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免水分离改良钩针辅助单孔腹腔镜内环腹膜外闭合治疗儿童腹股沟斜疝 被引量:8

Without hydrodissection for single-port laparoscopic percutaneous extraperitoneal internal ring closure using an inner grappler in the treatment of inguinal hernia in children
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摘要 目的探讨免水分离法应用于改良钩针辅助单孔腹腔镜内环腹膜外闭合治疗儿童腹股沟斜疝的安全性、有效性及可操作性。方法 2017年12月至2018年4月,在河北医科大学第二医院小儿外科收治的腹股沟斜疝患儿中,32例采用免水分离法实施改良钩针辅助单孔腹腔镜内环腹膜外闭合治疗。在脐单孔腹腔镜监视下,将改良钩针钩挂丝线经腹横纹内环体表投影处穿刺至内环前壁腹膜外,旋转钩针使钩针斜面背离术者视野,顶起后腹膜,利用钩针锹面顺势推进越过输精管与后腹膜之间间隙,在危险三角内抛置丝线于腹腔内;钩针沿原路退回至内环前壁腹膜外,进针经内环外侧间隙至精索血管外侧,再次旋转钩针使钩针斜面背离术者视野,顶起后腹膜,利用钩针锹面顺势推进越过精索血管与后腹膜之间间隙,沿此前针孔穿透后腹膜进入腹腔钩挂预置线牵出体外结扎闭合内环口。回顾性分析患儿基本情况、手术情况。对所有患儿随访至术后6~10个月,分析术后复发率和并发症发生情况。结果32例患儿的年龄为12个月~2岁6个月,男27例,女5例。术前诊断单侧腹股沟疝25例,双侧7例。术中证实单侧疝21例,双侧疝11例。43侧疝均采用免水分离方法实施改良钩针辅助单孔腹腔镜内环腹膜外闭合术。单侧和双侧疝的平均手术时间分别为(8.2±1.6)和(16.5±1.5) min。术后随访6~10个月,未出现伤口感染、医源性隐睾或睾丸萎缩等并发症,无复发疝、鞘膜积液和皮肤结肉芽肿形成。结论采用免水分离方法实施改良钩针辅助单孔腹腔镜内环腹膜外闭合术治疗小儿腹股沟斜疝,操作安全便捷,手术效果满意。 Objective To explore the safety, availability and feasibility of single-port laparoscopic percutaneous extraperitoneal internal ring closure using an inner grappler without hydrodissection for inguinal hernia in children. Methods From December 2017 to April 2018, 32 children with inguinal hernias in Department of Pediagric Surgery of The Second Hospital of Hebei Medical University were undertook single-port laparoscopic percutaneous extraperitoneal internal ring closure using an inner grappler without hydrodissection. Under visualization of single-port laparoscopic, an inner grappler with a non-absorbable suture was inserted at abdominal transverse striation to extraperitoneal space. The inclined surface of an inner grappler with suture was out of the operator's vision and reached back retroperitoneum and passed through the space between the vas deferens and the retroperitoneum and kept in abdominal cavity from the dangerous triangle. The same technique was utilized to pass through spermatic vessel on outside of hernia, followed by ligation and close the orifice of inner hernia. The basic and surgical conditions of the children were analyzed retrospectively. All of the cases were followed up for 6-10 months after operation and whose postoperative recurrence rate and complications were analyzed. Results Age of all patients ranged from 12 months to 2 years and 6 months (27 males, 5 females). Among of the cases, 25 cases were diagnosed as unilateral inguinal hernia, 7 cases were diagnosed as bilateral inguinal hernias pre-operation. While 21 cases were diagnosed as unilateral inguinal hernia, 11 cases were diagnosed as bilateral inguinal hernias during operation. A total of 43 cases were successfully completed using single-port laparoscopic percutaneous extraperitoneal internal ring closure using an inner grappler without hydrodissection technique. Mean operating time for unilateral and bilateral inguinal hernia was (8.2±1.6 )min and(16.5±1.5)min. Follow-up for 6-10 months after operation, there were no wound infections, iatrogenic cryptorchidism or testicular atrophy and other complications, as well as recurrence hernia, hydrocele, and suture granuloma formations. Conclusions It is safe and convenient to apply the single-port laparoscopic percutaneous extraperitoneal internal ring closure using an inner grappler without hydrodissection technique for the children with inguinal hernia. The result of the operation is satisfactory.
作者 刘雪来 张永婷 李索林 LIU Xue-lai;ZHANG Yong-ting;LI Suo-lin(Department of Surgery, Children's Hospital Capital Institute of Pediatric, Beijing 100020, China;Department of Pediagric Surgery, The Second Hospital of Hebei Medical University Hebei, Shijiazhuang 050000, China)
出处 《发育医学电子杂志》 2019年第2期141-145,共5页 Journal of Developmental Medicine (Electronic Version)
基金 河北省医学适用技术跟踪项目(G201720)
关键词 腹股沟斜疝 单孔腹腔镜 改良钩针 输精管 精索血管 免水分离 Huge inguinal hernia Single-port laparoscopy Inner grappler Vas deferens Spermatic vessels Free hydrodissection
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