摘要
目的探讨腹腔镜小儿腹股沟斜疝内环缝合联合疝囊高位结扎术的可行性。方法2003年1月-2004年12月，我院采用腹腔镜小儿腹股沟斜疝内环缝合联合疝囊高位结扎术治疗小儿腹股沟斜疝21例。经脐置入5inm30。腹腔镜，明确患侧内环口及腹横筋膜悬韧带后脚（posterior crus，PC），在耻骨联合与脐孔的中点置入3mm分离钳。于患侧内环口的体表投影处，用普通针持夹持3-0 prolene带线圆针刺入腹腔，穿过PC，分离钳夹住圆针反向经腹横肌弓状缘从内环口顶部穿出腹腔。剪掉圆针，Endoclose针夹带prolene线由内环口的体表投影处穿入腹壁至腹膜外层，先内后外，围绕内环口在腹膜外完成荷包缝合，线拉出体外后打结。结果21例均顺利完成手术。手术时间16—50min，平均32．9min。术后住院1—2d，术后恢复日常活动时间1—4d，平均1．4d。术后无出血、阴囊血肿及切口感染并发症。21例随访1—24个月，平均15个月，未见复发病例。结论腹腔镜小儿腹股沟斜疝内环缝合联合疝囊高位结扎术是具有解剖学基础的新术式，疗效确切，安全可行。
Objective To discuss the feasibility of laparoscopic closure of the iuternal ring and high ligation of the hernial sac in children with indirect inguinal hernia. Methods Laparoscopic closure of the internal ring and high ligatiou of the hernial sac was conducted in 21 children with indirect inguinal from January 2003 to December 2004 in this hospital. A 5-mm 30° laparoscope was introduced through the umbilicus. The internal ring and the posterior crus （PC） on the side of hernia were identified. A 3-mm dissection forceps was placed on the midline between the umbilicus and pubic symphysis. At the skin projection of the internal ring on the side of hernia, a round-tip needle with 3-0 Prolene suture grasped by a regular needle holder was passed directly into the abdominal cavity to suture the posterior crus and then penetrate out of the abdomen via the roof of the internal ring through the musculoaponeurotic arch of the transversus abdominis. Then the Prolene suture was cut off, and passed by using the Endoclose device into the extraperitoneal cavity at the skin projection of the internal ring. The dissection was continued from without outward around the sac to encircle the neck and an extracorporeal high circumferential ligation of the sac was finished. Results The operation was successfully completed in all the 21 cases. The operating time was 16 - 50 rain （mean, 32.9 rain） , the postoperative duration in hospital was 1 - 2 d, and the time to normal activity, 1 - 4 d （mean, 1.4 d）, respectively. No postoperative bleeding, hematoma of scrotum, or incisional infection occurred. Follow-up checkups in the 21 cases for 1 - 24 months （mean, 15 mouths） showed no recurrence. Conclusions Laparoscopic closure of the internal ring and high ligation of the hernial sac is a novel, feasible, reliable and effective herniorrhaphy for the treatment of pediatric indirect inguinal hernia.
出处
《中国微创外科杂志》
CSCD
2006年第2期139-141,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
小儿
腹股沟斜疝
腹腔镜疝修补术
内环
Child
Indirect inguinal hernia
Laparoscopic herniorrhaphy
Internal ring
