腹腔镜在儿童对侧隐匿性腹股沟疝的临床价值

Clinical analysis of laparoscopic exploration for contralateral occult inguinal hernia in child

目的探讨腹腔镜诊疗儿童隐匿性腹股沟疝的临床意义。方法回顾性分析2010年1月至2014年5月，新疆维吾尔自治区人民医院收治内环口直径〉2cm及手法无法复位的嵌顿性腹股沟疝患儿32例，均行开放手术疝囊高位结扎，前壁加强的同时从疝囊置入30。腹腔镜探查对侧腹股沟管内环口，如发现对侧腹股管内环口未闭或者开放的窦道为隐匿性疝则同时行内环口关闭术。结果本组共32例均行切开手术，术中发现隐匿性疝15例。术中同时处理对侧隐匿性疝时，手术时间延长5—10rain。术后均无切口感染或睾丸炎等并发症，术后出现阴囊水肿5例，阴囊抬高后自行好转。术后2～5d出院。术后随访1个月至1年，无复发及睾丸回缩等。结论儿童隐匿性斜疝发病率较高，可从疝囊置入腹腔镜探查对侧并同时处理，可减少脐部切开探查，减少再次麻醉及手术的痛苦，降低医疗费用。

Objective To evaluate the laparoscopic diagnosis and treatment of pediatric occult inguinal hernia. Methods From January 2010 to May 2014, a total of 32 children who had incarcerated inguinal hernia with inner ring diameter more than 2 cm, were admitted to Xinjiang Uygnr Municipal People＇s Hospital. All of them received open hernia sac high ligation surgery and anterior abdominal wall reinforcement. In the operations, the inner ring of contralateral inguinal canal was explored by 30° laparoscopy, if an occult hernia was found, it would be closed at the same time. Results 15 cases of occult hernia were found in the all 32 open surgery. When the eontralateral occult hernia was repaired simultaneously, the operation time was prolonged by 5 to 10 minutes. No wound infection or orchitis was found. 5 cases of them developed scrotal edema, which was cured after scrotal elevation. Patients were discharged from hospital in 2 to 5 days after surgery, and followed up for 1 months to 1 year. No recurrence or testis shortening was observed. Conclusion Children have a high incidence of contralateral occult hernia, which can be detected with laparoscopic exploration through ipsilateral hernia sac. Meanwhile, it can reduce the umbilical incision, avoid secondary anesthesia or re-operation, reduce, and decrease medical expense.