腹腔镜下缝扎内环口治疗小儿鞘膜积液

Hydroceles in children of laparoscopic treatment

目的 探讨小儿鞘膜积液腹腔镜治疗的新方法。方法 2 0 0 0年 11月～ 2 0 0 3年 11月应用微型腹腔镜缝扎内环口方法治疗小儿鞘膜积液 4 5 3例 ,年龄 1～ 12岁 (平均年龄 4岁 )。结果 术中经过顺利 ,手术时间 5～ 8min ,伤口不需缝合 ,未出现严重并发症。术后 2～ 3d出院。随访患儿症状消失 ,术后无瘢痕。治愈率 99.3%。结论 腹腔镜下缝扎内环口治疗小儿鞘膜积液 ,切口小 ,损伤小 ,疼痛轻 ,恢复快 ,手术时间及住院时间短 ,操作简单、安全、疗效可靠。可同时发现及处理隐性内环口未闭 ,比传统鞘状突高位结扎术优越。

Objective To evaluate a new procedure of laparoscopy to treat hydrocele in children. Methods 453 children at the age of 1 to 12 years old(mean age 4 years) were treated by laparoscopic surgery for hydroceles from November, 2000 to November, 2003. Under anesthesia of ketamine, the mini laparoscope was inserted via the umbilicus. An ipsilateral instrument port was created. All the patients were treated by suture around the internal ring with sledge needle and extracorporeal ligation under the view of the mini laparoscope. Results The operative procedures were uneventful. The operation times were 5 to 8 minutes, and the patients were discharged on day 2 or 3 post operatively with no major complication. The incision didn't need suture and there was no obvious scar formation after operation. All the cases were followed up at the 1 st month, 6 th month and the 1st year postoperatively. All cases were cured except for 3 cases, which made a 99.3% successful rate, with a recurrence of 0.7% . Omentocele at the umbilical incision was discovered in the other 2 cases. Conclusions Ligation around the internal ring under mini laparoscope is a simple, quick, safe procedure with minimal invasion for the treatment of hydrocele in children.It is convenient to deal with hidden patent internal rings during the operation. This procedure has more advantages than the traditional open surgery and deserves more clinical trials.