腹腔镜经皮穿刺腹膜外腹股沟斜疝结扎术的不良因素与处理

Adverse factors and treatment of laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia

目的总结并分析腹腔镜经皮穿刺腹膜外结扎术(LPEC)治疗小儿腹股沟斜疝时可能遭遇的各类不良因素,探讨适宜的处理方法和原则。方法回顾分析该院2011年3月-2013年3月218例LPEC时遭遇到的各类不良因素、手术过程、处理方法及术后。结果该组病例中82例出现不同程度的输精管辨认困难,其中4例最终无法辨认;69例遭受到腹膜褶皱的困扰;32例大龄或内环口开放巨大的病例;5例因为膀胱充盈,2例乙状结肠充盈;2例穿刺导致局部腹膜出现严重破损;2例大网膜疝入并与疝囊粘连;4例腹膜外气肿。术中采用各种方法灵活处理,最终212例完成LPEC手术,另外6例中转为传统小切口手术。该组无1例因术后复发及其他明显并发症出现。结论绝大数小儿腹股沟斜疝可以通过LPEC治愈,但可能遭遇多种不良因素,灵活处理并遵守一定原则可以预防、降低或解除不良因素影响。

[ Objective ] To retrospectively analyze the various factors affecting laparoscopic percutaneous ex-traperitoneal closure （LPEC） for pediatric inguinal hernia （PIH）, and to explore the measures. [ Methods ] A retro-spective analysis was carried out for 218 cases which were treated with transumbilical laparoscopic LPEC using 3different techniques between March 2011 and March 2013. The adverse factors of the LPEC procedures, the mea-sures and postoperative complications were collected. [Results] 212 LPEC were completed and the other 6 wereconverted to conventional surgery. There were no recurrences. Some adverse factors were encountered during theprocedures and solved properly including unclear visualization of vas deferens （82）, peritoneum gauffer （69）, old ageor huge hernias （32）, full bladders （5）, full colons （2）, tear of peritoneum （2）, Extraperitoneal emphysema （4）, epi-ploon conglutinated to the sac （2）. [ Conclusion ] The majority of children with PIH can be cured by LPEC, butsome various adverse factors would be encountered which must be solved with some techniques and principles.