腹腔镜下疝囊超高位结扎治疗小儿腹股沟疝

目的探讨腹腔镜下疝囊超高位结扎加腹膜悬吊治疗小儿腹股沟疝的效果。 方法选取南京医科大学附属常州市第二人民医院2016年4月至2018年1月收治的腹股沟疝患儿104例，采用改良的术式进行手术，观察平均手术时间、住院时间、术后复发率及术后并发症的发生率，评价手术效果。对常规腹腔镜疝囊高位结扎术进行改良：带双股Prolene线的导针经皮下穿刺，向内环口内侧旋转达1/2圈后，置入双股线；取单股线硬膜外导针同点刺入至腹膜外，向内环口外侧旋转达1/2圈，双股线带出单股线。抽拉单股线，部分腹膜悬吊形成皱襞伴随打结固定。 结果手术时间：单侧（15.3±2.1）min，双侧（21.7±3.3）min。术后平均住院时间（13.5±3.7）h。术后未出现阴囊血肿或出血等重大并发症。 结论改良腹腔镜下疝囊超高位结扎加腹膜悬吊治疗小儿腹股沟疝操作简单且安全，且取材容易，值得进一步实践以用于临床推广。

Modified laparoscopic ultra-high ligation of the hernia sac with peritoneal suspension for treatment of inguinal hernia in children

ObjectiveTo detect the effect of laparoscopic ultra-high ligation of the hernia sac with peritoneal suspension in treating the inguinal hernia in children. MethodsImprovement of routine laparoscopic high ligation of the hernia sac: a needle with the double Prolene suture was subcutaneously punctured, rotated 1/2 turn one side of the inner ring, and placed into the abdominal cavity. Another needle with the single suture was guided through the same punctured point, were rotated 1/2 turn to another side of the inner ring, and the double-stranded suture brought out the single-stranded suture. Single-stranded suture was pulled and part of the peritoneal suspension formed with fold and knot. With this modified surgical procedure, 104 patients were operated on to observe the average operation time, length of stay, postoperative recurrence rate, and the incidence of postoperative complications, and evaluate the surgical effect. ResultsThe operation time was (15.3±2.1) minutes for unilateral hernia and (21.7±3.3) minutes for bilateral. The average length of stay after surgery was (13.5±3.7) hours. There were no major complications such as scrotal hematoma or hemorrhage after surgery. ConclusionThe laparoscopic ultra-high ligation of the hernia sac with peritoneal suspension is simple and safe for the treatment of children's inguinal hernia. It is easy to obtain and is worthy of further practice for clinical promotion.