腹腔镜治疗小儿急性腹股沟嵌顿性斜疝45例报告

Laparoscopic approach to acutely incarcerated inguinal hernia in children:a report of 45 cases

目的:探讨腹腔镜治疗小儿急性腹股沟嵌顿性斜疝的临床应用价值。方法:2002年1月至2006年12月,应用腹腔镜手术治疗小儿急性腹股沟嵌顿性斜疝45例。其中男42例,女3例,10周~7岁,平均3.8岁。手法复位不成功后,立即行腹腔镜手术。腹腔镜下还纳内容物,检查肠管,并行内环口高位结扎术,脐正中襞覆盖内环口及其周围。结果:45例均在腹腔镜下复位成功,无中转开腹,平均手术时间30min(10~50min),肠鸣音恢复时间6.2 h(4.0~10h),住院4.5 d(2~7d),无并发症发生。随访6~48个月,平均26个月,无复发及睾丸萎缩。结论:腹腔镜治疗小儿急性嵌顿性斜疝具有直视下可同时还纳疝内容物,检查嵌顿器官,修补疝内环口等优点。术中内容物复位容易,住院时间短,术后康复快,值得推广。

Objective ：To study the clinical value of laparoscopic approach to acutely incarcerated inguinal hernia in children. Methods：From Jan. 2002 to Dec. 2006,45 patients （aged 10 weeks to 7 years;median,3.8 years ;42 male,3 female） with acutely in- carcerated inguinal hernia underwent immediate laparoscopy after unsuccessful manual reduction. The hernial content was reduced in a combined technique of external manual pressure and internal pulling by forceps. The bowel was inspected, the hernia was repaired, then the median umbilical fold was sutured on the internal ring to repair the defect. Results：In all 45 patients, the procedure was successful. No conversion to the open approach was l〉quired. The mean operative time was 30min （range, 10-50min）, the recovery time of bowel function was 6.2h （range ,4-10h） and the hospitalization time was 4.5d （range ,2-7d）. No complications occurred. During a follow-up period of 6 to 48 mot^ths, there was no recurrence and atrophy of testis. Conclusions：The advantages of the laparoseopic approach to acutely incarcerated inguinal hernia in children are as following： simultaneous reduction under direct visual control,inspection of the incarcerated organ,and definitive repair of the hernia. It appears easier than the conventional approach because the internal inguinal ring is widened by intraabdominal carbon dioxide insufflation. The procedure is worth being prolnoted clinically with shone hospitalization and fast recovery.