腹腔镜下小儿腹股沟斜疝疝囊高位结扎32例报告.DOCVIP

临床医学论文-腹腔镜下小儿腹股沟斜疝疝囊高位结扎32例报告 ??????? 作者：李平，周旭坤，李忠，罗毅，江涛，刘顺顺，吴梅清，李栋 【摘要】? 目的：探讨腹腔镜治疗小儿腹股沟斜疝的临床应用价值。方法：回顾分析行腹腔镜小儿腹股沟斜疝疝囊高位结扎32例的临床资料。结果：32例手术均获成功。平均手术时间单侧10min，双侧18min，术后住院1d，无并发症。随访2~18个月，无1例复发。结论：腹腔镜治疗小儿腹股沟斜疝安全可行，患儿创伤小，并发症少，康复快，复发率低。 　　【关键词】? 疝，腹股沟；儿童;腹腔镜 　　Indirect inguinal hernia treated with laparoscopic high ligation of hernial sac in child patients:with a report of 32 cases 　　【Abstract】? Ｏbjective:To explore the clinical value of treating child indirect inguinal hernia with laparoscopy.Methods:The clinical data of 32 cases were analyzed retrospectively,28 cases had unilateral indirect inguinal hernia,and 4 cases had bilateral indirect inguinal hernia.3 cases were relapsing indirect inguinal hernia after operation,They consisted 29 males and 3 females.Results:The operation was successful in all of the 32 cases.The mean operation time?was 10 min in unilateral indirect inguinal hernia,18 min in bilateral indirect inguinal hernia.and the hospitalization after operation was one day.No complication occured in these cases.No recurrence was found at a followup of 218 months.Conclusions:The treatment of child indirect inguinal hernia with laparoscopy is safe and feasible.It has the advantages of little injury,quick recover and low recurrence rate. 　　【Key words】? Hernia,inguinal;Child；Laparoscopy ??? 经腹股沟切口行疝囊高位结扎是治疗小儿腹股沟疝的传统方法。随着腹腔镜技术的发展及微创概念的普及，腹腔镜技术已用于小儿斜疝的治疗［1，2］。2004年1月至2005年8月我院行腹腔镜两孔操作法完成小儿腹股沟斜疝内环口疝囊高位结扎术32例，效果可靠。现报道如下。 　　1? 资料与方法 　　11? 临床资料? 本组32例中男29例，女3例，1.3~15岁，其中单侧腹股沟斜疝28例，双侧4例，常规手术后复发性斜疝3例。 　　1.2? 手术方法? 采用气管插管全麻。患儿取仰卧位，头低足高20°，健侧倾斜20°。脐下缘戳孔5mm置入腹腔镜作为观察孔，脐右侧3cm作5mm戳孔，作为操作孔，气腹压力为8mm Hg。镜下清晰可见斜疝内环口及环旁腹膜下精索、输精管，内镜光源照射下可见腹壁下动脉血管走行。于内环口体表投影处外上缘约3cm处自腹壁穿入带针缝线，尾线一端留于体外。持针器自操作孔置入腹腔，持针沿内环口腹膜下潜行一周缝合，腹腔内结扎，助手协助挤压阴囊及腹股沟管，将疝囊内CO2气体排出，并拉紧尾线，收紧疝环荷包，重新打3~4结，剪线，缝针自腹壁穿出，排尽腹腔积气，结束手术。 　　2? 结果 　　本组32例36侧疝囊高位结扎，手术时间单侧5~15min，平均10min,双侧12~30min,平均18min。术后第2天出院，切口瘢痕轻微，无并发症，全组随访2~18个月，无1例复发。 　　３? 讨论 　　３１? 腹腔镜下小儿腹股沟的解剖观察? 腹腔镜下腹股沟斜疝内环口清晰可见，呈椭圆形开口，似洞穴状深入到阴囊，斜疝内环口下方透过腹膜可见位于腹膜下的白色输精管，进