CAJ | 학술논문

目的：总结并分析单孔腹腔镜和雪橇针治疗小儿腹股沟斜疝的手术经验与处理技巧，探讨适宜的处理方法或原则。方法2010年10月至2013年10月，山东省泰安市中心医院收治637例小儿腹股沟斜疝，均接受腹腔镜经皮穿刺腹膜外结扎术（LPEC）手术治疗，术中执行单孔腹腔镜、腹壁单次穿刺和全腹膜外结扎等技术规范。回顾性分析术中遭遇到的不良因素、手术过程、处理方法及术后随访。结果术后随访2～38个月，本组完成腹腔镜经皮穿刺腹膜外结扎术634例，其他3例患者中转为传统小切口手术。手术时间（24．5±8．2）min，术中出血（1．5±0．5）ml，术中在其他部位增加操作通道和器械4例。本组患者遭遇输精管显示不清、腹膜褶皱遮挡、瓣膜状皱襞、腹膜明显撕裂、巨大疝、膀胱充盈或乙状结肠充盈、大网膜疝入并与疝囊粘连、腹膜外气肿、嵌顿疝、合并其他疾病、特殊部位出血、断线脱线、内脏下滑靠近内环口等情况。结论严格遵守操作规范，单孔腹腔镜经皮穿刺腹膜外结扎术能够胜任绝大数儿童腹股沟疝手术，但可能遭遇多种不良因素，恰当处理可以减少意外损伤和术后并发症的发生。
목적：총결병분석단공복강경화설취침치료소인복고구사산적수술경험여처리기교，탐토괄의적처리방법혹원칙。방법2010년10월지2013년10월，산동성태안시중심의원수치637례소인복고구사산，균접수복강경경피천자복막외결찰술（LPEC）수술치료，술중집행단공복강경、복벽단차천자화전복막외결찰등기술규범。회고성분석술중조우도적불량인소、수술과정、처리방법급술후수방。결과술후수방2～38개월，본조완성복강경경피천자복막외결찰술634례，기타3례환자중전위전통소절구수술。수술시간（24．5±8．2）min，술중출혈（1．5±0．5）ml，술중재기타부위증가조작통도화기계4례。본조환자조우수정관현시불청、복막습추차당、판막상추벽、복막명현시렬、거대산、방광충영혹을상결장충영、대망막산입병여산낭점련、복막외기종、감돈산、합병기타질병、특수부위출혈、단선탈선、내장하활고근내배구등정황。결론엄격준수조작규범，단공복강경경피천자복막외결찰술능구성임절대수인동복고구산수술，단가능조우다충불량인소，흡당처리가이감소의외손상화술후병발증적발생。
Objective To summarize and analyze the adverse factors affecting laparoscopic percutaneous extraperitoneal closure(LPEC)for pediatric inguinal hernia(PIH),and to explore the proper treatment or measures.Methods 637 children with PIH underwent transumbilical LPEC between October 201 0 and October 201 3.The retrospective analysis was conducted to evaluated the adverse factors,operation process,management and outcome of follow-up.Results 634 LPEC were completed,but the other 3 were converted to conventional surgery.The mean operating time was (24.5 ±8.2)minutes.There were no recurrences.A good number of adverse factors were encountered during the procedures and solved properly, including unclear visualization of vas deferens,radial peritoneum fold,vertical peritoneum fold,huge hernias, full bladders,full colons,hernias with comorbidity,tear of peritoneum,epiploon adhesion to the sac,blood loss in special place,irreducible incarcerated hernia,fracture or loss of the sutures,suspected sliding hernias, etc.Conclusions Transumbilical LPEC would be adequate to most PIH,but it may encounter various adverse factors,which should be solved with appropriate techniques and principles.