腹腔镜手术治疗小儿腹股沟嵌顿疝

目的探讨腹腔镜手术在小儿腹股沟嵌顿疝中的应用价值。方法全麻后腹腔镜引导下手法复位嵌顿疝,腹腔镜下疝囊高位结扎术。结果21例小儿嵌顿疝均在腹腔镜下完成疝囊高位结扎,2例同时行小肠浆膜破裂修补术,1例行乙状结肠肠脂垂切除术,无并发症发生。18例患儿随访3~19个月,平均11.4月,无复发。结论腹腔镜手术治疗小儿腹股沟嵌顿疝安全可行,创伤小,恢复快。     

腹腔镜下疝囊高位结扎术治疗小儿腹股沟嵌顿疝十例临床体会

目的探讨腹腔镜下疝囊高位结扎术治疗小儿腹股沟嵌顿疝的治疗效果及手术优势。方法回顾性分析2014年7月至2015年5月收治的10例小儿腹股沟嵌顿疝行腹腔镜下疝囊高位结扎术治疗成功患者的临床资料,术后进行随访。结果 10例手术均成功在腹腔镜下完成,术中未发现肠管坏死,手术时间平均为40 min(25~60 min),出血极少。术后第1天患者排气后进食,第2天出院。本组未出现术后并发症,无死亡患者。术后随访患者最长6个月,最短2周,10例患者目前均未出现疝复发及明显不适等情况,生活质量良好。结论小儿腹股沟嵌顿疝是外科急症,需及时手术治疗。实践证明腹腔镜下疝囊高位结扎术治疗小儿嵌顿疝是安全、合理、有效的,和传统小儿嵌顿疝开刀手术比较有明显优势。     

腹腔镜手术治疗小儿嵌顿性腹股沟斜疝的临床分析（附33例报告）

目的：探讨腹腔镜手术治疗小儿嵌顿性腹股沟斜疝的临床应用价值。方法：回顾分析2013年1月至2014年1月为33例嵌顿性腹股沟斜疝患儿行腹腔镜手术的临床资料。结果：9例麻醉后自动复位,17例腹腔镜下复位,7例难复性嵌顿疝经腹股沟小切口打开疝囊颈束环后腹腔镜下复位,33例复位成功后均行腹腔镜疝囊高位结扎术,14例同时行对侧隐匿疝治疗。7例打开疝囊颈束环者,丝线缝合修补并缩窄内环口,2例镜下同期切除阑尾。无一例中转开腹。手术时间平均（19.8±9.9）min,平均住院（3.2±1.1）d。术后无切口感染、阴囊血肿发生。随访3-12个月,无睾丸萎缩、复发等并发症发生。结论：腹腔镜下腹腔探查、嵌顿疝松解术及疝囊高位结扎术治疗小儿腹股沟嵌顿性斜疝安全、简便、暴露充分、微创、并发症少、术后康复快,术中可同时处理对侧隐匿性疝。     

腹腔镜疝囊高位结扎术治疗小儿腹股沟嵌顿斜疝163例

目的总结腹腔镜手术治疗小儿腹股沟嵌顿斜疝的安全性及临床效果。方法回顾性分析014年7月至2015年6月,西安市儿童医院腹腔镜疝囊高位结扎术治疗小儿腹股沟嵌顿斜疝163例的临床资料。术前诊断右侧嵌顿者82例,左侧嵌顿者69例,双侧嵌顿者12例。腹腔镜直视下体外手法复位将嵌顿疝复位。如嵌顿脏器无缺血坏死,行腹腔镜下疝囊高位结扎术。同时探查对侧,如存在隐匿疝则术中一起处理。结果 162例患者均成功复位后行腹腔镜下疝囊高位结扎术,1例患者中转开放手术。术中发现对侧隐匿性鞘状突未闭并同时手术共58例。术后1例复发,再次手术治愈。结论腹腔镜治疗小儿腹股沟嵌顿斜疝安全、有效、微创、美容,避免水肿疝囊的解剖,是理想的手术方式。     

