改良微小单孔腹腔镜下细针带线行小儿疝高位结扎的体会

目的探讨改良微小单孔腹腔镜下细针带线高位结扎治疗小儿疝的疗效。方法患者全身麻醉后,在脐下穿刺建立气腹,置入5mm微型腹腔镜,探查患侧疝环位置和大小,并观察对侧有无隐性疝,于患侧内环口体表投影处切开2mm切口,尖端带线穿刺针由此在腹膜外绕内环口行半荷包潜行穿刺,并在腹腔内留一线圈后退针;同一方法做另一个半荷包潜行穿刺,用第二根线将第一根线的线圈拉出体外,使之在内环口形成一个完整的荷包,缩紧,皮下打结。若有对侧疝则按相同方法处理。结果本组26例病例均顺利完成,2例嵌顿疝在麻醉后镜下探查1例为肠管,另1例为网膜,在手法复位协助下均顺利还纳,镜下观察5min血运良好。第1～3例手术时间单侧疝32～68min,平均52min;双侧疝80min。第4～10例手术时间单侧疝15～45min,平均34min;双侧疝40min。第11～26例手术时间单侧疝10～20min,平均12min;双侧疝18min。麻醉清醒后可进食,患儿能耐受疼痛。术后平均48h可出院,术后无切口感染、血肿形成,无阴囊水肿。随访3～18个月,无复发,无其他并发症发生。结论改良微小单孔腹腔镜高位结扎治疗小儿疝不破坏腹股沟管的解剖结构,安全、简单、创伤轻微。

Experience of single port mini-laparoscopic assisting with needle and line for high ligation of inguinal hernia in children

Objective To investigate the effect of the treatment of inguinal hernia with single port mini-Laparoscopic in children.Methods Patients with general anesthesia,punctured to establish pneumoperitoneum below the belly button,placed 5mm mini-laparoscopy,probed the location and size of the affected side hernia ring,and observed whether the hidden contralateral hernia.On the surface projection of the ipsilateral internal ring made a 2 mm incision,then using a needle(tip with a line)form this incison sneak punctured in extraperitoneal and made a half purse-string suture around the internal ring,and leaving a coil in the abdominal cavity,pulled out the needle,made another half purse-string suture around the internal ring as the same way,then pulled the first line’s coil out of the body by the second line,so that the first line made a whole purse-string suture around the internal ring,tightened,tied.If there was contralateral hernia,did it as the same way.Results Twenty-six patients were successfully completed without change to the traditional transit high ligation of hernia sac.Two cases of incarcerated hernia(one was intestinal,the other was omentum),after anesthesia were successfully back assisted by manual reduction,and observed five minutes having good blood supply.One to 3 cases,the surgical time of unilateral hernia was 32 ～ 68 min(52 min);bilateral hernia was 80 min.Four to 10 cases,the surgical time of unilateral hernia operation time was 15 ～ 45 min(34 min);bilateral hernia was 40min.Eleven to 26 cases,the surgical time of unilateral hernia 10 ～ 20min(12min),bilateral hernia was 18min.After anesthesia children can eat and drink,children also can tolerate the pain.The 48h later child can be discharged,There was no wound infection,hematoma formation,no scrotal edema.Follow-up of 3 to 18 months,no recurrence,no other complications occurred.Conclusions The treatment of inguinal hernia with single port mini-Laparoscopic in children does not destroy the inguinal canal anatomy,and it was safe,simple,minor damage.