单孔腹腔镜手术治疗婴幼儿疝—腹腔空间优化策略与细针挑拨法

Single-port laparoscopic surgery for infant hernia:abdominal space optimization strategy and fine-needle picking

目的:探讨单孔腹腔镜小儿内环口闭合术中腹腔空间优化策略及输精管的暴露技巧。方法:收集2018年2月至2021年12月收治的300例腹股沟斜疝及鞘膜积液患儿(观察组)的临床资料,在单孔腹腔镜下采用腹腔空间优化策略必要时细针挑拨疝囊暴露输精管的方法完成内环高位闭合术,并与前期未使用优化策略及细针挑拨法的300例患儿(对照组)进行对比,比较两组手术时间、手术成功率、术后并发症等。结果:观察组均完成单孔腹腔镜下内环高位闭合术,无增加Trocar或改变手术方式的病例,术后均恢复良好。观察组手术成功率(300 vs.266)、手术时间[单侧(14.92±3.15)min vs.(16.49±4.31)min,双侧(23.68±4.98)min vs.(28.59±4.38)min]、术后并发症发生率(1 vs.8)均优于对照组,差异有统计学意义。结论:腹腔空间优化策略结合细针挑拨法可提高单孔腹腔镜小儿内环高位闭合术的手术成功率,缩短手术时间,安全可靠。

Objective:To explore the abdominal space optimized strategy and the exposure technique of deferent duct in single-port laparoscopic internal ring closure of inguinal hernia in infants and young children.Methods:Clinical data of 300 children(observation group)with indirect inguinal hernia and hydrocele who underwent single-port laparoscopic high closure of the internal ring using a two-hooked core needle apparatus from Feb.2018 to Dec.2021 were collected.The abdominal space optimization strategy was adop-ted.When necessary,fine needle was used to pick the hernia sac to expose the vas deferens to complete the closure of the internal ring.The previous 300 patients(control group)treated with single-port laparoscopic closure of the internal ring without optimization strategy and fine needle picking method was set as control group.Surgery duration,success rate of surgery,and postoperative complications of two groups were compared.Results:All 300 patients of observation group were successfully treated with single-port laparoscopic high closure of internal ring.There were no cases of increasing trocar or changing the operation mode.All patients recovered well.The success rate(300 vs.266),operative time[unilateral(14.92±3.15)min vs.(16.49±4.31)min,bilateral(23.68±4.98)min vs.(28.59±4.38)min],and postoperative complications(1 vs.8)of the observation group were significantly prior to the control group.Conclusions:The combination of abdominal space optimization strategy and fine-needle picking method can improve the success rate of operation,shorten the operative time,is safe and reliable.