单孔腹腔镜下特制疝针治疗儿童腹股沟斜疝的问题及处理

Adverse factors and coping skills of laparoscopic percutaneous extraperitoneal closure for 196 cases of pediatric inguinal hernia

目的：总结单孔腹腔镜下特制疝针实施小儿腹股沟斜疝手术时遇到的一些实际问题及处理技巧。方法2014年3月至7月，我们收治196例小儿腹股沟斜疝，患儿均接受腹腔镜下特制疝针经皮穿刺腹膜外内环口结扎术。回顾性分析术中遇到的常见问题、解决方法及术后随访情况。结果本组完成腹腔镜经皮穿刺腹膜外结扎术193例，3例中转为传统小切口手术。手术时间5～40 min，平均14.5 min，术中出血1.5 mL，术中在其他部位增加操作通道和器械5例。腹膜皱襞遮挡33例，大网膜疝入并与疝囊粘连2例，腹膜外气肿2例，结扎线缠绕大网膜12例，合并其他疾病1例，断线脱线2例，内脏下滑靠近内环口5例，腹膜撕裂2例，巨大疝3例，阴囊积气1例，穿刺部位小血肿2例，脐疝1例。结论单孔腹腔镜经皮穿刺腹膜外结扎术已成为小儿腹股沟斜疝的首选手术方式，具有创伤小、恢复快、能同时发现对侧隐性疝等多种优点，但在实际操作过程中仍有诸多问题，正确处理可以减少或避免意外损伤及术后并发症的发生。

Objective To analyze and summarize the adverse factors affecting laparoscopic percutane-ous extraperitioneal closure （LPEC）for pediatric inguinal hernia （PIH）,and to explore the coping skills. Methods 196 children who diagnosed as PIH were applied with LPEC from March 2014 to July 2014.The ad-verse factors,coping skills and outcome of follow-up were retrospective analyzed. Results 193 LPEC were completed,but the other 3 cases converted to conventional surgery.The operating time was 5 ~40 minutes.A serious of adverse factors were encountered during the operation and solved properly,including 33 cases with radical peritoneum fold,2 cases with epiploon adhesion to the hernial sac,2 cases with extraperitoneal emphyse-ma,12 cases with sutures swine to the epiploon,1 case with hernias with comorbidity,2 cases with fracture of loss of the sutures,5 cases with viscera sliding hernias,2 cases with tear of peritoneum,etc. Conclusion-s LPEC had become the first choice for the treatment of PIH,it is effective for children with minimal invasion and low recurrence rate,which could be handled at the contralateral inguinal hernia.However there are a series of adverse factors during the procedure,which should be solved with appropriate techniques and principles.