微型腹腔镜下内环高位结扎联合包皮环套术治疗小儿腹股沟斜疝及包.docVIP

微型腹腔镜下内环高位结扎联合包皮环套术治疗小儿腹股沟斜疝及包 　 作者：司徒升，余健雄，周沛华，方万强 【摘要】 目的：探讨微型腹腔镜下内环高位结扎联合包皮环套术治疗小儿腹股沟斜疝及包茎的可行性与优点。方法：对9例斜疝患儿先行微型腹腔镜下内环高位结扎术,随后对有包茎的患儿行包皮环套术。结果：患儿均顺利完成腹腔镜下内环高位结扎术和包皮环套术。术后恢复顺利,随访1~9个月，斜疝无复发。结论：微型腹腔镜下内环高位结扎术治疗小儿腹股沟斜疝较传统手术具有创伤小、美观、操作简便、手术时间短、并发症少、术后康复快等优点,联合包皮环套术术后容易清洗、护理，避免了二次手术和麻醉,减少了患儿的痛苦及治疗费用，是安全可行的。 　　【关键词】 腹腔镜术；疝，腹股沟；包茎；儿童 　　Microlaparoscopic high ligation of hernial sac combined with circumcision using circumcision rings in the treatment of indirect inguinal hernia and phimosis in children 　　【Abstract】 Ｏbjective:To explore the feasibility and advantages of microlaparoscopic high ligation of hernial sac combined with circumcision using circumcision rings in the treatment of indirect inguinal hernia and phimosis in children.Methods:Nine cases with indirect inguinal hernia underwent microlaparoscopic high ligation of hernial sac and then had prepuce removed using circumcision rings.Results:All the operations were completed successfully.No recurrence was found during the followup period of 19 months.Conclusions:Microlaparoscopic hernia sac high ligation for indirect inguinal hernia has the advantages of minor damage,shorter operation time,less complication,quicker recovery,more beautiful and simple than traditionary operation.To combine circumcision using circumcision rings is safe and feasible,and reduces the pain and costs of the patient. 　　【Key words】 Laparoscopy;Hernia,inguinal;Phimosis;Child 小儿腹股沟斜疝是常见的小儿疾病,包茎更是多见。我们自2005年10月开始尝试用微型腹腔镜下内环高位结扎与包皮环套术联合手术治疗,取得了良好的效果,现报道如下。 　　1 资料与方法 　　1.1 临床资料 本组９例，1~7岁,左侧斜疝3例,右侧6例。其中复发疝１例,巨大疝1例,术中发现对侧隐性疝2例,均有包茎,4例包皮下积存包皮垢。 　　1.2 手术方法 　　1.2.1 腹腔镜器械 5mm微型腹腔镜,3mm操作钳,雪橇型带线针及钩针［１］。 　　1.2.2 操作 (1)麻醉:氯胺酮加静脉复合麻醉；(2)体位:头低脚高位20°~30°；（３）取脐缘处切口5mm，穿刺ＣＯ２气腹,压力8~9mm Hg,穿入5mm Trocar,进腹腔镜,在脐旁腹直肌外侧缘作３mm切口,穿刺3mm Trocar,进操作钳,另一针孔位于患侧内环口体表投影处,直径15mm。腹腔镜下找到患侧内环口,带线针和针钩先后在针孔处穿入与操作钳配合,分别缝合内环口内外半周腹膜,缝合时两针在腹膜下潜行,避开精索血管及输精管。带线针穿7号丝线缝合内侧后,退出带线针,把缝线留在腹腔内,针钩从同一针孔刺入内环口外侧腹膜下用钩将线从腹腔带出,使疝环口成荷包缝合,皮下打结关闭内环口,解除气腹完成手术。 　　1.2.3 包皮环套术 分别选用直径为13cm、15cm及17cm由硬塑料制成的包