单孔腹腔镜注水疝钩针治疗小儿鞘膜积液85例报告

Single-port Laparoscopic Hernia Hook Needle for Treatment of Pediatric Hydrocele:Report of 85 Cases

目的探讨单孔腹腔镜注水疝钩针治疗小儿鞘膜积液的可行性和疗效。方法2017年5月~2018年12月我科对85例小儿鞘膜积液采用经脐单孔腹腔镜手术。经脐部置入腹腔镜,疝钩针带4号丝线经患侧内环口体表处穿刺进入腹膜外间隙潜行,借助水分离技术使输精管和精索血管与后腹膜间隙分离,环绕内环口1周完成鞘状突高位结扎。结果85例单孔腹腔镜手术均顺利完成,未增加辅助操作孔,无中转开放手术。手术时间单侧13~20 min,平均16 min;双侧23~36 min,平均29 min。85例随访4~9个月,平均6个月,1例患儿术后3周腹股沟穿刺点发生迟发性线结反应,经保守治疗后痊愈;无切口感染、阴囊血肿、睾丸萎缩、医源性隐睾等并发症,无复发。结论单孔腹腔镜注水疝钩针治疗小儿鞘膜积液安全、可行,术后体表无明显瘢痕,操作简便,疗效满意,值得在临床上推广应用。

Objective To discuss the feasibility and surgical outcomes of the single-port laparoscopic hernia hook needle in treating pediatric hydrocele.Methods A total of 85 pediatric patients with hydrocele were treated with single-port laparoscopic surgery from May 2017 to December 2018.Under laparoscopic visualization through a umbilical port,a hernia hook needle with 4#nonabsorbable suture was inserted at the corresponding point of the internal ring.The vasculature and spermatic cord were separated from the retroperitoneal space by water separation technique,and laparoscopic high ligation of vaginal process was completed around the internal ring.Results All the operations were successfully completed without conversion to open surgery.No auxiliary operating hole was required.The operating time was 13-20 min for unilateral cases,with an average of 16 min and 23-36 min for bilateral cases,with an average of 29 min.The 85 patients were followed up for 4-9 months,with an average of 6 months.One patient developed a delayed tissue reaction surrounding the surgical knot at the inguinal puncture site at 3 weeks postoperatively,and recovered after conservative treatment.There were no complications of wound infections,scrotal hematoma,iatrogenic cryptorchidism or testicular atrophy.No postoperative recurrence was found.Conclusions The single-port laparoscopic hernia hook needle for pediatric hydrocele is safe and feasible.The procedure leaves no obvious scar on the surface,which yields a satisfactory outcome and is thus worthy of clinical application.