注水分离腹膜与输精管及睾丸血管法在腹腔镜小儿疝手术中的应用

随着微创概念的普及,腹腔镜技术也应用于小儿疝的治疗[1,2]。但腹腔镜小儿疝手术中很容易误结扎到输精管及睾丸血管。我们应用注水分离腹膜与输精管及睾丸血管法在腹腔镜下行疝囊高位结扎手术100例,避免误扎输精管及睾丸血管,现报道如下。     

单孔腹腔镜疝高位结扎术在小儿隐匿疝治疗中的意义

【摘要】 目的〓评价单孔腹腔镜在小儿隐匿疝诊断及治疗中的价值。方法〓收集我院2008~2012收治的小儿腹股沟斜疝高位结扎术病例1864例,隐匿疝病例534例(28.6%),隐匿疝病例中采用单孔腹腔镜手术436例(腔镜组),传统开放手术98例(传统组)。通过隐匿疝的发现率,治疗总费用、住院天数及手术并发症统计和分析,评估腹腔镜诊治小儿隐匿疝的优势。结果〓单孔腹腔镜手术组与传统开放手术组在小儿隐匿疝发现率、治疗总费用、住院天数和手术并发症等方面的比较有显著性差异(P<0.05)。结论〓单孔腹腔镜行小儿疝高位结扎术不但能同时发现术前漏诊的对侧隐匿疝,并可同时手术治疗,避免了患儿再次手术的痛苦,减少了经济负担,具有传统开放手术不可比拟的优点。     

美容缝合法在小儿疝手术中的应用

目的:探讨美容缝合法在小儿疝手术中的应用及其效果。方法:随机选择32例小儿疝手术作为治疗组,另外选择30例作为对照组,其中治疗组患儿术中切口采用美容缝合法,对照组采用传统方法缝合,术后半年对患儿进行随访,并对术后切口愈合情况进行评估,作统计学分析。结果:62例患儿切口均为Ⅰ期愈合。治疗组30例(93.75%)患儿切口愈合为线状,瘢痕不明显,患儿家长对切口愈合情况十分满意,2例(6.25%)切口稍有瘢痕增生,与手术后切口受到污染有关,患儿家长对切口不满意。对照组患儿切口20例(66.67%)有切口缝线痕迹,切口有部分瘢痕增生8例(26.67%),家长对切口愈合情况不太满意,另2例(6.67%)切口愈合良好,家长对切口十分满意。两组比较有显著统计学差异。结论:小儿疝手术中应用整形美容法缝合切口,术后切口愈合理想,患儿家长满意度高,切口愈合后无缝线瘢痕。美容缝合法缝合小儿疝切口值得推广应用。     

腹腔镜手术治疗小儿腹股沟斜疝的价值

探讨腹腔镜手术治疗小儿腹股沟斜疝的手术方法及临床效果。选取2013年11月—2016年5月手术治疗的600例腹股沟斜疝患儿进行回顾性分析,其中300例采取腹腔镜手术治疗(腹腔镜组)、300例采取传统手术治疗(传统组),对比两组患儿的围手术期指标、手术效果。腹腔镜组的手术时间、手术出血量、术后下床活动时间、术后住院时间均显著低于传统组,差异有统计学意义(P<0.05);腹腔镜组的手术费用高于传统组,差异有统计学意义(P<0.05);两组患儿术前的各项肝功能指标、CRP水平差异均无统计学意义(P>0.05);术后24 h的ALT、AST、TP差异无统计学意义(P>0.05),腹腔镜组TBIL高于传统组(P<0.05),DBIL和CRP水平低于传统组(P<0.05)。腹腔镜手术治疗小儿腹股沟斜疝具有手术创伤小、恢复快、效果可靠的优点,但是手术费用较高,CO2气腹可能导致患儿血清TBIL、DBIL发生短暂性改变。     

小儿腹股沟斜疝腹腔镜手术的护理

选取2017-12—2018-08间在新郑市第二人民医院接受腹股沟斜疝腹腔镜手术的36例患儿。针对其心理、生理特点及腹腔镜手术的特殊性,开展术前心理支持、密切术中医护配合,加强术后疼痛干预等围手术期护理。36例患儿手术过程顺利、术后恢复良好,均痊愈出院。住院时间(4±1.56)d。患儿家属对护理工作总满意率为100.00%。     