小切口治疗小儿腹股沟嵌顿疝26例报告

目的探讨采用腹横纹小切口经腹股沟管行疝囊高位结扎术治疗小儿腹股沟嵌顿疝的疗效。方法26例小儿腹股沟嵌顿疝在氯胺酮麻醉后行手法复位，采用腹股沟区沿皮肤横纹切口行疝囊高位结扎术。结果手术时间20-40min，平均30min。术后住院1-3d，平均2．5d。24例随访6-24个月，平均20个月，无阴囊血肿及医源性隐睾，无复发。结论经腹横纹小切口治疗小儿腹股沟嵌顿疝是一种行之有效的方法。     

腹腔镜在小儿腹股沟嵌顿疝手术中的应用

目的 探讨腹腔镜小儿腹股沟嵌顿疝手术的疗效. 方法 应用腹腔镜疝修补术治疗小儿腹股沟嵌顿疝32例（右侧20例,左侧12例）,经脐置入5 mm 30°腹腔镜,探查肠管有无坏死,对侧有无隐匿性疝,在耻骨联合与脐孔的中点置入5 mm分离钳,在患侧内环口体表投影点,用Endoclose针夹带7号丝线穿入腹壁至腹膜外层,围绕内环口在腹膜外完成荷包缝合,线拉出体外打结.若内环口直径≥1.5 cm,行疝内环缝合联合疝囊高位结扎术. 结果 32例均顺利完成手术,手术时间15～40 min,平均26 min.术后住院1～3 d,平均2.2 d.术后无并发症.32例随访4～28个月,平均21个月,无复发.结论 腹腔镜下修补小儿腹股沟嵌顿疝,疗效确切,安全可行.     

二孔法腹腔镜与开腹手术治疗小儿腹股沟斜疝的比较

目的比较腹腔镜与开腹手术治疗小儿腹股沟斜疝的疗效。方法2001年4月~2006年1月,我们采用微型腹腔镜二孔法治疗小儿腹股沟斜疝410例(腹腔镜组),并与2004年9月~2006年1月408例开腹疝囊高位结扎术(开腹组)进行疗效比较。腹腔镜组脐窝置入1个5 mm trocar,探查双侧内环口,在患侧相当于麦氏点的稍上方置入另1个5 mmtrocar并导入持针器,在疝囊颈外上方穿入一带线缝针,术者单手持针,在疝囊入口水平腹膜下缝合鞘突入口一周,收紧缝线,结扎鞘突。开腹组经腹股沟外环处横切口行疝囊高位结扎术。结果腹腔镜组手术顺利,单侧手术时间(33.4±9.6 m in)显著少于开腹组(38.0±7.6 m in)(t=-7.596,P=0.000)。腹腔镜组无阴囊水肿、切口下积血积液、感染等并发症,平均随访23.2月(1~55个月),早期3例复发,再次腹腔镜手术修补成功,其余无睾丸萎缩、医源性隐睾及肠粘连等远期并发症。开腹组平均随访10个月(1~18个月),18例复发,8例经腹腔镜、10例经开腹手术治愈;医源性阴睾9例,再次开腹手术治愈。结论二孔法腹腔镜手术治疗小儿腹股沟斜疝较开腹手术恢复快,创伤小,无须伤口拆线,同时可用于处理腹股沟隐性疝和双侧腹股沟疝,不适用于心功能不全及新生儿嵌顿疝。     

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。     

经疝囊腹腔镜探查诊治腹股沟嵌顿疝的临床价值

目的探讨经疝囊腹腔镜探查在开放性腹股沟嵌顿疝手术中的临床应用。方法 2010年12月~2015年12月15例腹股沟嵌顿性疝术中发现疝内容物已回纳,经疝囊用腹腔镜行腹腔探查后,根据具体情况行相应的修补手术。结果探查后发现小肠坏死,行小肠部分切除1例,小肠浆膜撕裂行部分修补2例,余12例行开放无张力疝修补或疝囊高位结扎术。15例随访3个月~2年,平均15个月,术后无睾丸萎缩、医源性隐睾、切口疝等并发症,均无复发。结论经疝囊使用腹腔镜探查可以安全有效地探查腹腔,对腹股沟嵌顿疝的患者非常有益。     

