腹腔镜下自制疝气针在小儿腹股沟斜疝合并大网膜粘连中的应用

Application of homemade hernia needle under laparoscopy for inguinal hernia plus omentum adhesion in children

目的探讨腹腔镜下自制疝气针在处理小儿腹股沟斜疝合并大网膜粘连中应用的可行性和安全性。方法回顾性分析2014年8月至2015年8月在腹腔镜下采用自制疝气针处理11例小儿腹股沟斜疝合并大网膜粘连患儿的临床资料。其中,男10例,女1例;年龄1岁5个月至9岁6个月,平均5岁10个月。本组均在术中发现大网膜与疝囊粘连,经过牵拉大网膜及揉搓阴囊等方式不能使大网膜从疝囊中脱落,考虑大网膜与疝囊粘连紧密。采用专利自制疝气针(CN2015200065366.7)结扎大网膜近端,远端切割,随后常规完成疝气针全腹膜外疝囊高位结扎术。结果11例患儿术后均无阴囊内活动性出血、肿胀及疼痛、腹胀,醒后流食且无不适。本组所有患儿术后第1天复查血常规,血红蛋白在正常参考值范围内。本组患儿平均住院时间为2.7d。所有患儿于出院后1周、1个月、1年复查睾丸及阴囊B型超声,均提示睾丸血供正常,阴囊无残留组织,疝气无复发。结论腹腔镜下自制疝气针在处理小儿腹股沟斜疝合并大网膜粘连,术后无活动性出血及其他不适,值得临床探讨、应用和推广。

Objective To explore the feasibility and safety of homemade hernia needle under laparoscopy for inguinal hernia plus omentum adhesion in children. Methods Retrospective analysis was performed for 11 cases of inguinal hernia from August 2014 to August 2015. Eleven cases of omental adhesion were detected under laparoscopic. We used homemade hernia needle (utility model patent CN2015200065366.7 pending) ligation of proximal omentum and distal resection. Finally routine extra-peritoneal high ligation of hernial sac was performed. Results Eleven patients had no postoperative onset of active scrotum bleeding, swelling, pain or abdominal distension. After awakening, they ingested liquid food without discomfort. At Day 1 post-operation, hemoglobin was normal. After discharge, regular ultrasonic follow-ups were performed. Conclusions Laparoscopic high ligation of hernial sac is effective for omental adhesions. Homemade hernia needle has no postoperative onset of active bleeding or other discomforts. Wider popularization is recommended.