CAJ | 학술논문

目的探讨采用脐旁微切口及腹腔内打结技术行疝囊高位结扎手术的安全性及手术效果.方法回顾性分析2012年10月至2013年10月,采用脐旁微切口及腹腔内打结技术行腹股沟斜疝手术102例,136侧的临床资料.其中,双侧34例,单纯左侧18例,单纯右侧50例.具体方法如下:经脐5 mm Trocar置镜,脐旁两侧免Trocar置3mm常规操作钳及针持.内环口上外3 cm腹壁外以2-0不可吸收带针缝线自腹壁穿入腹腔,尾线留置在腹壁外侧,环形缝合内环口一周,避开精索及血管.采用腹腔内绕线、腹腔外牵拉尾线辅助打结,腹壁外剪线.皮肤胶粘合伤口.结果单侧病例平均手术时间15.5 min,双侧平均20.2 min.无精索血肿、腹腔脏器损伤、腹壁气肿及手术后阴囊水肿发生.术后第1天自由活动率为93％.随访时间4～17个月,目前无复发病例,无患儿出现腹股沟区异物感或异物反应;术后2个月腹壁基本无可视疤痕.结论免Trocar腹腔镜技术、常规器械腹腔内打结进行疝囊高位结扎治疗小儿腹股沟斜疝,安全有效,对巨大型腹股沟斜疝尤为适用.操作难度同常规三孔腹腔镜技术,腹壁皮肤外观好,与单孔手术类似,无皮下异物感或异物反应.
목적 탐토채용제방미절구급복강내타결기술행산낭고위결찰수술적안전성급수술효과.방법 회고성분석2012년10월지2013년10월,채용제방미절구급복강내타결기술행복고구사산수술102례,136측적림상자료.기중,쌍측34례,단순좌측18례,단순우측50례.구체방법여하:경제5 mm Trocar치경,제방량측면Trocar치3mm상규조작겸급침지.내배구상외3 cm복벽외이2-0불가흡수대침봉선자복벽천입복강,미선류치재복벽외측,배형봉합내배구일주,피개정색급혈관.채용복강내요선、복강외견랍미선보조타결,복벽외전선.피부효점합상구.결과 단측병례평균수술시간15.5 min,쌍측평균20.2 min.무정색혈종、복강장기손상、복벽기종급수술후음낭수종발생.술후제1천자유활동솔위93％.수방시간4～17개월,목전무복발병례,무환인출현복고구구이물감혹이물반응;술후2개월복벽기본무가시파흔.결론 면Trocar복강경기술、상규기계복강내타결진행산낭고위결찰치료소인복고구사산,안전유효,대거대형복고구사산우위괄용.조작난도동상규삼공복강경기술,복벽피부외관호,여단공수술유사,무피하이물감혹이물반응.
Objective To evaluate the feasibility and safety of a novel laparoscopic approach for high ligating inguinal hernias in children using two microincisions besides umbilical and intraperitoneal knot-tying.Methods Between June 2012 and October 2013,a total of 136 inguinal high ligations were performed for 102 children.There were 86 boys and 16 girls with a mean age of 2.4 years (25 days-13.6 years).Their clinical data were retrospectively analyzed.One 5 mm trocar was inserted through umbilicus into abdomen.Forceps and needle holder were punctured into abdomen through two 3 mm incisions at both sides of umbilicus without trocars.2-0 non-absorbable suture was introduced into the peritoneal cavity through anterior abdominal wall near internal inguinal ring.The orifice of hernial sac was closed extraperitoneally with a purse-string suture around internal inguinal ring and intraperitoneal knot-tying performed.Results All operations were completed successfully.The mean operative duration was 15.5 min for unilateral and 20.2 min for bilateral lesions.No postoperative bleeding,abdominal wall emphysema,abdominal viscera injury or scrotal edema was found.And there was no occurrence of postoperative testicular atrophy/hypotrophy or hernia recurrence.And 93％ of them resumed routine activities at Day 1 postoperation.During a mean follow-up period of 9.9 (4-17) months,there was no report of recurrence,visible scar on abdominal wall or foreign body feel of inguinal portion.Conclusions Mini-invasive laparoscopic approach is both safe and efficacious for inguinal hernia in children.The difficulty is the same as tri-port laparoscopic technology.And its cosmetic outcome is similar as the single-port laparoscopy.