二孔法腹腔镜疝囊高位结扎术治疗小儿腹股沟斜疝的随机对照研究

目的探讨二孔法腹腔镜疝囊高位结扎术治疗小儿腹股沟斜疝的效果及安全性。方法选取清远市清新区人民医院2015-01—2017-01间收治的腹股沟斜疝患儿82例,随机分为2组,各41例。对照组行小切口疝囊高位结扎术,观察组行二孔法腹腔镜疝囊高位结扎术。比较2组效果及安全性。结果观察组手术时间、住院时间短于对照组,切口长度小于对照组,疼痛评分(VAS)低于对照组,差异均有统计学意义(P0.05)。但住院费用明显高于对照组,差异有统计学意义(P0.05)。结论二孔法腹腔镜疝囊高位结扎术治疗小儿腹股沟斜疝,安全、可靠。     

新生儿腹股沟嵌顿疝的诊治分析

目的总结新生儿腹股沟嵌顿疝的诊治经验。方法2012年7月~2019年3月我院共收治32例新生儿腹股沟斜疝嵌顿,均完善腹壁疝彩超,彩超提示疝内容物存在血供可试行手法复位(复位成功后家属选择手术时间),复位失败安排急诊手术,彩超提示疝内容物无血流信号安排急诊手术。结果手法复位成功8例,择期完成手术。余24例手法复位失败急诊手术,其中10例采用开放手术,14例采用腹腔镜手术。24例术中见嵌顿内容物14例为小肠,2例为盲肠,2例为大网膜,6例为卵巢;睾丸坏死4例,卵巢坏死1例,肠坏死5例。术后切口感染3例,经换药处理后痊愈出院。32例随访2个月~6年10个月,中位随访时间2年11个月,无复发、鞘膜积液及睾丸萎缩发生,开放手术患儿发生医源性隐睾1例,2例对侧异时疝,均再次手术。结论新生儿腹股沟斜疝消化道症状常见,全面查体及彩超检查非常重要。一经诊断应及时手术治疗,以避免嵌顿所导致的严重并发症。术式首选腹腔镜下腹膜外疝囊高位结扎术。     

腹腔镜手术治疗婴幼儿腹股沟嵌顿性斜疝62例

目的：探讨腹腔镜手术在婴幼儿腹股沟嵌顿性斜疝中的临床应用价值。方法2011年2月-2014年2月采用腹腔镜急诊手术治疗婴幼儿腹股沟嵌顿疝62例,气管插管全麻后腹腔镜辅助手法复位,复位失败于腹股沟外环体表投影1．5 cm小切口,松解嵌顿,均行腹腔镜下内环口高位结扎。结果62例均顺利完成腹腔镜手术：腹腔镜辅助复位49例,手术时间（32．4±11．9）min,住院时间（4．3±1．1）d;腹腔镜嵌顿松解13例,手术时间（52．1±15．4）min,住院时间（5．1±1．7）d。无输精管、精索血管损伤,无阴囊血肿、切口感染等并发症。62例随访2-24个月,平均14个月,术后无睾丸萎缩、医源性隐睾、切口疝等并发症,术后复发1例,复发率1．6％（1/62）。结论腹腔镜下可同时发现和处理对侧隐性内环口未闭,腹腔镜手术治疗婴幼儿腹股沟嵌顿性斜疝安全可行,疗效确切。     

小儿腹股沟嵌顿疝手法复位后的并发症及处理

目的总结小儿腹股沟嵌顿疝手法复位后并发症的诊治经验。方法回顾性分析2012-01—2013-12间收治的15例手法复位后出现并发症的腹股沟嵌顿疝患儿的临床资料。结果 15例均住院接受了开腹手术治疗。术中发现:3例为假性复位,切开疝囊松解并复位肠管。12例为消化道穿孔,其中5例腹腔污染重而行肠造瘘术,术后3～6个月行闭瘘术,1例闭瘘术后1个月因粘连性肠梗阻再一次手术松解肠粘连;7例腹腔污染较轻,家长拒绝造瘘,一期行肠穿孔修补术。1例穿孔修补术后2周因发现嵌顿疝对侧腹股沟出现斜疝,而行疝囊高位结扎术。其余患儿均恢复顺利。术后随访1～23个月,未再出现其他不适。结论严格掌握小儿腹股沟嵌顿疝手法复位的适应证、禁忌证,选取正确的操作手法。手法复位后需密切观察病情变化,以便能及时发现并发症并选取适当的治疗方法,最大限度降低患儿不必要的痛苦。     

