可进辅助器械单孔腹腔镜下交通性鞘膜积液鞘状突高位结扎术临床观察

Clinical efficacy of high ligation of the communicating hydrocele testis with single-port laparoscopy

目的 探讨可进辅助器械单孔腹腔镜在小儿交通性鞘膜积液鞘状突高位结扎术的可行性、安全性及优势。方法 选择2020年2月至2022年2月在本院入院,患有交通性鞘膜积液的60例患儿作为研究对象,均采用可进辅助器械单孔腹腔镜行鞘状突高位结扎术。年龄1.5~9岁,分析手术时长、术中出血量、术后疼痛时长、术后切口长度及住院时长、手术前和手术后阴囊相关关键指标[舒张末期血流速度(EDV)、收缩峰值血流速度(PSV)、动脉阻力指数(RI)]等。结果 术中均发现未闭合鞘状突,60例交通性鞘膜积液患儿经可进辅助器械单孔腹腔镜行鞘状突高位结扎术,手术过程顺利,无1例增加辅助孔,无1例中转为开放手术,2例分离精索血管时损伤精索小静脉,少量出血,观察后不影响操作。手术时长为(12.21±3.12)min,术后疼痛时长为(1.35±0.71)d,术后切口长度为(7.50±1.12)mm,住院时长为(3.12±1.55)d,手术后2月、4月、6月患儿阴囊的EDV、PSV、RI相关指标均呈现逐渐增高的趋势,手术前后差异有统计学意义(P<0.05)。术后未出现切口感染、神经受损、睾丸萎缩、精索损伤、睾丸血管破裂及其他血管损伤等情况,无阴囊水肿及血肿,手术瘢痕小,位于脐部较隐蔽,随访患儿症状消失,无复发。结论 可进辅助器械单孔腹腔镜在小儿交通性鞘膜积液行鞘状突高位结扎术,具有切口短、基本无疼痛、手术时间短、操作简便安全高效等特点。

Objective To investigate the feasibility and safety of high ligation of the communicating hydrocele testis with single-port la-paroscopy. Methods Total of 60 pediatric patients with communicating hydrocele testis cases admitted in our hospital from June 2020 to June 2021were analyzed. Patients’ age were from 1.5 to 9 years. The operation time, blood loss during operation, postoperative pain time, incision length and hospitalization time, scrotal parameters before and after operation including end diastolic velocity(EDV), peak systolic velocity(PSV), arterial resis-tance index(RI) were calculated. Results All cases were found to be processus vaginalis unclosed during the operation. 60 cases of communicating hydrocele testis underwent high ligation of the process by using single-port laparoscope with auxiliary instruments. The operation was successful, and no case was converted to open surgery. In 2 cases, the small spermatic vein was injured when separating spermatic cord blood vessel, and a small amount of hemorrhage was found. The operation time was(12.21 ±3.12)min, postoperative pain time was(1.35 ±0.71)d, incision length was(7.50±1.12)mm, hospitalization time was(3.12±1.55)d, EDV, PSV and RI of scrotum were improved at 2, 4, 6 months after operation, and had an increasing trend.The differences were statistically significant(P<0.05). Wound infection, nerve injury, testicular atrophy, spermatic cord injury, scrotal edema, testicular artery and other blood vessels of gonad injury were not found after operation. Recurrence was not happened in all cases. Conclusion Single-port laparoscope can be used for high ligation of sheathing process in children with communicating hydrocele testis. The surgery has advantages of small incision, light pain, short operation time, quick recovery. Overall, it is a simple, safe and effective surgery.