腹腔镜下小儿腹股沟斜疝的内环口分型及临床意义

Laparoscopic classification of the internal ring in children with indirect inguinal hernia

目的探讨腹腔镜下小儿腹股沟斜疝的分型及其临床意义.方法回顾性分析我院2002年6月～2004年6月间,采用经脐双切口腹腔镜下疝囊高位结扎术治疗的540例患儿的临床资料.结果本组540例小儿斜疝中大开口型420例(77.8%),小开口型120例(22.2%),漩涡型101例(18.8%),隐匿型24例(4.4%).4种类型患儿均行腹腔镜下疝囊高位结扎术,经6个月～2年随访,其中3例复发(复发率0.6%),3例第一次术中漏诊,未出现其他严重并发症.结论根据腹腔镜下疝内环口特点可将小儿腹股沟斜疝分为大开口型、小开口型、漩涡型和隐匿型四种类型,术中根据不同类型特点采用适当手术方法,可避免术中漏诊和术后复发,值得临床参考应用.

Objective To evaluate the anatomic classification of the internal ring in children with indirect inguinal hernia by laparoscopy. Methods From June 2002 to June 2004, the clinical data of 540 patients underwent trans-umbilicus two-port to accomplish high ligation of the hernia sac under laparoscopy were analyzed retrospectively. The morphology of the internal rings was classified as follows： type 1, a widely open internal ring, type 2, a narrow open internal ring, type 3, a whirlpoollike internal ring, and type 4, a concealed internal ring. Results Of all classifications, the number of type 1, 2, 3 and 4 was 420, 120, 101, and 24, respectively. The recurrence incidence was 0.6% （3 cases） during the follow-up term of 6 months to 2 years. And the contralateral hernia was missed in the other 3. No other serious complications happened. Conclusions The internal ring in children with indirect inguinal hernia could be classified into different types according to their laparoscopic features. The classification system is advantageous to select the suitable laparoscopic procedure and decease the recurrence incidence.