单切口腹腔镜治疗小儿白线疝的探讨

Efficacies of single-incision laparoscopy for hernia of linea alba in children

目的探讨经脐单切口腹腔镜治疗小儿白线疝的疗效。方法2014年5月至2015年5月本中心收治白线疝患儿6例，平均年龄为（1．8±1．5）岁，术前彩色超声检查疝环直径为（3．2±0．7）cm。术前彩超检查确定疝环位置并标记，选择经脐纵向切口，切口长度为脐轮上下缘间距离，长约2cm。脐部正中切121置入5mm Trocar建立气腹，腹腔压力维持在8～10mmHg。腹腔镜监视下经脐旁（距脐中Trocar0．5cm）右侧腹直肌置入一个5mm Trocar，经脐旁Trocar置入操作器械，剪开自线疝的疝囊，清除腹膜外脂肪，显露疝环，游离两侧白线，经腹壁进针（2—0带针丝线），间断缝合两侧白线，连续缝合腹膜，如在游离疝环过程中，见白线缺损规则、整齐，则将疝囊切除，直接将两侧白线及腹膜间断缝合，以缩短麻醉及手术时间。结果本组6例患儿均顺利完成单切口腹腔镜修补手术。手术时间30-45min，平均32．5min；术中均无出血，术后康复快。麻醉清醒后进食，疼痛能耐受。术后平均12h可出院，术后无切口感染。随访1～12个月，无复发，无肠梗阻等其他并发症发生。结论单切口腹腔镜治疗小儿白线疝充分利用脐部切口，从腹腔内完整解剖白线疝结构，完全修补。不需要特殊腹腔镜器械即可完成手术。该技术安全、有效、微创，是值得推广的新技术。

Objective To explore the technique and outcomes of single incision laparoscopy for hernia of linea alba in children. Methods From May 2014 to May 2015, 6 cases underwent singleincision laparoscopy. A 2 cm vertical umbilical incision was established and stretched horizontally. An extra-long 5-ram 30 laparoscope was inserted through a 5 mm middle port. And a 3 mm lateral port was made for instruments. Extraperitoneal fat was cleaned after resecting hernial sac. Coloboma of linea alba was repaired by tissue approximation at each side. And peritoneum was reconstructed with continuot/s suturing. Results Preoperative abdominal ultrasound showed the average diameter of hernia ring was 3.2 ± 0. 7 cm and the mean operative duration 32. 5 （30-45） min. Oral intake was resumed during anesthetic recovery period. All patients could endure pain and were discharged at postoperative 12 hours. During a follow-up period of 1 to 12 months, there was no postoperative onset of wound infection, recurrence or other complications. Conclusions Single incision laparoscopy is both mini-invasive and efficacious for hernia of linea alba. And its cosmetic outcomes are satisfactory.