经脐双孔腹腔镜手术在小儿腹股沟嵌顿性斜疝中的应用

目的：探索经脐双孔腹腔镜手术在小儿腹股沟嵌顿性斜疝中的临床应用价值。方法回顾性分析2014年1月至2014年6月本院实施的125例腹股沟嵌顿性斜疝患儿腹腔镜手术治疗资料，并与95例传统开放手术病例进行比较。结果腹腔镜组右侧腹股沟嵌顿性斜疝89例，左侧36例。其中85例麻醉后复位；35例腹腔镜直视下手法复位；5例难复性嵌顿疝经腹股沟小切口打开外环口后腹腔镜下复位。13例患儿合并其它临床问题，其中2例嵌顿肠管浆肌层撕裂；4例嵌顿肠管合并穿孔；3例合并阑尾炎；4例美克尔憩室，同时手术处理。平均住院时间（4.4±0.3）d，术后无切口感染、阴囊血肿发生。随访9～15个月，无睾丸萎缩、复发等并发症发生。对照组右侧嵌顿80例，左侧15例，平均住院（7.4±4.3）d，术后切口感染3例，阴囊血肿10例，睾丸萎缩3例，复发3例。结论经脐双孔腹腔镜手术治疗婴幼儿腹股沟嵌顿性斜疝是一种安全的微创手术，具有损伤小、恢复快、住院时间短等优点，特别是在处理复杂性嵌顿疝时优点更突出，值得临床推广。

Value of transumbilical laparoscopy for incarcerated oblique inguinal hernia in infants

Objetive To evaluate the value of transumbilical laparoscopy for incarcerated oblique ingui-nal hernia in infants.Methods A total of 1 25 cases with incarcerated inguinal hernia undergoing transumbili-cal double-hole laparoscopy from January 201 4 to June 201 4 were retrospectively analyzed and compared with traditional open surgery group (n =95). Results Among them,incarcerated inguinal hernia was right (n =89)and left (n =36).And 85 cases were reduced after anesthesia while another 35 cases reduced manually under direct vision of laparoscope.For 5 cases of failed reduction,a small incision was made in groin outer sur-face projection for releasing lesion.Thirteen cases were associated with other clinical problems.Tearing of intes-tinal line was found in 2 cases after in-cavity reduction.Intestinal perforation occurred in 4 cases.Hernia con-tents were lleocecal associated with appendicitis in 3 cases and there was 1 case of purulent appendix.Four ca-ses of Meckel's diverticulum were found during cavity exploration.Three parents agreed to resection.Surgery was performed simultaneously.The average hospital stay was (4.4 ±0.3)days.There was no occurrence of incision infection,postoperative scrotal hematoma or other complications.The follow-up period was 9 ~1 5 months.No testicular atrophy,iatrogenic cryptorchidism or incisional hernia was observed.In control group,there were post-operative incision infection (n =3),scrotum hematoma (n =1 0),testicular atrophy (n =3)and recurrence (n=3). Conclusions Transumbilical double-hole laparoscopy is both safe and micro-invasive for complicated incarcerated inguinal hernia in infants.