钳夹式疝环闭合针辅助腹腔镜钩针法疝环闭合术治疗成人腹股沟斜疝

Clamped Hernia Ring Needle Assisted Laparoscopic Hook Hernia Ring Closure for Adult Indirect Inguinal Hernia

目的探讨钳夹式疝环闭合针辅助腹腔镜钩针法疝环闭合术治疗成人腹股沟斜疝的可行性。方法 2013年3月～2017年1月对168例腹股沟斜疝在腹腔镜下用钳夹式疝环闭合针行钩针法疝环闭合术,以自制的钳夹式疝环闭合针夹持慕丝线经腹股沟内环体表投影处穿刺,腹腔镜肠钳辅助夹持内环最坚韧处(腹横筋膜外突形成的卵圆形裂隙外缘)分别于12、6点,1、5点及11、8点多次穿刺夹住或勾出慕丝线后于腹壁外结扎,最后再将内环口腹膜高位结扎,每次穿刺腹壁保持进出线在同一路径,予以疝环闭合。结果均顺利完成手术,其中145例行单侧疝环闭合术,23例行双侧疝环闭合术。单侧和双侧腹股沟疝手术时间分别为(13.6±3.2)min和(16.8±4.6)min。术后无切口感染、医源性隐睾或睾丸萎缩、阴囊水肿、血肿等并发症发生。168例随访8～36个月,平均20.6月,2例复发,4例线结肉芽肿形成,余162例均未复发。结论钳夹式疝环闭合针辅助腹腔镜钩针法疝环闭合术治疗成人腹股沟斜疝安全可行,操作简单,值得推广。

Objective To study the feasibility of clamped hernia ring needle to assist laparoscopic inguinal hernia ring closure in the treatment of adult indirect inguinal hernia. Methods We selected 168 patients with indirect inguinal hernia in our hospital from March 2013 to January 2017. All the patients received Crochet method of laparoscopic hernia ring closure with clamped hernia ring needle. The Mersilk suture was punctured through the internal inguinal ring to the surface projection by using a self-made clamped hernia ring needle. The toughest place of the internal ring（ at the transversalis fascia with protruding oval fissure） was clamped with laparoscopic intestinal forceps,and multiple punctures were performed at 12,6 o＇clock direction,1,5 o＇clock direction,and 11,8 o＇clock direction to ligation outside the abdominal wall. Finally high ligation was made at the peritoneal inner ring. During the puncture the silk thread was kept out of the line every time in the same way. Results All the operations were successfully completed,including 145 cases of unilateral hernia closed surgery and 23 cases of bilateral hernia ring closure surgery. The operation time of unilateral and bilateral inguinal hernia was（ 13. 6 ± 3. 2） min and（ 16. 8 ± 4. 6） min,respectively. No incision infection,iatrogenic cryptorchidism,or testicular atrophy,scrotal edema,hematoma and other complications occurred postoperatively. The 168 cases were followed up for 8-36 months（ mean,20. 6 months）. There were 2 cases of recurrence and 4 cases of granuloma formation.The remaining 162 cases had no recurrence. Conclusions Clamped hernia ring needle assisted laparoscopic inguinal hernia ring closure is safe and feasible. The procedure is simple and worthy of promotion.