CAJ | 학술논문

目的：探讨经脐单一部位腹腔镜下腹膜外缝合治疗小儿腹股沟斜疝的可行性。方法回顾分析1080例腹股沟斜疝行单部位腹腔镜下腹膜外缝合疝囊高位结扎术患儿的临床资料。结果738例入院诊断单侧腹股沟斜疝者，术中发现185例对侧隐匿性斜疝，发现率为25．07％，双侧者342例。2例因患儿肠管胀气，无法暴露内环口，转常规手术，余均在经脐单一部位腹腔镜下完成疝囊高位结扎术。单侧手术时间为8～19 min，平均11．6 min，双侧手术时间为13～31 min，平均18．4 min。术中缝合时损伤精索血管出血者14例，损伤髂血管出血者4例，腹壁下动脉损伤者7例，压迫后均自行止血。脐部渗液者3例。脐部切口裂开者2例，予重新缝合敷贴加压固定后痊愈，线结反应者7例。术后平均住院1．3 d，随访4～16个月，复发6例，复发率为0．55％。结论经脐单一部位腹腔镜下腹膜外缝合治疗小儿斜疝效果确切，且操作容易，符合切开美观的需求，如改良穿刺器械、减少并发症，进一步总结经验，可作临床推广。
목적：탐토경제단일부위복강경하복막외봉합치료소인복고구사산적가행성。방법회고분석1080례복고구사산행단부위복강경하복막외봉합산낭고위결찰술환인적림상자료。결과738례입원진단단측복고구사산자，술중발현185례대측은닉성사산，발현솔위25．07％，쌍측자342례。2례인환인장관창기，무법폭로내배구，전상규수술，여균재경제단일부위복강경하완성산낭고위결찰술。단측수술시간위8～19 min，평균11．6 min，쌍측수술시간위13～31 min，평균18．4 min。술중봉합시손상정색혈관출혈자14례，손상가혈관출혈자4례，복벽하동맥손상자7례，압박후균자행지혈。제부삼액자3례。제부절구렬개자2례，여중신봉합부첩가압고정후전유，선결반응자7례。술후평균주원1．3 d，수방4～16개월，복발6례，복발솔위0．55％。결론경제단일부위복강경하복막외봉합치료소인사산효과학절，차조작용역，부합절개미관적수구，여개량천자기계、감소병발증，진일보총결경험，가작림상추엄。
Objective To evaluate the efficacy of single-incision laparoscopy for extraperitoneal repair of indirect inguinal hernia in children.Methods Clinical data of the 1 080 patients underwent laparoscopic high of hernial sac transfixion in our hospital from February 201 2 to July 201 3 were analyzed retrospectively.Results The operation was successfully completed in all of the cases,among whom 738 ca-ses showed unilateral hernia and 342 cases presented bilateral hernias.Of the unilateral hernia,1 85 cases were occult hernias(25 .07%).In-ner mouth surgery in 2 cases of severe dilatation of intestine converted to open surgery.The operation time ranged from 8 to 1 9 min(mean, 1 1 .6 min)for unilateral procedures,and 1 3 to 31 min(mean,1 8.4min)for bilateral procedures.Thirty-seven cases suffered complications, including spermatic vessels bleeding of 1 4 cases,external iliac vessels bleeding of 4 cases and arteriae epigastrica vessels bleeding of 7 cases, the navel exudation of 3 cases,disruption of navel wound of 2 cases,and the line foreign reaction of 7 cases.The mean postoperative hospital stay was 1 .3 days.Follow-up was achieved for 4 to 1 6 months in this series,and 6 cases(0.55%)had recurrent hernia with a recurrence rate of 0.55%.Conclusion Single-incision laparoscopy for extraperitoneal repair in treatment of children's indirect inguinal hernia is a effective method with simple procedure and it increases patients'satisfaction with their scar results.