单孔微犁腹腔镜小儿腹股沟疝高位结扎术368例报告

目的探讨单孔微型腹腔镜治疗小儿腹股沟疝的疗效。方法2006年6月-2011年2月使用3mm微型腹腔镜,于脐部做-4mm切口,置入4mm troear作为观察孔,采用将硬膜外穿刺针自制成内芯有倒钩的疝钩针治疗小儿腹股沟痂368例。结果368例手术均成功,于术时间5-35min,平均7min。术后住院l-2d,平均1．5d。无并发症。100例随访6-24个月,平均12个月,2例分别于术后l、3个月复发,再次行腹腔镜手术治愈,术后无明显瘢痕。结论单孔微型腹腔镜治疗小儿腹股沟疝安全、有效,并发症少,术后无明显瘢痕。     

Two-trocar needlescopic approach to incarcerated inguinal hernia in children

Background

Many studies described the safety and effectiveness of laparoscopy in the treatment of inguinal hernia in children. Needlescopic techniques have been recently used in repairing inguinal hernias, which made this type of surgery more cosmetic and less invasive. However, few reports have described its role in the treatment of incarcerated inguinal hernia. The aim of this study was to assess the feasibility and outcome of needlescopy in the treatment of incarcerated inguinal hernia in children.

Methods

A total of 250 children, comprising 190 boys and 60 girls, who presented with incarcerated inguinal hernia were analyzed. Their ages ranged from 6 months to 6 years (mean age, 2 years). In 170 (68%) cases, manual reduction was successful. One hundred of these patients were subjected to definitive surgery in the same day, whereas the remaining 70 patients were subjected to needlescopy 1 to 3 days later. In 80 (32%) cases, external manual reduction was unsuccessful. These children were subjected to urgent needlescopic reduction and herniorrhaphy. The incarcerated herniae were easily reduced and the contents thoroughly inspected under direct vision. Then the hernia was repaired in the same setting.

Results

In all patients, there was no need to convert the procedure to an open approach. Immediate needlescopic herniorrhaphy in the same session was added without significant increase in operative time. The mean operative time is 10 minutes. There were no intraoperative complications.

Conclusions

The study showed that needlescopic approach to incarcerated inguinal hernia in children is feasible, safe, easy, and preferable to the open surgery. In addition to reduction of incarcerated hernial contents under direct vision, it allows definitive treatment of hernial defect at the same time without significant increase in operative time and hospital stay.     

老年腹股沟嵌顿疝87例急诊手术疗效分析

目的 探讨老年腹股沟嵌顿疝的急诊手术选择和治疗效果。方法 回顾性分析2015年1月至2017年4月北京朝阳医院急诊手术的87例老年腹股沟嵌顿疝病人资料,分为腹腔镜组（12例）和开放组（75例）,分析病人的临床资料、手术方式选择及并发症发生率等。结果 腹腔镜组12例均行腹腔镜腹股沟疝修补手术;开放组75例病人中,71例行开放腹股沟疝修补术,4例行传统疝修补术。随访时间11（10~14）个月。79例（90.8%）病人完成随访,1例病人死亡。开放组出现肠瘘1例,两组病人均未出现复发、慢性疼痛等并发症。腹腔镜组和开放组的的感染发生率分别为0和5.3%（P=0.000）,血肿发生率分别为0和14.7%（P=0.000）,术后1个月血清肿发生率分别为33.3%（4/12） 和40.3%（27/67）（P=0.012）、术后 3个月血清肿发生率分别为16.7%（2/12）和 31.3%（21/67）（P=0.024）,住院时间分别为5（4~6）d和7（6~10）d（P=0.032）,差异均有统计学意义。结论 老年腹股沟嵌顿疝病人诊断明确后均应行急诊手术,手术策略与手术方式的选择应遵循个体化治疗的理念,尽管腹腔镜手术具有探查腹腔的优势,但应综合评估后慎重选择。     

Transumbilical endoscopic surgery for incarcerated inguinal hernias in infants and children

Purpose

To describe transumbilical laparoscopic herniorrhaphy after unsuccessful attempted manual reduction of incarcerated inguinal hernias in infants and children.

