腹腔镜手术治疗婴儿肥厚性幽门狭窄合并腹股沟斜疝

目的总结婴儿肥厚性幽门狭窄腹腔镜下幽门环肌切开术,同时探查双侧内环口,若合并腹股沟斜疝则同时行腹腔镜下疝囊高位结扎术的经验。方法腹腔镜下先行幽门环肌切开术,然后腹腔镜转向盆腔探查双侧内环口,若未闭合（直径≥0.3 cm）则行疝囊高位缝扎术。结果86例中合并腹股沟斜疝32例（37.2%）,其中单侧13例,双侧19例。手术时间较单纯行幽门环肌切开术增加5~20 min,平均15 min。均于术后6 h开始喂养,术后2~6 d,平均3.5 d出院。86例术后随访3~24个月,平均13个月,无并发症发生。结论腹腔镜下幽门环肌切开术同时行疝囊高位结扎术避免了二次行嵌顿疝复位或疝囊高位结扎手术的可能性,同时因疝囊小,没有因疝内容反复进出或嵌顿形成的瘢痕而易于操作,较传统手术更不易损伤精索。

Endoscopic Treatment for Infantile Hypertrophic Pyloric Stenosis Complicated with Inguinal Hernia

Objective To summarize our experience on laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis complicated with inguinal hernia.Methods From September 2006 through July 2008,86 patients were enrolled in the study.After laparoscopic pyloromyotomy for pyloric stenosis,additional inguinal exploration was performed and then further operation was done if inaugural hernia was detected.Results Inaugural hernia was diagnosed in 32（37.2%） of the 86 patients,including unilateral lesions in 13（40.6%）,and bilateral in 19（59.4%）.The mean operation time was longer than simple pyloromyotomy by 5-20 min（mean,15 min）.Oral feeding was initiated 6 hours postoperation.The patients were discharged from hospital in 2-6 days（mean,3.5 days） after the surgery.The patients were followed up for 3-24 months（mean,13 months）,during which no technical failures or complications occurred.Conclusions Laparoscopic hernia repair is feasible in infants.Inguinal incarceration is often inaugural in infants to damage to the testicular vessels during a difficult herniotomy.This study shows that it is the ideal time for inguinal hernia correction during pyloromyotomy.