改良腹腔镜技术在小儿腹股沟巨大嵌顿性斜疝中的应用

Modified laparoscopic closure of internal orifice for giant incarcerated hernia in children

目的探讨改良腹腔镜手术在小儿腹股沟巨大嵌顿性斜疝中的应用价值。方法2012年2月至2016年2月我们采用改良腹腔镜手术治疗小儿腹股沟巨大嵌顿性斜疝52例,均采取气管插管全身麻醉,于后腹腔镜下辅助手法复位,对复位失败者于腹股沟外环体表投影处做1.5 cm小切口,松解嵌顿,均行腹腔镜下双荷包加缝脐内侧襞内环口高位结扎术(改良法)。结果 52例患儿均顺利完成手术,腹腔镜下辅助复位36例,手术时间(35.4±9.16)min,住院时间(4.5±1.5)d,腹腔镜下嵌顿松解16例,手术时间(54.9±13.6)min,住院时间(5.5±1.7)d。无输精管、精索血管损伤,无阴囊血肿、切口感染等并发症。52例获随访,随访时间3~24个月,平均l4个月,术后无一例出现睾丸萎缩、医源性隐睾、切口疝、疝复发等。结论改良腹腔镜手术治疗小儿腹股沟巨大嵌顿性斜疝安全可行,疗效确切,腹腔镜下可同时发现和处理对侧隐性内环口未闭。

Objective To evaluate the clinical value of laparoseopic techniques for giant incarcerated hernia in children. Methods The clinical data of 52 children with giant incarcerated hernia between February 2012 and February 2016 undergoing emergency modified laparoscopy was retrospectively analyzed. Operations were performed under general anesthesia with tracheal intubation. After laparoseopie assisted manual reduction, laparoscopic double purse-string plus suture with medical umbilical flap high-ligation of internal ring （ modi- fied） was performed. If reduction was unsuccessful, a small incision 1.5 cm in length was made in groin outer surface projection for releasing the lesion. Results Modified laparoscopy was successfully performed in all 52 cases. And laparoseopie assisted reduction was completed in 36 cases with an operative duration of （ 35.4 ± 9. 16） min and a mean postoperative hospitalization stay of （4.5 ± 1.5 ） days. Laparoseopic embedded Bolton loosening was performed in 16 cases with an operative duration of （54. 9 ± 13. 6） rain and a mean postopera- tive hospitalization stay of（5.5 ± 1.7）days. There was no injury of seminiferous duet or spermatie vessel. No postoperative scrotal hematoma, incision infection or other complications occurred. The mean follow-up period was 14 （3 -24） months. No testieular atrophy, iatrogenie cryptorchidism or incisional hernia was not- ed. Conclusions Modified laparoscopy is both safe and effective for giant incarcerated hernia.