腹腔镜在小儿腹股沟直疝及股疝手术中的应用

Laparoscopic repairing of direct inguinal and femoral hernias in children

目的探讨腹腔镜在治疗小儿腹股沟直疝及股疝中的应用价值。方法回顾性分析2015年1月至2019年12月腹腔镜手术治疗的5例腹股沟直疝、1例Pantaloon疝(同时存在斜疝及直疝)及1例股疝患儿的临床资料。其中,腹股沟直疝5例及Pantaloon疝1例均为男童;年龄(38.2±21.5)个月;疝位于右侧4例,左侧2例。右侧股疝1例,男,年龄4岁7个月。术前诊断腹股沟直疝1例;术前诊断为腹股沟斜疝,术中证实为Pantaloon疝1例;术前误诊为腹股沟斜疝,术中证实为直疝2例;行患侧斜疝手术时偶然发现对侧直疝2例。结果行直疝疝囊高位结扎+同侧脐内侧韧带加强2例,手术时间分别为32 min及24 min,术后住院时间1 d。其中1例术后3个月复发,再次手术行腹腔镜下修补直疝缺损(将髂耻束与联合腱间断缝合),手术时间为122 min,术后住院时间为2 d,随访至今无复发。另4例均行腹腔镜下直疝缺损修补术,手术时间为(112.0±17.5)min,术后住院时间为1~2 d,随访至今均无异常。股疝1例,术前诊断为右侧腹股沟斜疝,术中证实为右侧股疝,腹腔镜下修补股疝缺损(将髂耻束与Cooper韧带间断缝合),手术时间为125 min,术后住院时间为2 d,随访至今无异常。结论腹腔镜不仅能够明确小儿腹股沟直疝及股疝诊断,且可同时行手术治疗。髂耻束在腹腔镜下腹股沟直疝及股疝的修补中十分重要。

Objective To evaluate the value of laparoscopy in the diagnosis and treatment of direct inguinal and femoral hernias in children.Methods All male cases were retrospectively reviewed for pediatric direct inguinal and femoral hernias treated laparoscopically from January 2015 to December 2019.Direct inguinal hernias were identified(n=5)and hernia en pantaloon(n=1).The mean age was(38.2±21.5)months.The involved side was right(n=4)and left(n=2).Femoral hernia was identified in a 55-month-old boy.Preoperative diagnosis was direct inguinal hernia(n=1)and misdiagnosed as indirect inguinal hernia(n=3).There were,hernia en pantaloon during operation(n=1)and accidental discovery during operation(n=2).Results All laparoscopic procedures were successful.In the first two cases,direct inguinal hernia was percutaneous extraperitoneal closed and medial umbilical ligament served as enforcement.Surgical duration was 32 and 24 min and postoperative hospital stay lasted 1 day.However,one relapsing case was operated 3 month later.Conjoined tendon was sutured to iliopubic tract for closing defect.Surgical duration was 122 min and postoperative hospitalization stay 2 days.In the last 4 cases,conjoined tendon was sutured to iliopubic tract for closing defect.Surgical duration was(112.0±17.5)min and postoperative hospitalization stay(1-2)days.No postoperative recurrence was observed.Femoral hernia was misdiagnosed preoperatively as indirect inguinal hernia.Iliopubic tract was sutured to Cooper's ligament for closing femoral orifice.Operative duration was 125 min and postoperative hospital stay 2 days.No postoperative recurrence was observed.Conclusions Laparoscopy is effective in the diagnosis and treatment of direct inguinal and femoral hernias.Iliopubic tract is essential for laparoscopic repairing of direct inguinal and femoral hernias.