临床小儿外科杂志
臨床小兒外科雜誌
림상소인외과잡지
JOURNAL OF CLINICAL FEDIATRIC SURGERY
2015年
3期
226-228
,共3页
刘洁%段光琦%王啸%唐睿%随帮志
劉潔%段光琦%王嘯%唐睿%隨幫誌
류길%단광기%왕소%당예%수방지
腹腔镜%疝,腹股沟%治疗%儿童
腹腔鏡%疝,腹股溝%治療%兒童
복강경%산,복고구%치료%인동
Laparoscopes%Hernia,Inguinal%Therapy%Child
目的:总结单孔腹腔镜下特制疝针实施小儿腹股沟斜疝手术时遇到的一些实际问题及处理技巧。方法2014年3月至7月,我们收治196例小儿腹股沟斜疝,患儿均接受腹腔镜下特制疝针经皮穿刺腹膜外内环口结扎术。回顾性分析术中遇到的常见问题、解决方法及术后随访情况。结果本组完成腹腔镜经皮穿刺腹膜外结扎术193例,3例中转为传统小切口手术。手术时间5~40 min,平均14.5 min,术中出血1.5 mL,术中在其他部位增加操作通道和器械5例。腹膜皱襞遮挡33例,大网膜疝入并与疝囊粘连2例,腹膜外气肿2例,结扎线缠绕大网膜12例,合并其他疾病1例,断线脱线2例,内脏下滑靠近内环口5例,腹膜撕裂2例,巨大疝3例,阴囊积气1例,穿刺部位小血肿2例,脐疝1例。结论单孔腹腔镜经皮穿刺腹膜外结扎术已成为小儿腹股沟斜疝的首选手术方式,具有创伤小、恢复快、能同时发现对侧隐性疝等多种优点,但在实际操作过程中仍有诸多问题,正确处理可以减少或避免意外损伤及术后并发症的发生。
目的:總結單孔腹腔鏡下特製疝針實施小兒腹股溝斜疝手術時遇到的一些實際問題及處理技巧。方法2014年3月至7月,我們收治196例小兒腹股溝斜疝,患兒均接受腹腔鏡下特製疝針經皮穿刺腹膜外內環口結扎術。迴顧性分析術中遇到的常見問題、解決方法及術後隨訪情況。結果本組完成腹腔鏡經皮穿刺腹膜外結扎術193例,3例中轉為傳統小切口手術。手術時間5~40 min,平均14.5 min,術中齣血1.5 mL,術中在其他部位增加操作通道和器械5例。腹膜皺襞遮擋33例,大網膜疝入併與疝囊粘連2例,腹膜外氣腫2例,結扎線纏繞大網膜12例,閤併其他疾病1例,斷線脫線2例,內髒下滑靠近內環口5例,腹膜撕裂2例,巨大疝3例,陰囊積氣1例,穿刺部位小血腫2例,臍疝1例。結論單孔腹腔鏡經皮穿刺腹膜外結扎術已成為小兒腹股溝斜疝的首選手術方式,具有創傷小、恢複快、能同時髮現對側隱性疝等多種優點,但在實際操作過程中仍有諸多問題,正確處理可以減少或避免意外損傷及術後併髮癥的髮生。
목적:총결단공복강경하특제산침실시소인복고구사산수술시우도적일사실제문제급처리기교。방법2014년3월지7월,아문수치196례소인복고구사산,환인균접수복강경하특제산침경피천자복막외내배구결찰술。회고성분석술중우도적상견문제、해결방법급술후수방정황。결과본조완성복강경경피천자복막외결찰술193례,3례중전위전통소절구수술。수술시간5~40 min,평균14.5 min,술중출혈1.5 mL,술중재기타부위증가조작통도화기계5례。복막추벽차당33례,대망막산입병여산낭점련2례,복막외기종2례,결찰선전요대망막12례,합병기타질병1례,단선탈선2례,내장하활고근내배구5례,복막시렬2례,거대산3례,음낭적기1례,천자부위소혈종2례,제산1례。결론단공복강경경피천자복막외결찰술이성위소인복고구사산적수선수술방식,구유창상소、회복쾌、능동시발현대측은성산등다충우점,단재실제조작과정중잉유제다문제,정학처리가이감소혹피면의외손상급술후병발증적발생。
Objective To analyze and summarize the adverse factors affecting laparoscopic percutane-ous extraperitioneal closure (LPEC)for pediatric inguinal hernia (PIH),and to explore the coping skills. Methods 196 children who diagnosed as PIH were applied with LPEC from March 2014 to July 2014.The ad-verse factors,coping skills and outcome of follow-up were retrospective analyzed. Results 193 LPEC were completed,but the other 3 cases converted to conventional surgery.The operating time was 5 ~40 minutes.A serious of adverse factors were encountered during the operation and solved properly,including 33 cases with radical peritoneum fold,2 cases with epiploon adhesion to the hernial sac,2 cases with extraperitoneal emphyse-ma,12 cases with sutures swine to the epiploon,1 case with hernias with comorbidity,2 cases with fracture of loss of the sutures,5 cases with viscera sliding hernias,2 cases with tear of peritoneum,etc. Conclusion-s LPEC had become the first choice for the treatment of PIH,it is effective for children with minimal invasion and low recurrence rate,which could be handled at the contralateral inguinal hernia.However there are a series of adverse factors during the procedure,which should be solved with appropriate techniques and principles.