经脐单切口腹腔镜下儿童腹股沟疝高位结扎术

Transumbilical Single-incision Laparoscopic Inguinal High Ligation for Inguinal Hernia in Children

目的探讨经脐单切口腹腔镜手术治疗儿童腹股沟疝的应用价值。方法 2010年3月～2011年12月,对腹股沟斜疝439例,其中术前诊断为双侧斜疝94例,术前诊断为单侧斜疝而术中探查为双侧斜疝104例,术中发现单侧直疝2例,传统手术后复发疝16例。在脐上缘做10 mm弧形切口,切口内偏右侧穿入5 mm trocar,偏左侧穿入3 mm trocar,用改良套管钩针行内环口环形荷包缝扎术。结果 241例单侧腹股沟斜疝手术时间(10.1±5.0)min,198例双侧手术时间(15.2±2.5)min。总住院时间1～3 d,平均2 d。所有患儿术后随访6～12个月。1例复发。无阴囊积液、血肿、感染等并发症发生。结论经脐单切口腹腔镜手术治疗儿童腹股沟疝疗效肯定,伤口小,安全快速,操作简便。

Objective To evaluate laparoscopic inguinal high ligation via a single umbilical incision for children with inguinal hernia. Methods Since March 2010 to December 2011, 439 children with inguinal hernia were admitted to our hospital. Before operation, bilateral indirect inguinal hernia was diagnosed in 94 cases. During the operation, 104 patients, who were diagnosed with unilateral indirect inguinal hernia preoperation, were confirmed as having bilateral indirect inguinal hernia; besides, two patients were diagnosed with unilateral direct hernia; and 16 patients were diagnosed with recurrent hernia after traditional operation. We made a 10- ram curved incision along the upper edge of the umbilicus, so that to insert a 5-ram trocar towards the right side, and a 3-mm trocar towards the left. A modified Crochet hook was used to complete circumferential closure of the sack at the level of the internal ring. Results The mean operation time for unilateral procedure was （ 10.1 ＋ 5. O） rain （241 cases） , and that for bilateral operation was （ 15.2 ＋ 2.5） min （ 198 cases）. The mean hospital stay of the series was 2 days （ ranged from 1 to 3 days）. All the patients were followed up for 6 to 12 months, only one of them had recurrence during the period. No hematoma, scrotal hydrocele and infection occurred. Conclusion Laparoscopic inguinal high ligation via a single umbilical incision is effective, safe, and simple for the treatment of children with inguinal hernia.