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。

Application of Laparoscopic Surgery for Incarcerated Hernia in 62 Infants

Objective To evaluate the clinical value of laparoscopic techniques in the treatment of incarcerated inguinal hernia in infants . Methods The clinical data of 62 infants with incarcerated inguinal hernia between February 2011 and February 2014 treated by emergent laparoscopic surgery was retrospectively analyzed .The operations were performed under general anesthesia with tracheal intubation .After laparoscopic assisted manual reduction , laparoscopic high ligation was carried out .If the reduction failed, a small incision 1.5 cm in length was made in the groin outer surface projection to release the lesion . Results The laparoscopic surgery was successfully performed in all the 62 cases.Laparoscopic assisted reduction was completed in 49 cases, with an operation time of 32.4 ±11.9 min and a mean postoperative hospital stay of 4.3 ±1.1 days.Laparoscopic embedded Bolton loose solution was performed in 13 cases, with an operation time of 52.1 ±15.4 min and a mean postoperative hospital stay of 5.1 ±1.7 days.No seminiferous duct or spermatic vessels injuries were noted .No postoperative scrotal hematoma , incision infections , or other complications happened.All the patients were followed up for 2-24 months （average, 14 months）.No testicular atrophy, iatrogenic cryptorchidism, or incisional hernia was observed .Postoperative recurrence was recorded in 1 case, with a recurrence rate of 1.6%（1/62）. Conclusions Laparoscopic surgery in the treatment of infantile inguinal strangulated hernia is safe and effective .The procedure is helpful for detecting and dealing with concealed hernia .