腹腔镜治疗小儿腹股沟复发疝的临床效果

Clinical effect of laparoscopy in the treatment of recurrent inguinal hernia in children

目的探讨腹腔镜治疗小儿腹股沟复发疝的临床效果。方法选取于我院行腹股沟斜疝疝囊高位结扎术后复发的85例患儿作为研究对象,采用腔镜下单纯疝囊高位结扎、双重高位结扎以及在高位结扎基础上脐正中皱襞覆盖内环口的个体化治疗。通过对患儿疝复发原因的分析提出解决办法,并观察患儿术后的并发症、随访情况。结果85例患儿中6例术中发现隐匿疝,其中37例年长儿和巨大疝患儿进行了个体化的治疗,行疝囊高位结扎和在双重高位结扎的基础上进行脐正中襞覆盖内环口修补术,未发现隐匿疝,其他患儿均行复发疝及隐匿疝疝囊高位结扎。术后随访5~29个月,患儿中无疝复发,无阴囊血肿、医源性隐睾、睾丸萎缩及皮下线结反应等并发症发生。结论采用腹腔镜下个体化的手术方法对不同原因及年龄段复发疝患儿的治疗是安全的,术后并发症及复发率低。

Objective To investigate the clinical effect of laparoscopy in the treatment of recurrent inguinal hernia in children.Methods A total of 85 children with recurrent inguinal hernia who underwent high ligation of hernia sac in our hospital were selected as the study objects and individually treated with endoscopic high ligation of simple hernia sac,double high ligation and the middle umbilical fold covering the inner ring on the basis of high ligation.Through the analysis of the causes of recurrence of children’s hernia,the solutions were put forward,and the postoperative complications and follow-up were observed.Results Among the 85 children,concealed hernia was found in 6 cases during the operation.There were 37 cases of elder children and children with giant hernia,who were treated with individualized therapy,including high ligation of hernia sac and repair of the inner ring mouth covered by navel median fold on the basis of double high ligation.No concealed hernia was found.The other children were treated with the high ligation of the recurrent hernia and the concealed hernia sac.After 5-29 months of follow-up,there was no recurrence of hernia,scrotal hematoma,iatrogenic cryptorchidism,testicular atrophy and hypodermic junction reaction.Conclusion It is safe to treat children with recurrent hernia of different causes and ages with individualized laparoscopic operation,and the postoperative complications and recurrence rate are low.