腹腔镜在小儿腹股沟嵌顿疝手术中的应用

目的 探讨腹腔镜小儿腹股沟嵌顿疝手术的疗效. 方法 应用腹腔镜疝修补术治疗小儿腹股沟嵌顿疝32例（右侧20例,左侧12例）,经脐置入5 mm 30°腹腔镜,探查肠管有无坏死,对侧有无隐匿性疝,在耻骨联合与脐孔的中点置入5 mm分离钳,在患侧内环口体表投影点,用Endoclose针夹带7号丝线穿入腹壁至腹膜外层,围绕内环口在腹膜外完成荷包缝合,线拉出体外打结.若内环口直径≥1.5 cm,行疝内环缝合联合疝囊高位结扎术. 结果 32例均顺利完成手术,手术时间15～40 min,平均26 min.术后住院1～3 d,平均2.2 d.术后无并发症.32例随访4～28个月,平均21个月,无复发.结论 腹腔镜下修补小儿腹股沟嵌顿疝,疗效确切,安全可行.     

二孔法腹腔镜与开腹手术治疗小儿腹股沟斜疝的比较

目的比较腹腔镜与开腹手术治疗小儿腹股沟斜疝的疗效。方法2001年4月~2006年1月,我们采用微型腹腔镜二孔法治疗小儿腹股沟斜疝410例(腹腔镜组),并与2004年9月~2006年1月408例开腹疝囊高位结扎术(开腹组)进行疗效比较。腹腔镜组脐窝置入1个5 mm trocar,探查双侧内环口,在患侧相当于麦氏点的稍上方置入另1个5 mmtrocar并导入持针器,在疝囊颈外上方穿入一带线缝针,术者单手持针,在疝囊入口水平腹膜下缝合鞘突入口一周,收紧缝线,结扎鞘突。开腹组经腹股沟外环处横切口行疝囊高位结扎术。结果腹腔镜组手术顺利,单侧手术时间(33.4±9.6 m in)显著少于开腹组(38.0±7.6 m in)(t=-7.596,P=0.000)。腹腔镜组无阴囊水肿、切口下积血积液、感染等并发症,平均随访23.2月(1~55个月),早期3例复发,再次腹腔镜手术修补成功,其余无睾丸萎缩、医源性隐睾及肠粘连等远期并发症。开腹组平均随访10个月(1~18个月),18例复发,8例经腹腔镜、10例经开腹手术治愈;医源性阴睾9例,再次开腹手术治愈。结论二孔法腹腔镜手术治疗小儿腹股沟斜疝较开腹手术恢复快,创伤小,无须伤口拆线,同时可用于处理腹股沟隐性疝和双侧腹股沟疝,不适用于心功能不全及新生儿嵌顿疝。     

腹腔镜手术治疗小儿腹股沟斜疝138例

目的探讨腹腔镜手术应用于小儿腹股沟斜疝的临床效果及其价值。方法回顾性分析2009年1月至2011年1月经腹腔镜手术治疗小儿腹股沟斜疝的138例患儿的临床资料,其中男131例,女7例,平均年龄（4．9±0．2）岁。单侧腹股沟斜疝114例,双侧腹股沟斜疝24例;术中发现对侧隐匿疝8例,对侧鞘状突未闭6例。全部患儿均采用腹腔镜手术治疗,均经过术后随访5—8个月,复发患儿再行腹腔镜手术。结果全部患儿均顺利完成手术,手术时间平均21min,住院时间3～5d。随访结果发现术后1个月2例出现复发,再次腹腔镜手术后治愈。结论经腹腔镜下手术治疗小儿膀股沟斜疝是一种专伞有效的手术方式,具有手术时间锕、创伤小、恢每懊的优点。     

微型腹腔镜下小儿斜疝手术的改进

目的 探讨微型腹腔镜下治疗小儿斜疝的新方法。方法 1998年3月至2000年12月应用微型腹腔镜和操作钳配合自行设计和改进的针型器械,运用自行设计的提插式的缝合方法荷包缝扎内环口周边腹膜治疗小儿斜疝600例,年龄从8个月～12岁。结果 手术时间5～8分钟,恢复快、住院时间4～5天,皮肤无需缝线、术后无疤痕,600例复发5例。结论 腹腔镜荷包缝扎内环口周边腹膜治疗小儿斜疝,其手术原理可靠,切口小、损伤小、操作简便快捷。     

A simple single-port laparoscopic-assisted technique for completely enclosing inguinal hernia in children

Single-port endoscopic-assisted percutaneous extraperitoneal closure of inguinal hernia with variable devices is a novel technique in minimal-access surgery for pediatric inguinal hernias. However, a small peritoneal gap of the suture at the location of spermatic vessels and vas deferens may be left untouched, whereas some subcutaneous tissues, including nerves and muscles, may cause injury by their inclusion in the upper portion of the circuit suturing. The technique may fail to entirely enclose the hernia defect and has the potential to lead to higher incidence of hydrocele and hernia recurrence. The authors describe the modification of single-port endoscopic-assisted ligation with a homemade hooked injection needle, which is designed to cause hydrodissection to the preperitoneal space, tautly enclose the hernia defect without upper subcutaneous tissues and a lower peritoneal gap, and aid in the achievement of a near-zero recurrence rate.     

