改良腹腔镜疝囊高位结扎术治疗小儿腹股沟斜疝

目的探讨改良的腹腔镜下疝囊高位结扎术治疗小儿腹股沟斜疝的效果。方法对常规腹腔镜疝囊高位结扎术进行改良:腹腔镜下采用普通8号注射器针头带入4号丝线,体外持针,腹腔内辅助,分次行疝囊颈2个"半圈"缝合,将腹腔内两线头经辅助Trocar拖出体外,打结,倒拉回腹腔内,收紧线尾,打结于腹股沟处皮下。采用改良的手术术式对183例患儿进行手术,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。结果 183例(男142例,女41例)患儿(共计278侧次)均成功实施了腹腔镜下疝囊高位结扎术,无一例中转开放。手术时间单侧6.8～15.2 min,平均(13.1±1.2)min;双侧22.7～33.3 min,平均(28.4±4.7)min。术后住院时间1～3 d,平均(2.3±0.6)d;术后复发率为0.7%。术中发现隐匿疝48例(发现率达35.2%),均同时予以高位缝扎。结论改良的腹腔镜下疝囊高位结扎术操作简单,易于掌握,疗效肯定,且取材容易,值得进一步实践以用于临床推广。

Modified laparoscopic high ligation in treatment of inguinal hernial sac in infants: a report of 183 cases

ObjectiveTo study the clinical effectiveness of a modified laparoscopic high ligation in treatment of inguinal hernial sac in infants.MethodsThe high ligation of hernial sac was conducted using a modified method: the laparoscopic suture of hernia sac was performed with No.4 thread in two semi-circles, facilitated by a No.8 syringe needle holding outside of the body. Two thread ends were knotted outside by supporting trocar and then put back into the abdomen. The thread end was tightened and knotted subcutaneously at the groin. A total of 183 infants received the modified ligation. The average operation time, postoperative hospitalization stay, and the rates of postoperative reoccurrence and complication were observed and the operative efficacy was evaluated.ResultsThe modified laparoscopic high ligation was successfully conducted in all the 183 infants (142 males and 41 females, 278 sides in total) without transitional opening. Unilateral operation time lasted from 6.8-15.2 min (with a mean of [13.1±1.2] min). Bilateral operation time lasted from 22.7-33.3 min (with a mean of [28.4±4.7] min). Postoperative hospitalization stay varied from 1 day to 3 days (with a mean of [2.3±0.6] days). The postoperative reoccurrence rate was 0.7%. Delitescence hernia was identified in 48 cases (35.2%) and was treated by high ligation.ConclusionOur modified laparoscopic high ligation for treatment of inguinal hernia sac is effective, easy-to-perform and easy-to-learn, making it worth popularizing in clinic.