CAJ | 학술논문

目的探索经脐双孔法腹腔镜手术在小儿特殊类型腹股沟疝的临床运用价值.方法回顾性分析2012年1月至2015年1月15例特殊类型腹股沟疝患儿行腹腔镜手术的临床资料.男8例,女7例,年龄3个月～6岁2个月(平均3岁).8例腹股沟滑疝,4例为Amyand's疝,3例腹股沟直疝.结果 8例腹股沟滑疝中女6例,男2例.5例女孩发生在左侧,1例女孩发生在右侧,均为卵巢及输卵管构成疝囊壁的一部分;2例男孩发生在右侧,为回盲部,均无法直接还纳入腹腔.4例Amyand's疝,均为男孩,与其他类型腹股沟疝不同的是,4例患儿中3例有发热病史,疝内容物体检时可见阴囊红肿,触痛明显,疝内容物1例为回盲部合并阑尾炎,3例嵌顿物为孤立的化脓性阑尾,4例患儿均在腹腔镜下完成疝囊高位结扎,右下腹悬吊法行阑尾切除,远端疝囊冲洗后放置橡皮引流条.3例腹股沟直疝,2例男孩,1例女孩,1例为双侧,2例合并斜疝,左、右侧各1例,手术主要在经脐双孔法基础上完成,必要时根据术中情况另外放置其他Trocar.术后平均住院时间(2.8±0.8)d,术后无切口感染、阴囊血肿发生.随访6个月～3年,无睾丸萎缩、复发等并发症发生.结论经脐双孔法腹腔镜手术治疗特殊类型腹股沟疝安全、微创、恢复快,值得推广应用.
목적 탐색경제쌍공법복강경수술재소인특수류형복고구산적림상운용개치.방법 회고성분석2012년1월지2015년1월15례특수류형복고구산환인행복강경수술적림상자료.남8례,녀7례,년령3개월～6세2개월(평균3세).8례복고구활산,4례위Amyand's산,3례복고구직산.결과 8례복고구활산중녀6례,남2례.5례녀해발생재좌측,1례녀해발생재우측,균위란소급수란관구성산낭벽적일부분;2례남해발생재우측,위회맹부,균무법직접환납입복강.4례Amyand's산,균위남해,여기타류형복고구산불동적시,4례환인중3례유발열병사,산내용물체검시가견음낭홍종,촉통명현,산내용물1례위회맹부합병란미염,3례감돈물위고립적화농성란미,4례환인균재복강경하완성산낭고위결찰,우하복현조법행란미절제,원단산낭충세후방치상피인류조.3례복고구직산,2례남해,1례녀해,1례위쌍측,2례합병사산,좌、우측각1례,수술주요재경제쌍공법기출상완성,필요시근거술중정황령외방치기타Trocar.술후평균주원시간(2.8±0.8)d,술후무절구감염、음낭혈종발생.수방6개월～3년,무고환위축、복발등병발증발생.결론 경제쌍공법복강경수술치료특수류형복고구산안전、미창、회복쾌,치득추엄응용.
Objective To evaluate the value of transumbilical two-port laparoscopy on specialtype pediatric inguinal hernias.Methods Retrospective analyses were conducted for the clinical data of 15 cases with special-type inguinal hernias from January 2012 to January 2015.Results Among 8 cases of sliding inguinal hernia,there were 6 girls (5 left sided,1 right sided) and 2 boys (bilateral).Ovary and Fallopian tubes constituted a part of hernia sac in all girls while sliding component of hernia sac was ileocecum in boys.None was reducible.Four boys had Amyand's hernia and three of them had a history of fever and a tender irreducible scrotal swelling with red edematous skin.The incarcerated contents of hernia sac were ileocecum with inflamed appendix (n =1) and isolated suppurative appendix (n =3).Laparoscopic hernia sac high ligation was performed.With suspension at right lower quadrant,the appendixes were removed laparoscopically,a thorough wash of sac followed by rubber drainage was then performed.Direct inguinal hernia was found in 2 boys and 1 girl.One had bilateral hernias and another two coexisting indirect inguinal hernia.Trans-umbilicus two-port laparoscopy was performed with additional trocar required under specific circumstances.The average length of hospital stay was 2.8 ± 0.8 days.There was neither incision infection nor scrotal hematoma.During a follow-up period of 6 months to 3 years,neither recurrence nor testicular atrophy occurred.Conclusions Transumbilical two-port laparoscopy is both safe and mini-invasive for special-type inguinal hernias.