单切口腹腔镜治疗儿童腹股沟嵌顿斜疝121例

目的探讨单切口腹腔镜治疗儿童腹股沟嵌顿斜疝的疗效。方法回顾性分析2013年3月至2014年6月，首都儿科研究所行单切口腹腔镜治疗儿童腹股沟嵌顿斜疝121例。术前诊断右侧嵌顿疝89例，左侧嵌顿疝32例。经脐切口置入trocar建立气腹，置入腹腔镜、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。探查对侧如存在隐性疝则同时处理。结果121例患儿均顺利完成单孔腹腔镜手术。术中探查发现合并对侧隐性疝34例。嵌顿疝内容物90例为肠管，20例为卵巢，11例为网膜。手法协助复位均顺利还纳，镜下观察5min，121例嵌顿脏器均血运良好。单侧疝（87例）手术时间为9～15min，平均12min；双侧疝（34例）手术时间为15～28min，平均24min。麻醉清醒后进食，疼痛均能耐受。术后平均12h出院。随访1～15个月，无切口感染，无阴囊水肿、血肿等并发症，无复发。结论单切口腹腔镜治疗儿童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，探查对侧有无隐性疝。该技术安全、有效、微创，值得推广。

Single-incision laparoscopic technique for incarcerated inguinal hernia in children

Objective The purpose of this study was to explore the value of single-incision laparoscopic approach for incarcerated inguinal hernia in children. Methods From March 2013 to June 2014, a total of 121 cases of incarcerated inguinal hernia in children who underwent single-incision laparoscopic operation in the Capital Institute of Pediatrics were enrolled in this study. There were 89 cases with preoperative diagnosis of right incarcerated hernia, and 32 in left side. Pneumoperitoneum was created following a trocar introduced via umbilical incision. Putting a laparoscope and a no damage clamp to inspect the hernia contents and the degree of incarceration. Hernia was reduced with the help of external manual pressure. A laparoscopic high ligation of hernia sac would be performed when no incarcerated viscera injury was found. If existed, a contralateral occult hernia would be repaired simultaneously. Results All the operations were successfully completed. The contralateral occult hernia were detected in 34 cases. Incarcerated hernia contents included 90 cases of bowel, 20 cases of ovarian, 11 cases of omentum. After the successful assisted manipulative reduction, with 5minutes of observation, the organ blood supply were good in all cases. Unilateral hernia （87 cases） took 9 to 15 minutes, mean 12 minutes; while 15 to 28 minutes in bilateral hernia （34 cases）, mean 24 minutes. Children started on an oral diet after anesthesia awake, with a tolerable pain. All had discharge in mean of 12 hours after the operation. There was no postoperative wound infection, scrotal edema and hematoma. The follow-up was 1 to 15 months, no recurrence and other complications. Conclusion Single-incision laparoscopy for incarcerated inguinal hernia in children does not destroy the anatomical structure of inguinal canal, which can receive high ligation of hernia sac, explore with a direct-view in both hernia contents and contralateral groin area. Technically, it is safe, effective, and minimally invasive, is a worth promoting new tech