改良单孔法微型腹腔镜治疗小儿斜疝的临床分析

【摘要】〓目的〓总结改良单孔法微型腹腔镜小儿腹股沟斜疝疝囊高位结扎术的手术方法、疗效及优缺点。方法〓回顾性分析2011年6月至2014年6月100例腹股沟斜疝患儿行改良单孔法腹腔镜疝囊高位结扎术的临床资料。其中单侧斜疝95例,双侧斜疝5例。手术特点主要通过一个改良的腹壁穿刺针进行穿刺、疝囊高位结扎,完成手术。结果〓100例手术均获成功,平均手术时间单侧疝10~35 min,双侧疝25~45 min,术后平均1~2 d出院,无明显并发症和复发病例。结论〓改良单孔法腹腔镜小儿腹股沟斜疝疝囊高位结扎术安全,有效,并发症少,可同期处理对侧隐匿性腹股沟斜疝。     

一孔法腹腔镜小儿腹股沟斜疝高位结扎术

目的探讨腹腔镜治疗小儿腹股沟斜疝新方法. 方法采用一孔法腹腔镜手术治疗小儿腹股沟斜疝48例,右侧31例,左侧13例,双侧4例,单侧斜疝中5例对侧存在隐性疝,均在腹腔镜下行内环口高位缝扎术. 结果手术时间7～14 min,平均9 min,术后平均住院24 h,皮肤无须缝线.随访3～15个月,平均9.5个月,未见复发. 结论一孔法腹腔镜下内环口高位缝扎术效果好,损伤轻,操作简便.     

单孔腹腔镜治疗小儿腹股沟疝术式改进

目的 改进腹腔镜手术治疗小儿腹股沟疝方式。方法 采用单孔腹腔镜手术治疗小儿腹股沟疝40例,右24例侧,左侧12例,双侧4例,单侧疝中3例有隐性疝。均在腹腔镜下行疝内口缝扎术。结果 手术时间10—30min,平均18min。术中和术后均未发生并发症。本组全部随访4—26个月无复发。结论本法创伤小、恢复快、不需伤口拆线。可同期处理腹股沟隐性疝和双侧腹股沟疝。     

Laparoscopic inguinal hernia repair in children.

BACKGROUND: This study aimed to document the authors' experience with laparoscopic inguinal hernia repair in children. METHODS: Ninety-three hernia repairs were performed in 64 children. The neck was closed with a purse string suture by using 4-0 absorbable suture. RESULTS: Ninety-three indirect inguinal hernial sacs were closed in 64 children. Nine percent of children had an ectopic testis. The mean operating time for laparoscopic ring closure was 25 minutes (range, unilateral 21 to 35; bilateral, 28 to 50). The contralateral processus vaginalis was patent in 20% of children. In 24% of children, the final procedure was modified based on the findings of a dilated internal ring. A laparoscopic ilio-pubic tract repair was done in these cases. Laparoscopic mobilization, orchiopexy followed by ilio-pubic tract repair was done in 9% of children. Scrotal swelling occurred in one child. Hydrocoele occurred in one patient. Recurrence rate was 3.1%. CONCLUSION: Laparoscopic inguinal hernia repair in children can be offered, as it is safe, reproducible, and technically easy for experienced laparoscopic surgeons. Ilio-pubic tract repair may be added in cases with dilated internal ring. Recurrence following laparoscopic ring closure can be managed with laparoscopic ilio-pubic tract repair. The long-term follow-up of laparoscopic ilio-pubic tract repair is awaited.     

Laparoscopic flip-flap technique versus conventional inguinal hernia repair in children.

BACKGROUND AND OBJECTIVES: Inguinal hernia repair is one of the most frequently performed pediatric surgical operations. Several pediatric laparoscopic inguinal hernia repair techniques have been introduced. But debate is unresolved regarding the feasibility of laparoscopy for treating pediatric inguinal hernias. METHODS: A retrospective cohort study enrolled 33 patients who underwent congenital inguinal hernia repair by either the new laparoscopic flip-flap technique or conventional open repair. Patients were divided into 2 groups according to the type of surgery: Group A included those who underwent the new laparoscopic technique, and Group B included those who underwent conventional open repair. RESULTS: Group A comprised 15 patients (mean age, 39 months), and group B comprised 18 (mean age, 44 months). Mean operative time was 47.5 minutes for Group A versus 27.5 minutes for Group B. Intraoperative complications for Group A included 1 case (7%) of vas deferens injury, and 3 cases (20%) in which the flaps were torn during suturing. In Group B, no intraoperative complications were encountered. In both groups, the mean postoperative hospital stay was 5.5 hours. Postoperative follow-up of 3 months revealed recurrence in 4 patients in Group A (27%), while there were no recurrences in Group B. CONCLUSION: Our preliminary experience shows unsatisfactory outcomes with laparoscopic flip-flap hernia repair in children. In spite of advancement in the application of laparoscopy in pediatric surgery, conventional open hernia repair is still the gold standard for children, in our experience. Future studies with more numbers and longterm follow-up should be conducted.     

