腹腔镜辅助下鞘状突高位结扎术治疗儿童鞘膜积液327例

10 years experience of children hydrocele treatment by laparoscopic high ligation of vaginal process

目的：总结我们10年来采用腹腔镜辅助下鞘状突高位结扎术治疗小儿鞘膜积液的临床经验。方法自2002年1月至2013年1月，我们在腹腔镜辅助下采用“雪橇形”内环口修补针于腹膜外双重结扎未闭合的鞘状突内环口，同时穿刺抽净鞘膜囊内积液的手术方式，治疗2岁以上鞘膜积液患者327例，其中术前诊断为交通性鞘膜积液110例，非交通性鞘膜积液217例。结果327例中，325例患侧鞘状突内环口未闭，孔径3～5 mm；64例（约占19．6％）术前诊断为单侧的患儿术中发现对侧内环口未闭。术后常规随访1年，4例术后1～3个月出现同侧鞘膜囊内中等量积液（3～6 mL），复发率约1．2％，其中3例门诊观察2～3个月自行消退；1例再次经皮细针抽吸后自愈。病理学检查发现鞘膜囊内膜主要由单层柱状上皮构成，有一定的吸收功能，但分泌功能极弱。结论儿童鞘膜积液发病机制与鞘状突未闭有关，鞘膜囊液体主要来自于腹腔。腹腔镜下鞘状突高位结扎术治疗鞘膜积液长期疗效满意，且可以及时发现对侧隐匿病变，是一种安全有效的治疗手段。

Objetive To assess our 10 -year experience of the efficacy and safety of laparoscopic repair for pediatric hydrocele.Methods We performed this procedure in 327 patients older than 24 months from Jan 2002 to Jan 2013 using our specially designed curved awl.The patent internal ring was closed under laparosco-py and fluid within the hydrocele emptied by percutaneous needle aspiration.Among these children,110 had been diagnosed as “communicating hydroceles”before surgery. Results Laparoscopic exploration revealed 325 of 327 children had patent internal rings （pore size 3 ~5 min in diameter）.Sixty-four （19.6%）contralat-eral but asymptomatic patent processus vaginalis were diagnosed during laparoscopy.Routine post-surgical fol-low-ups had been performed for at least one year.Four kids had recurrence,with only moderate amount of fluid accumulation （3 ~6 mL）1 ~3 months after the surgery.3 of them spontaneously resolved during subsequent 2 or 3-month follow-ups.The remaining one needed percutaneous needle aspiration.Our pathological studies showed that hydrocele sac was lined by simple columnar epithelium,which had absorbable capacity but little secretory function. Conclusions Laparoscopic repair for hydroceles provides satisfactory long-term results and owes advantages on contralateral exploration.Pathogenesis of pediatric hydrocele is related with patent internal rings.And the source of fluids mainly derived from abdominal cavity.