“跨内环口”腹股沟斜切口治疗儿童腹股沟嵌顿性斜疝

Treatment of incarcerated indirect inguinal hernia with ＂cross-internal ring＂ inguinal oblique incision in children

目的总结＂跨内环口＂斜切口治疗嵌顿性腹股沟斜疝的治疗经验。方法回顾性分析2014年1～12月，就诊于武汉儿童医院的13例嵌顿性腹股沟斜疝合并高度腹胀患儿的临床资料。13例患儿，男9例，女4例；年龄2～15个月，平均年龄5.8个月。右侧10例，左侧3例。术前均有不同程度肠梗阻症状。＂跨内环口＂斜切口的解剖定位：耻骨结节与髂前上棘连线中点，相当于内环口处可触及一明显嵌闭环，划一个沿腹股沟管方向斜切口，头侧延长2 cm逐层向下打开腹膜，足侧延长1 cm逐层打开腹股沟管，总长3 cm。结果所有患儿均经＂跨内环口＂腹股沟斜切口完成手术。患儿术后2～ 5 d恢复饮食，无迟发型肠穿孔、腹腔脓肿、切口感染等并发症发生。术后住院4～7 d，平均5.2 d。所有病例术后随访24～36个月，无病例复发，所有患儿均无医源性隐睾及术后粘连性肠梗阻发生。结论＂跨内环口＂斜切口是治疗嵌顿性腹股沟斜疝合并高度腹胀患儿的简单、安全和合理的手术入路。

ObjectiveTo summarize the surgical experiences of incarcerated indirect inguinal hernia with ＂ cross-internal ring＂ inguinal oblique incision in children.MethodsFrom January 2014 to December 2014, 13 patients with incarcerated indirect inguinal hernia complicated with severe abdominal distension were recruited. Anatomical orientation of ＂ cross-internal ring＂ inguinal oblique incision was at the midpoint of line connecting pubic tubercle and anterior superior spine. A markedly inserted and closed ring could be felt at internal ring mouth and an oblique incision was made along inguinal canal. The incision was extended cerebrally by 2 cm to open peritoneum layer-by-layer and extended caudally by 1 cm to open inguinal canal. Its total length was 3 cm.ResultsAmong them, there were 9 boys and 4 girls with an average age of 5.8 （2-15） months. The involved side was right （n=10） and left （n=3）. All cases of intestinal obstruction were successfully operated via the above incision. Food intake was resumed at Days 2-5 post-operation. There was no onset of such complications as delayed intestinal perforation, intra-abdominal abscess or incision infection. The average postoperative hospitalization stay was 5.2 （4-7） days. During a postoperative follow-up period of 24-36 months, there was no instance of recurrence, iatrogenic cryptorchidism or adhesive intestinal obstruction.Conclusions＂ Cross-internal ring＂ inguinal oblique incision is simple, safe and reliable for incarcerated indirect inguinal hernia complicated with severe abdominal distension.