腹腔镜治疗儿童腹股沟直疝

目的探讨腹腔镜治疗儿童腹股沟直疝的可行性并总结手术治疗经验。方法收集2014年1月至2019年1月期间于广州市妇女儿童医疗中心在腹腔镜下诊断为腹股沟直疝的15例患儿的临床资料。其中,男11例,女4例;平均月龄为52个月,范围为20~144个月;术前均诊断为斜疝,术中经腹腔镜证实为直疝;其中6例既往因误诊为腹股沟斜疝而行开放疝囊高位结扎术,术后再次出现腹股沟区可复性包块,此次手术经腹腔镜探查证实为腹股沟直疝;右12侧,左6侧,其中3例为双侧;3例pantalon疝,1例疝囊底部有脂肪瘤。选取经腹腔镜下直疝疝环口结扎+脐内侧韧带覆盖加固修补术的6例患儿作为研究对象。结果6例患儿中,2例既往因误诊腹股沟斜疝行开放疝囊高位结扎术,术后再次出现腹股沟区可复性包块,此次手术证实为腹股沟直疝;2例为单纯腹股沟直疝;1例为pantalon疝,同时行斜疝内环结扎及直疝疝环结扎并以脐内侧韧带覆盖加固;对1例疝囊底部的脂肪瘤同时予以切除,然后修补疝环缺损并以脐内侧韧带覆盖加固。所有患儿术后恢复良好,随访12~60个月无复发,也无血肿、伤口感染等并发症。结论腹腔镜治疗儿童腹股沟直疝避免了对腹股沟区的解剖,操作简便、耗时短、安全、有效、并发症少,可作为儿童直疝治疗的标准术式。

Laparoscopic repairing of pediatric direct inguinal hernia

Objective To explore the feasibility of laparoscopy for pediatric direct inguinal hernia and to summarize its management experience.Methods Clinical data were reviewed for 15 children with direct inguinal hernia diagnosed laparoscopically from January 2014 to January 2019.There were 11 boys and 4 girls with an average age of 52(20-144)months.Indirect hernias were diagnosed preoperatively and confirmed intraoperatively.Six cases misdiagnosed as indirect inguinal hernia underwent open high ligation of hernia sac.Reducible mass of inguinal region re-appeared postoperatively.It was confirmed as direct inguinal hernia by laparoscopic exploration.The involved side was right(n=12),left(n=6)and bilateral(n=3).There were pantalon hernia(n=3)and lipoma at the bottom of hernia sac(n=1).Six children with laparoscopic ligation of direct hernia ring and covering reinforcement of medial umbilical ligament were selected as research subjects.Results Two cases were misdiagnosed as indirect inguinal hernia and both underwent open high ligation of hernia sac,but reducible mass in inguinal region re-appeared postoperatively.Both were confirmed as direct inguinal hernia.There were simple direct inguinal hernia(n=2)and pantalon hernia(n=1).Indirect and direct hernia rings were co-ligated and medial umbilical ligament was covered and reinforced.In another case,lipoma at the bottom of hernia sac was excised and defect repaired and reinforced by medial umbilical ligament.All children recovered well postoperatively.During a follow-up period of 12-60 months,there was no instance of recurrence,hematoma,wound infection or other complications.Conclusions Laparoscopy for direct inguinal hernia may avoid anatomizing inguinal region in children.Such a standard approach is simple,fast,safe and efficacious with fewer complications.