腹腔镜脐内侧襞瓣加强内环口疝修补术在儿童及青少年腹股沟斜疝中的应用

Application of medical umbilical ligament flap covering the internal ring to reinforce laparoscopic herniorrhaphy in children and teenagers with indirect inguinal hernias

目的探讨腹腔镜脐内侧襞瓣加强内环口疝修补术在治疗儿童和青少年腹股沟斜疝中的可行性及优越性。方法从2001年10月至2005年1月,我院对110例(140侧)儿童实施了疝囊高位结扎术(A组)。2005年1月至2011年2月,对于300例(405侧)患儿疝囊高位结扎术(B组)中,对有疝复发危险因素的47例患儿,加做脐内侧襞瓣覆盖加强内环口。结果 B组具有疝复发危险因素患儿47例,经腹腔镜脐内侧襞腹膜瓣加强内环口疝修补术均顺利完成。A组随访2～122个月,平均56个月,4例复发(2.8%)。B组随访5～74个月,平均34个月,尚未见复发。二组患者随访期间均未见睾丸萎缩等并发症。结论腹腔镜疝囊高位结扎合并脐内侧襞瓣覆盖内环口疝修补术是安全可靠的,对有选择的腹股沟斜疝患儿以及青少年腹股沟斜疝有进一步降低疝复发的作用。

Objective To establish medical umbilical ligament flap covering the internal ring as reinforcement of laparoscopic high ligation herniorrhaphy. The feasibility and advantages of the application in children and teenagers with indirect inguinal hernias were addressed. Methods Laparoscopic high ligation of the IR was performed in Group A of 110 children with 140 indirect hernias between October 2001 and January 2005. From January 2005 to February 2011 ,similar repairs in 300 consecutive children （Group B） with 405 indirect hernias were carried out. The umbihcal medial fold flap to strengthen the internal ring was used for 47 cases of children with risk factors of hernia recurrence. Results There were 47 cases of children with risk factors. All 47 eases of medial laparoscopic umbilical fold peritoneal flap to strengthen the internal ring hernia repair were successfully completed. The mean duration of follow-up in Group A was 2 to 122 months with a mean of 56 months. Four cases were recurred （2.8%）. The mean duration of follow-up in Group B was 5 to 74 months with a mean of 34 months, no recurrence was observed. There was no complication （ eg. Testicular atrophy） in the two groups of patients. Conclusions The application of medial umbilical ligament flap covering the internal ring to reinforce laparoscopic herniorrhaphy was safe and feasible for children and teenagers with indirect inguinal hernias.