腹腔镜下免Trocar放入微型操作钳治疗小儿腹股沟斜疝

No-trocar iaparoscopic approach for high ligating inguinal hernias in children using mini-instruments

目的探讨采用脐旁微切口及腹腔内打结技术行疝囊高位结扎手术的安全性及手术效果。方法回顾性分析2012年10月至2013年10月，采用脐旁微切口及腹腔内打结技术行腹股沟斜疝手术102例，136侧的临床资料。其中，双侧34例，单纯左侧18例，单纯右侧50例。具体方法如下：经脐5mm Trocar置镜，脐旁两侧免Trocar置3mm常规操作钳及针持。内环口上外3cm腹壁外以2-0不可吸收带针缝线自腹壁穿入腹腔，尾线留置在腹壁外侧，环形缝合内环口一周，避开精索及血管。采用腹腔内绕线、腹腔外牵拉尾线辅助打结，腹壁外剪线。皮肤胶粘合伤口。结果单侧病例平均手术时间15．5min，双侧平均20．2min。无精索血肿、腹腔脏器损伤、腹壁气肿及手术后阴囊水肿发生。术后第1天自由活动率为93％。随访时间4～17个月，目前无复发病例，无患儿出现腹股沟区异物感或异物反应；术后2个月腹壁基本无可视疤痕。结论免Trocar腹腔镜技术、常规器械腹腔内打结进行疝囊高位结扎治疗小儿腹股沟斜疝，安全有效，对巨大型腹股沟斜疝尤为适用。操作难度同常规三孔腹腔镜技术，腹壁皮肤外观好，与单孔手术类似，无皮下异物感或异物反应。

Objective To evaluate the feasibility and safety of a novel laparoscopic approach for high ligating inguinal hernias in children using two microincisions besides umbilical and intraperitoneaI knot-tying. Methods Between June 2012 and October 2013, a total of 136 inguinal high ligations were performed for 102 children. There were 86 boys and 16 girls with a mean age of 2.4 years （25 days - 13.6 years）. Their clinical data were retrospectively analyzed. One 5 mm trocar was inserted through umbilicus into abdomen. Forceps and needle holder were punctured into abdomen through two 3 mm incisions at both sides of umbilicus without trocars. 2-0 non-absorbable suture was introduced into the peritoneal cavity through anterior abdominal wall near internal inguinal ring. The orifice of hernial sac was closed extraperitonealiy with a purse-string suture around internal inguinal ring and intraperitoneal knot-tying performed. Results All operations were completed successfully. The mean operative duration was 15.5 min for unilateral and 20. 2 min for bilateral lesions. No postoperative bleeding, abdominal wall emphysema, abdominal viscera injury or scrotal edema was found. And there was no occurrence of postoperative testicuiar atrophy/hypotrophy or hernia recurrence. And 93% of them resumed routine activities at Day l postoperation. During a mean follow-up period of 9. 9 （4 - 17） months, there was no report of recurrence, visible scar on abdominal wail or foreign body feel of inguinal portion. Conclusions Mini-invasive laparoscopic approach is both safe and efficacious for inguinal hernia in children. The difficulty is the same as tri-port laparoscopic technology. And its cosmetic outcome is similar as the single-port laparoscopy.