腹腔镜辅助经皮腹膜外鞘状突缝合环扎治疗小儿鞘膜积液

目的探讨腹腔镜辅助带线针经皮腹膜外鞘状突缝合环扎治疗小儿鞘膜积液的效果。方法回顾分析2008年7月至2009年4月21例鞘膜积液患儿采用腹腔镜治疗资料，年龄中位数2岁（1岁-6岁），术前诊断左侧7例，右侧10例，双侧4例。腹腔镜直视下用5ml注射器将生理盐水注射于内环口后壁腹膜外，水压分离腹膜与输精管、精索血管间隙，2-0不吸收带线针穿刺入腹腔，缝合环扎鞘状突，打结于腹膜外皮下。结果手术时间平均25min（15～60min），无腹内脏器损伤、阴囊血肿、伤口感染等。手术前后血红蛋白、血碳酸氢根比较差异均无统计学意义（P〉0．05）。6例（28．6％）术前诊断为单侧者在术中确诊对侧存在开放鞘状突，同法处理。术后住院时间1d-5d（平均2d）。随访1个月～10个月，无复发、切口疝及睾丸萎缩等发生。结论腹腔镜小儿鞘膜积液腹膜外缝合环扎可行、微创、安全、美容效果好。

Percutaneous extraperitoneal repair processus vaginalis to treat pediatric hydrocele by laparoseopic suturing ligation

Objective To investigate the result of percutaneous extraperitoneal repair by laparoseopic suturing ligation in treatment of pediatric hydrocele. Methoda The 21 boys with hydroeele who underwent laparoseopic repair between July 2008 and April 2009 were enrolled the study retrospectively. Their mean age was 2 year-old （range,12 months to 6 years）,and 7 left, 10 right, 4 bilateral were found before operation. With saline injection administered extraperitoneally under laparoscopy by 5ml syringe in order to apart from the testicular vessel and vas, 2-nonabsorbable needle inducted direct through the anterior abdominal wall and sutured the processus vaginalis circling, to tie a knob extraperitoneal. Resuhs The mean operative time was 25 minutes（range,15-60 min）,with no internal organs injuries, scrotal hematoma, wound infection. There were no significantly difference in hemoglobin and HCO3- in blood before and after operation （P〉0.05）. 6 patients （28.6%）have contralateral open processus vaginalis. The mean hospitalization time was 2 days （range, 1-5days）. In more than 6-month follow-up, there was no recurrence, incision hernia and testis atrophy were found. Conclusions Percutaneous extraperitoneal repair processus vaginalis to treat pediatric hydrocele by laparoscopic suturing ligation is feasible, safe, minimally invasive,and improved cosmesis.