关于腹腔镜腹股沟斜疝术后再发斜疝的经验总结

Experiences of recurrent hernia after laparoscopic single-site hernioplasty

目的对腹腔镜辅助经皮腹壁穿刺腹膜外内环结扎术(腹腔镜单孔法)治疗腹股沟斜疝,术后出现再发斜疝的临床经验进行总结与探讨。方法回顾2016年8月到2019年6月间,浙江大学医学院附属儿童医院腔镜中心开展了1168台腹腔镜单孔法手术。统计术后再发斜疝的病例,描述其临床特点及再次手术术式的选择,分析并总结经验。结果术后再发斜疝的患儿共8例,其中6例为复发疝,2例为对侧异时性斜疝。首次手术年龄为(1.4±0.6)岁,术后再发斜疝的间隔时间为(5.2±2.6)个月。7例术后再发患儿在再次手术中,接受了腹腔镜探查,1例复发疝和1例对侧异时性斜疝患儿的内环口形态特殊,临床少见,具有探讨价值。再次手术的术式依据外环口大小来选择。结论术后再发斜疝给患儿及其家庭带来的影响较大,且临床研究对腹腔镜单孔法术后再发斜疝的关注度不够,开展相关研究具有重要的临床意义,有助于推进腹腔镜单孔法在腹股沟斜疝领域的应用与发展。

Objective To summarize the clinical experiences of recurrence of inguinal hernia (IH) after laparoscopic single-site hernioplasty.Methods A total 1168 IH children underwent single-site laparoscopic percutaneous extraperitoneal closure from August 2016 to June 2019. The authors analyzed the postoperative recurrence of inguinal hernia to summarize its clinical characteristics and the choice of reoperative mode.Results The count of recurrent hernia was 8. And the involved side was unilateral (n=6) and ipsilateral (n=2). The age range was (1.4±0.6) years and interval time of recurring of hernia (5.2±2.6)months. Seven cases were explorated by laparoscopy during reoperation. One unilateral case and another ipsilateral case showed special and rare morphologies and were worth further discussions. The procedure of reoperation depended on the size of superficial inguinal ring.Conclusions Postoperative recurrence has a great impact on children and their families. Thus it has important clinical significance of conducting the relevant researches. And it is helpful to promote the application and development of laparoscopic techniques for indirect inguinal hernia.