使用大圆针行单孔腹腔镜疝囊高位结扎术在儿童巨大腹股沟疝治疗中的应用及解剖要点

Application value and anatomical key points of single hole laparoscopic high ligation of hernia sac with large round needle in the treatment of giant inguinal hernia in children

目的探讨使用大圆针行单孔腹腔镜疝囊高位结扎术在治疗儿童巨大腹股沟疝的临床效果及该方法的安全性和优势。方法回顾分析广州市番禺区何贤纪念医院2017年1月至2023年6月使用大圆针行单孔腹腔镜疝囊高位结扎术治疗巨大腹股沟疝患儿191例,所有病例均采用单孔腹腔镜下大圆针体外一次缝合加筋膜闭合器二次缝合手术,即经脐部设置5 mm腹腔镜监视下,在内环口投射体外位置使用普通开放手术针持夹持大圆针,由体外刺入潜行于腹膜外,以外科缝合的方式缝合内环口下半周径,然后使用筋膜闭合器穿刺缝合上半周径,使缝线在内环口腹膜外形成完整线环高位结扎疝囊,以关闭疝环口。结果191例患儿均在单孔腹腔镜下成功施行疝囊高位结扎,无中转开放手术。其中术前诊断右侧95例,左侧50例,双侧46例,术中发现对侧隐匿性疝56例。单侧平均手术时问18 min(10~35 min),双侧疝平均手术时间25 min(18~45 min)。平均住院时间16 h。术中精索血管损伤至腹膜外血肿2例,术后随访时间1-15个月,复发1例。结论使用大圆针行单孔腹腔镜疝囊高位结扎术在治疗儿童巨大腹股沟疝安全有效,更加贴合外科医生的缝合操作习惯,减少手术并发症,且取材简单、便宜,值得临床上推广。

Objective To investigate the clinical effect,safety and advantage of single hole laparoscopic high ligation of hernia sac with large round needle in the treatment of giant inguinal hernia in children.Methods A retrospective analysis was conducted on 191 children with giant inguinal hernia treated by single-aperture laparoscopic high ligation of hernia sac with large circular needle in He Xian Memorial Affiliated Hospital of Southern Medical University from January 2017 to June 2023.All cases were treated by single-aperture laparoscopic suture with large circular needle and secondary suture with fascia closure device,that was 5mm laparoscopic monitoring through the umbilical cord.An ordinary open surgical needle was used to hold a large circular needle in the external projection position of the inner ring opening,and then a surgical suture was used to suture the lower half circumference of the inner ring opening,and the upper half circumference of the inner ring opening was then used to puncture the suture line to form a complete wire ring outside the peritoneum and ligated the hernia sac at a high level,so as to achieve the purpose of closing the hernia ring opening.Results High ligation of hernia sac was performed successfully in 191 children under single-hole laparoscopy,and no case needed to be transferred to open operation.Among them,95 cases of right side,50 cases of left side and 46 cases of bilateral were diagnosed before surgery,and 56 cases of contralateral occult hernia were found during operation.The mean operation time of unilateral hernia was 18min(10-35min),and that of bilateral hernia was 25min(18-45min).The average length of stay was 16h.Intraoperative spermatic vascular injury resulted in 2 cases of extraperitoneal hematoma,one recrudescence was found during the postoperative follow-up time in 1-15 months.Conclusions Singlehole laparoscopic high ligation of hernia sac with large round needle is safe and effective in the treatment of giant inguinal hernia in children.The curved structure of the large round needle is more suitable for the suture operation habits of surgeons,can reduce the surgical complications,and the materials are simple and cheap,which is worthy of clinical application.