单孔腹腔镜手术治疗小儿腹股沟疝(鞘膜积液)

Single-incision Laparoscopic Surgery for Indirect Inguinal Hernia(Hydrocele) in Children

目的探讨单孔腹腔镜手术(single-incision laparoscopic surgery,SILS)治疗小儿腹股沟疝及鞘膜积液的疗效。方法 2006年6月～2011年4月应用SILS及改制的普通硬膜外穿刺针完成176例小儿腹股沟疝及鞘膜积液手术。取脐部纵切口,直视下置入3 mm或5 mm腹腔镜,用改制的16号硬膜外穿刺针带4号丝线经皮沿内侧腹膜下潜行穿入,依次越过腹壁下动静脉、输精管、髂外血管和精索,越过精索后刺破腹膜进入腹腔,更换有凹槽的穿刺针沿外侧腹膜下穿入,到达结扎线处进入腹腔,将结扎线带出体表,体外收紧结扎,悬吊于腹壁,完成手术。结果 176例SILS手术成功,术中发现对侧隐性疝58例,均同期处理。手术时间7～50 min,平均16 min。所有患儿术后3 d出院。176例随访12个月,1例同侧复发,1例同侧并发直疝(手术证实),55例鞘膜积液无复发。结论 SILS治疗小儿腹股沟疝操作简单,疗效满意。

Objective To investigate the efficacy of single-incision laparoscopic surgery （SILS） for pediatric inguinal hernia and hydrocele. Methods From June 2006 to April 2011, we performed SILS on 176 case of inguinal hernia （hydrocele） with modified puncture needles. Through a longitudinal umbilical incision, under a direct vision, we placed a 3-ram or 5-mm laparoscope. And then, by using a modified 16 G epidural puncture needle with 4^# suture we made a percutaneous peritoneal penetration passing by inferior epigastric artery and vein, vas deferens, external iliac vessels, and spermatic cord, and finally crossed the spermatic cord piercing the peritoneum into the peritoneal cavity, afterwards, replaced with a grooved puncture needle, a lateral retroperitoneal lower penetration was made so that to arrive at the ligation line and enter into the peritoneal cavity. Finally, an in vitro ligation was made, suspended in the abdominal wall, to complete the operation. Results The operation was successfully completed in 176 cases, among which contralateral occult hernia was detected intraoperatively in 58 cases, which was cured at the same time. The mean operation time was 16 min （ranged, 7 -50 min）. All the children were discharged from hospital in 3 days after the operation. They were followed up for 12 months, during which one patient had ipsilateral recurrence; one had ipsilateral recurrence complicated with direct hernia. In the 55 cases of hydrocele, no recurrence was found. Conclusion Single-incision laparoscopic surgery is effective and simple for pediatric inguinal hernia and hydrocele.