Methods

In our two hospitals, two-trocar transumbilical endoscopic surgery (TUES) is the standard technique used to repair incarcerated inguinal hernias in infants and children. Seventeen patients (aged 8 months to 2.5 years; median, 15 months; 15 boys, 2 girls) with incarcerated inguinal hernias underwent urgent laparoscopy after unsuccessful attempted manual reduction. Two 3- or 5-mm trocars were inserted into the abdomen through two intraumbilical incisions, under laparoscopic guidance. The hernia was reduced by combined external manual pressure and internal pulling with bowel forceps. After inspection of the bowel, a round needle with a 2-0 nonabsorbable suture was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The hernial orifice was closed with an extraperitoneal purse-string suture around the internal inguinal ring, and tied with an intraperitoneal knot. A similar procedure was performed on the contralateral side if the processus vaginalis was patent.

Results

The TUES procedure was successful in all patients. No conversions to open surgery were required. The mean operating time was 30 min (range, 25–40 min). All patients were discharged on the second postoperative day. No complications such as postoperative bleeding, hydrocele, or scrotal edema were observed. The mean follow-up period was 15 months. No cases of testicular atrophy, hypotrophy, or hernia recurrence were reported.

Conclusions

Our preliminary experience with using TUES for the treatment of incarcerated inguinal hernias in infants and children had satisfactory outcomes. This technique appeared to be safe, effective, and reliable, and had excellent cosmetic results.     

Laparoscopic inguinal hernia repair by the hook method in emergency setting in children presenting with incarcerated inguinal hernia

Background

The development of laparoscopic hernia repair has provided an alternative approach to the management of incarcerated inguinal hernia in children. Different laparoscopic techniques for hernia repair have been described. However, we hereby review the role of laparoscopic hernia repair using the hook method in the emergency setting for incarcerated inguinal hernias in children.

Methods

A retrospective review was conducted of all children who presented with incarcerated inguinal hernia and underwent laparoscopic hernia repair using the hook method in emergency setting between 2004 and 2010.

Results

There were a total of 15 boys and 1 girl with a mean age of 30 ± 36 months (range, 4 months to 12 years). The hernia was successfully reduced after sedation in 7 children and after general anesthesia in 4 children. In 5 children, the hernia was reduced by a combined manual and laparoscopic-assisted approach. Emergency laparoscopic inguinal hernia repair using the hook method was performed after reduction of the hernia. The presence of preperitoneal fluid secondary to recent incarceration facilitated the dissection of the preperitoneal space by the hernia hook. All children underwent successful reduction and hernia repair. The median operative time was 37 minutes. There was no postoperative complication. The median hospital stay was 3 days. At a median follow-up of 40 months, there was no recurrence of the hernia or testicular atrophy.

Conclusions

Emergency laparoscopic inguinal hernia repair by the hook method is safe and feasible. Easier preperitoneal dissection was experienced, and repair of the contralateral patent processus vaginalis can be performed in the same setting.     

Surgical Outcomes of Lichtenstein Tension-Free Hernioplasty for Acutely Incarcerated Inguinal Hernia

Purpose The purpose of our study was to evaluate the short-term and long-term outcomes of emergency Lichtenstein tension-free hernioplasty for acutely incarcerated inguinal hernia. Methods We conducted a retrospective study of patients who underwent emergency Lichtenstein hernioplasty for acutely incarcerated inguinal hernia between September 2002 and January 2006 in a major city hospital in Thailand. We analyzed the early postoperative complications and surgical outcomes. Results All 24 patients were men, with a mean age of 53.8 ± 19.2 years (range 19–77). There was no perioperative mortality and only two postoperative complications (8.3%): a subcutaneous fluid collection, which resolved spontaneously within 2 weeks; and a superficial surgical site infection, which was treated successfully by intravenous antibiotics. The hospital stay was 3.8 ± 2.1 days (range 2–12). All patients attended regular follow-up visits (mean 20.2 ± 10.7 months, range 3–43). Clinical recurrence was found in one patient (4.2%), 7 months postoperatively. Conclusion Lichtenstein hernioplasty can be used effectively as an emergency operation for incarcerated inguinal hernia with a good outcome and an acceptably low rate of postoperative complications.