腹腔镜经腹膜前无张力疝修补术(TAPP)治疗小儿巨大腹股沟疝

目的探讨腹腔镜经腹腔腹膜前疝修补术(transabdominal preperitoneal herniorrhaphy,TAPP)治疗小儿巨大腹股沟斜疝的临床疗效。方法 2008年10月～2011年1月,对24例3～14岁(平均6.6岁)患儿阴囊包块直径≥6 cm,内环直径≥2 cm的巨大腹股沟斜疝行TAPP术。经脐及稍下两侧腹直肌外缘置入5 mm trocar,在内环外上缘剪开壁腹膜,游离疝囊,将补片覆盖整个缺损,用3-0可吸收线缝合补片边缘在腹直肌、耻骨梳韧带及联合腱上,4-0可吸收线缝合腹膜。结果 24例腹腔镜手术均成功,手术时间50～110 min,平均70 min。术后住院2～4 d,无并发症。随访7～24个月,平均9个月,其中6例>12个月,无复发。结论对小儿巨大腹股沟斜疝行TAPP腹腔镜无张力疝修补术是安全有效的。

Transabdominal Preperitoneal Herniorrhaphy for Pediatric Huge Indirect Inguinal Hernia

Objective To discuss the clinical effect of transabdominal preperitoneal herniorrhaphy(TAPP) in the treatment of pediatric huge indirect inguinal hernia.Methods A total of 24 children with scrotal mass(≥ 6 cm in diameter and ≥2 cm in the diameter of the inner ring) received surgery in our hospital from October 2008 to January 2011.With three trocars that were introduced into the abdomen at the umbilicus and both outer edges of rectus abdominis,we opened the parietal peritoneum above the inner ring.After dissecting the hernial sac,a patch overlying the defect was sutured with the rectus abdominis,pectineal ligament and the conjoined tendon by a 3-0# absorbable suture.And then we closed the peritoneum with a 4-0# absorbable suture.ResultsThe procedure was completed in all the 24 patients in a mean of 70 min(ranged from 50 to 110).The patients were discharged from hospital in 2 to 4 days after the procedure without any complications.We followed up the patients for 7 to 24 months with a mean of 9 months(>12 months in 6 cases),during which no recurrence was detected.Conclusion TAPP is a safe and reliable tension-free approach for pediatric huge indirect inguinal hernia.