经脐单孔腹腔镜治疗小儿女性鞘状突未闭

Transumbilical single-port laparoscopic hernioplasty for patent processus vaginalis in female infants and children

目的：探讨经脐单孔腹腔镜手术在小儿女性鞘状突未闭的临床应用结局。方法：2014年3月～2015年12月收治鞘状突未闭女性患儿50例。年龄1～11岁。单侧46例（腹股沟斜疝45例、Nuck囊肿1例）,双侧4例。于脐左缘置入5 mm腹腔镜,采用硬膜外穿刺针于腹横纹插入并带入7号丝线环及2-0涤纶编织线,环形缝合后,于腹膜外高位结扎内环口。Nuck囊肿患儿,同法高位结扎鞘状突后经腹壁细针穿刺抽除囊液。结果：除2例疝囊大网膜粘连和3例滑疝外,均行经脐单孔腹腔镜手术,手术过程顺利。10例术中发现对侧隐性斜疝。手术时间单侧5～8 min,双侧8～13 min。术后随诊1～23个月,无并发症及复发病例。结论：经脐单孔腹腔镜治疗小儿女性鞘状突未闭,不延长手术时间,不增加麻醉风险,具有损伤更小、恢复更快、切口更隐蔽的优点。

Objective： To assess the clinical outcomes of transumbilical single-port laparoscopic hernioplasty in the treatment of patent processus vaginalis in female infants and children.Methods： Fifty female infants or children with patent processus vaginalis,aged from 1 to 11 years,were included from March2014 to December 2015,and treated with transumbilical single-port laparoscopic high ligation of hernia sac by using a epidural needle.Of the 50 patients,46 were unilateral vestige of vaginal process（ 45 being indirect inguinal hearnia,1 being female hydrocele）,and 4 contralateral inguinal region.Loop of 7-0 silk suture and polyester braided suture were guided into peritoneal cavity through extraperitoneal space by a epidural needle under the surveillance of micro-laparoscopy.For the patients with cyst of the canal of Nuck,high ligation of the hernia sac was performed,and a fine needle was used to aspirate the fluid in the sac via post-abdominal wall.Results： The operation was successfully completed in all cases except for 5 cases（ 2 cases complicated with adhesions and 3 cases sliding hernia）.Ten cases of contralateral patent processus vaginalis were found in procedure.The operative time was 5 to 8 min for unilateral cases,and 8 to 13 min for bilateral cases.Follow-up in one to 23 months showed no post-operative complications or relapse.Conclusion： Transumbilical single-port laparoscopic hernioplasty has a series of advantages in the treatment of female infants and children with patient processus vaginalis,including no additional operative time,fewer risks of anestheaia,less invasion,quick incision healing and good cosmetic results.