腹腔镜内环口缝扎术治疗小儿鞘膜积液

目的:探讨腹腔镜内环口缝扎术治疗鞘膜积液的临床疗效及安全性。方法:2004年7月至2012年1月于气管插管全麻下为1 182例鞘膜积液患儿行腹腔镜内环口缝扎术。其中男1 128例,女54例;单侧957例,双侧225例;交通性鞘膜积液554例,精索鞘膜积液223例,睾丸鞘膜积液405例。其中隐性鞘膜积液383例,复发性鞘膜积液38例。结果:1 182例患儿均顺利完成麻醉和手术,手术时间8～12 min,平均10 min。术中出血少于1 ml,无一例发生麻醉意外、脏器损伤及中转开腹,治愈率99.58%,腹部切口甲级愈合率100%。术后复发5例,切口大网膜疝出3例,阴囊水肿血肿29例;无一例发生切口感染、肠粘连、睾丸萎缩。结论:气管插管全麻腹腔镜内环口缝扎术治疗小儿鞘膜积液具有麻醉安全、组织创伤小、出血少、操作简单、术后康复快、并发症少、安全、美观、有效等优点,可达到治愈目的;适于任何类型的小儿鞘膜积液,值得广泛应用。

Treatment of hydrocele in children with laparoscopic suture and ligation of the internal ring

Objective:To discuss the clinical efficacy and safety of laparoscopic internal ring ligation to treat hydrocele.Methods:The clinical data of 1 182 children(male 1 128,female 54)suffering from hydrocele who underwent laparoscopic internal ring ligation from Jul.2004 to Jan.2012 were analyzed retrospectively.Of which there were 957 cases of one-sided hydrocele,225 cases of bilateral hydrocele;554 cases of communicating hydrocele,223 cases of hydrocele of the spermatic cord,405 cases of hydrocele of testis;383 cases of recessive hydrocele and 38 cases of recurrent hydrocele.Results:The anesthesia and operation of all the 1 182 patients were conducted successfully with no anesthetic complications,abdominal organs injury or conversion to open surgery.The mean operative time was 10 min(8-12 min).The mean blood loss was less than 1 ml.The overall cure rate was 99.58%,and the primary healing rate of abdominal incision was 100%.The main postoperative complications included 5 cases of relapse which were cured by reoperation,3 cases of greater omemtum herniation from incision,29 cases of scrotal edema and hematoma.No such complications as organ injury,incision infection,intestinal adhesion or testis atrophy occurred.Conclusions:Treatment of hydrocele in children with laparoscopic suture and ligation of the internal ring under tracheal intubation and general anesthesia has advantages of minimal invasion,safety,effectiveness,easy to take over,good cosmetic results,few complications,quick recovery,little blood loss,and is suitable for any hydrocele in children,so it is worthy of promotion.