单孔腹腔镜下应用改型硬膜外针治疗小儿腹股沟斜疝

Single-port Laparoscopy with Modified Epidural Needle for Indirect Inguinal Hernia in Children:Report of 70 Cases

目的探讨单孔腹腔镜下应用改型硬膜外针治疗小儿腹股沟斜疝的价值。方法2007年5月～2008年12月,选择腹股沟斜疝患儿70例。年龄6个月～3岁56例,4～7岁10例,7～13岁4例。单侧51例,双侧19例。于脐内置入5或10mm腹腔镜,采用自行设计并改型的硬膜外针(距针尖0.5cm处有V形缺口),于腹横纹插入并带入4号丝线,于腹膜外环形高位结扎内环口,并悬吊于腹壁。结果全部手术均成功,15例术中发现对侧隐性斜疝。手术时间51例单侧5～15min,19例双侧15～30min。术后随诊3～21个月,其中22例>12个月,无复发。结论在单孔腹腔镜下应用改型硬膜外针高位结扎内环口并悬吊治疗小儿腹股沟斜疝,具有损伤小、恢复快、无瘢痕,同时能发现并治疗对侧潜在小儿斜疝的优点。

Objective To evaluate the efficacy of laparoscopic treatment with one trocar for children with indirect inguinal hernia. Methods From May 2007 to December 2008,70 children with indirect inguinal hernia underwent laparoscopic high ligation of hernia sac by using a modified epidural needle in our hospital. Among the patients, 56 children aged from 6 months to 3 years, 10 aged 4 to 7, and 4 aged 7 to 13. Nineteen of the children had the disease in both sides, while the other 51 had unilateral hernia. A trocar was place into the abdominal cavity through the umbilicus with a modified epidural needle to introduce 4-0 silk suture. High iigation of the hernia was then performed, and fixed on the abdominal wall. Results The operation was successfully completed in all of the cases. The operation time ranged from 5 to 15 min in unilateral cases, and 15 to 30 min in bilateral cases. Follow-up was achieved for 3 to 21 months in this series （over 12 months in 22 cases）. During the period, no recurrence was found. Conclusions Laparoscopic high ligation of inguinal hernia sac with modified epidural needle is effective for children with minimal invasion and a low recurrence rate, without leaving scars at the abdomen.