibility of single-port laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia.Methods Between June 2013 and June 2015,a total of 312 patients with inguinal hernia underwent single-port laparoscopic percutaneous extraperitoneal closure.Under laparoscopic visualization,a modified hernia needle was inserted at the corresponding point of internal ring.Hernia defect was obliterated extraperitoneally by a nonabsorbable suture entering into abdomen on one side and exiting on the opposite side in an identical subcutaneous path around internal ring.Results A total of 442 inguinal repairs were successfully performed.The sides were unilateral (n =43) and bilateral (n =144).And 104 patients of unilateral indirect inguinal hernia were confirmed to be bilateral.There was no postoperative onset of bleeding,pain or early recurrence.During a mean follow-up period of 16.7 (5-29) months,there was no recurrence,visible scar on abdominal wall or foreign body feeling of inguinal site.Conclusions Singleport laparoscopic percutaneous extraperitoneal closure is both safe and efficacious for pediatric inguinal hernia It may be conveniently performed with high parental satisfaction,minimal scarring and excellent cosmetic outcomes.