Transumbilical endoscopic surgery for completely enclosing inguinal hernias in children

Background/Purpose

There has been great interest in natural orifice transluminal endoscopic surgery in recent years. We report another new approach for pediatric inguinal hernia repair: transumbilical endoscopic surgery (TUES). Compared with the natural orifice transluminal endoscopic surgery technique, TUES can obtain similar scarless results on the abdomen.

Methods

In our hospital, 2-trocar TUES was the standard procedure used to repair pediatric inguinal hernias. Through 2 intraumbilical incisions, two 5-mm trocars were inserted into the abdomen under laparoscopic guidance. With the use of a needle-holding forceps, a round needle with 2-0 nonabsorbable suture material was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The orifice of the hernial sac was closed extraperitoneally with a purse-string suture around the internal inguinal ring, and intraperitoneal knot-tying was performed.

Results

A total of 76 inguinal repairs were performed in 64 children (age range, 6 months to 9 years; median, 3.8 years; 44 boys, 20 girls). All operations were completed successfully by TUES, with the exception of one case of intraoperative bleeding because the inferior epigastric vein was punctured. The mean operating time was 20 minutes (range, 15-30 minutes). No postoperative bleeding, hydrocele, or scrotal edema in this group of patients was found, and there were no known cases of postoperative testicular atrophy or hypotrophy nor hernia recurrence on the symptomatic side.

Conclusions

Our preliminary experience shows satisfactory outcomes with TUES for completely enclosing inguinal hernias in children. This technique appears to be safe, effective, and reliable. The cosmetic result is excellent.     

一孔法腹腔镜小儿腹股沟斜疝高位结扎术的临床应用

目的探讨腹腔镜治疗小儿腹股沟斜疝新方法。方法采用一孔法腹腔镜手术治疗小儿腹股沟斜疝102例,其中右侧70例,左侧20例,双侧12例。单侧斜疝中有9例存在对侧隐性疝,均在腹腔镜下行内环口高位缝扎术。结果手术时间单侧疝平均14分钟,双侧疝26分钟。术后平均2天出院。皮肤切口无须缝线。无并发症。病人随访6～26个月,平均15个月,未见复发。结论一孔法腹腔镜下斜疝疝囊内环口高位缝扎术安全有效、创伤小、操作简便。     

Meta-analysis of laparoscopic inguinal hernia trials favors open hernia repair with preperitoneal mesh prosthesis

BACKGROUND: This meta-analysis was performed to determine the degree to which improvements in open hernia repair (OHR) in the last decade have altered the relative benefit of laparoscopic hernia repair (LHR). METHODS: Twenty-seven comparative trials including 4,688 randomized patients were evaluated. RESULTS: Within the control OHR, patients with routine mesh repair returned to work earlier than a sutured repair (16.4 versus 27.3 days, P = 0.010). During the study period, the increased use of mesh in OHR (3 of 12 initially versus 9 of 15 subsequent studies) was associated with an earlier return to work (25.9 to 16.8 days, P = 0.017); there was no significant improvement with corresponding LHR. CONCLUSIONS: Although LHR was associated with an earlier return to work compared with conventional sutured OHR, more recent mesh OHRs provide equivalent outcomes but at lower costs and potentially less severe complications, supporting an open technique using preperitoneal mesh prostheses as the optimal hernia repair.     

一孔法腹腔镜手术治疗小儿腹股沟嵌顿疝22例

目的：探讨一孔法腹腔镜手术在治疗小儿腹股沟嵌顿疝中的应用价值。方法 全麻后在腹腔镜辅助下手法复位嵌顿疝,采用一孔法行腹腔镜疝囊高位结扎术。结果 22例小儿嵌顿疝均行一孔法腹腔镜手术完成疝囊高位结扎,无手术并发症发生。18例患儿随访3～ 15个月,平均9.3个月,无复发,4例失访。结论 一孔法腹腔镜手术治疗小儿腹股沟嵌顿...