改良套管穿刺法在小儿腹腔镜鞘状突高位环扎术的应用

A modified trocar puncture method in operation of laparoscopic pediatric processus vaginalis suturing ligation

目的介绍一种新的改良腹腔镜套管穿刺法,探讨其在小儿腹腔镜鞘状突高位环扎术中的应用价值。方法收治62例交通性鞘膜积液患儿,所有患儿均采用腹腔镜鞘状突高位环扎术,其中,32例采用传统套管穿刺法,30例采用改良套管穿刺法,即在建立第一个套管后,在腹腔镜监视下带芯套管均匀用力穿过皮肤、皮下及肌层,直视下见到套管芯尖部顶住腹膜后,对着已建立的5mm套管呈一定方向及角度用力穿刺,比较两组的套管穿刺时间、总手术时间及并发症。结果两组手术均取得成功,传统套管穿刺组与改良套管穿刺组的平均穿刺时间为11±2.7minVS5.2±1.0min(P<0.05),总手术时间为24±4.0minVS19±3.1min(P<0.05);两组术中均无腹内脏器损伤,术后无阴囊血肿、伤口感染发生;60例术后得到3～12个月随访,无复发、切口疝及睾丸萎缩等发生。结论改良套管穿刺法能提高小儿腹腔镜套管穿刺的安全性,且比传统套管穿刺法节省手术时间,值得临床应用推广。

Objective To introduce a novel modified trocar puncture method and explore its clinical value in operation of laparoscopic pediatric processus vaginalis suturing ligation, Methods 62 pediatric cases with communicating hydrocele were enrolled in this study. All children were treated with laparoscopic processus vaginalis suturing ligation. Of which, 32 cases underwent traditional trocar puncture method and 30 cases underwent a novel modified trocar puncture method. That is, after the first trocar was established, trocars with puncture needle were forced across the skin, subcutaneous and muscular under laparoscope monitor and then facing the established 5mm trocar with a certain direction and angle under direct vision before going into abdominal cavity. The puncture time, total operation time and complications were compared between two groups. Results Both operations were successful. The trocar puncture time and total operation time in traditional trocar puncture group were longer significantly than that in modified trocar puncture group. No internal organs injury, postoperative scrotal hematoma and wound infection occurred in both groups. 60 cases received 3 to 12 months follow-up. No recurrence, incisional hernia and testicular shrinkage occurred. Conclusion The novel modified trocar puncture method can improve the safety during pediatric laparoscopic trocar puncture process with a shorter operation time than traditional trocar puncture method. It is worthy of clinical application and popularization.