腹股沟斜疝,单孔腹腔镜,改良钩针,免水分离,完全腹膜外 ," /> 腹股沟斜疝,单孔腹腔镜,改良钩针,免水分离,完全腹膜外 ,"/> Inguinal hernia,Single-port laparoscopy,Inner grappler,Free hydrodissection, Completely extraperitoneal ,"/> <div> <span style="line-height:2;font-size:14px;">免水分离完全腹膜外改良钩针辅助单孔腹腔</span><span style="line-height:2;font-size:14px;">镜内环闭合术治疗儿童腹股沟斜疝</span> </div>
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发育医学电子杂志  2020, Vol. 8 Issue (4): 333-337    DOI: 10.3969/j.issn.2095-5340.2020.04.009
  结构畸形   论著 |
免水分离完全腹膜外改良钩针辅助单孔腹腔镜内环闭合术治疗儿童腹股沟斜疝
刘雪来 李龙 谢向辉 李索林 杨晓锋 崔钊  张创 葛晓丽
1. 首都儿科研究所附属儿童医院 外科,北京 100020;2. 河北医科大学第二医院 小儿外科,河北 石家庄 050000;3. 长春儿童医院 外科,吉林 长春 130000
Application of single-port laparoscopic percutaneous completely extraperitoneal internalring closure using an inner grappler without hydrodissection in treatment of inguinal hernia in children
Liu Xuelai , Li Long, Xie Xianghui,et al
1.Department of Surgery, Children’s Hospital Capital Institute of Pediatrics, Beijing 100020, China; 2.Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Hebei, Shijiazhuang050000, China; 3. Department of Surgery, Changchun Children Hospital, Jilin, Changchun 130000, China
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摘要 
【摘要】 目的 探讨免水分离完全腹膜外改良钩针辅助单孔腹腔镜内环闭合治疗儿童腹股沟斜疝的安全性、有效性及可操作性。 方法 2017 年 11 月至 2018 年 3 月,在首都儿科研究所附属儿童医院外科和河北医科大学第二医院小儿外科收治的腹股沟斜疝患儿中,27 例采用免水分离法实施改良钩针辅助单孔腹腔镜内环腹膜外闭合治疗。在脐单孔腹腔镜监视下,将改良钩针钩挂丝线经腹横纹内环体表投影处穿刺至内环前壁腹膜外,钩针斜面背离术者视野,顶起后腹膜,利用钩针锹面顺势推进越过输精管与后腹膜之间间隙,在危险三角内抛置丝线于腹膜外间隙内;钩针沿原路退回至内环前壁腹膜外,进针经内环外侧间隙至精索血管外侧,钩针斜面背离术者视野,顶起后腹膜,利用钩针锹面顺势推进越过精索血管与后腹膜之间间隙,在危险三角内腹腔钩挂预置线牵出体外结扎闭合内环口。回顾性分析患儿基本情况、手术情况。对所有患儿随访至术后 13 ~ 17 个月,分析术后复发率和并发症发生情况。 结果 27 例患儿的年龄为 11 ~ 21 个月,男 25 例,女 2 例。术中证实单侧疝 16 例,双侧疝11 例。38 侧疝均采用免水分离方法实施改良钩针辅助单孔腹腔镜内环腹膜外闭合术。单侧和双侧疝的平均手术时间分别为(9.5±1.4)和(18.3±1.6) min。术后随访 13 ~ 17 个月,未出现切口感染、医源性隐睾或睾丸萎缩等并发症,无复发疝、鞘膜积液和皮肤结肉芽肿形成。 结论 采用免水分离完全腹膜外方法实施改良钩针辅助单孔腹腔镜内环腹膜外闭合结扎术治疗小儿腹股沟斜疝,操作安全便捷,手术效果满意。
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关键词:  腹股沟斜疝')" href="#">    
Abstract: 
【Abstract】 Objective To describe single-port laparoscopic percutaneous completely extraperitoneal internal ring closure using an inner grappler without hydrodissection for inguinal hernia in children, as well as its safety, effectiveness and feasibility. Methods Between November 2017 and March 2018, 27 children
with inguinal hernias undertook laparoscopic percutaneous completely extraperitoneal closure in Department
of Surgery, Children's Hospital Capital Institute of Pediatrics and Department of Pediatric Surgery, the Second
Hospital of Hebei Medical University. Under single-port laparoscopic vision, an inner grappler with a non
absorbable suture was inserted at abdominal transverse striation to extraperitoneal space and was readily kept in an
identical subcutaneous path. The inclined surface of an inner grappler with suture reached back retroperitoneum
and passed through vas deferens without using hydrodissection technique. The same technique was utilized to
pass through spermatic vessel on outside of hernia, followed by ligation and close the orifice of inner hernia in
extraperitoneal internal ring closure using an inner grappler without puncture of peritoneum. Anthropological data
including basic data of patients and perioperative data were reviewed. All patients were followed up ranging
from 13 to 17 months after operation, and postoperative recurrence and complications were analyzed.
Results Age of all patients ranged from 11 months to 21 months, and 25 males and 2 females were involved
in the study. A total of 38 sides of orifices (16 cases of lateral hernia and 11 cases of bilateral hernia) were
successfully conducted single-port laparoscopic percutaneous completely extraperitoneal internal ring closure
using an inner grappler without hydrodissection. Mean operating time for unilateral and bilateral repairs
was (9.5±1.4) and (18.3±1.6) min. There were no wound infection, recurrence, iatrogenic cryptorchidism or
testicular atrophy, as well as granuloma with a 13 to 17 months of follow-up. Conclusion Single-port laparoscopic
percutaneous completely extraperitoneal internal ring closure using an inner grappler without hydrodissection is
safe and feasible for pediatric huge inguinal hernia.
Key words:  Inguinal hernia')" href="#">')" href="#"> Completely extraperitoneal
收稿日期:  2019-11-18                     发布日期:  2020-11-04     
基金资助: 
北京市属医学科研院所公益发展改革试点项目(京医研2019-11);公益性行业科研专项(201402007);2018 年度儿科学科协同发展中心“儿科专项”(XTZD20180301)
通讯作者:  李龙https://baike.baidu.com/item/李龙/5301086?fr=aladdin    E-mail:  lilong23@126.com
引用本文:    
刘雪来 李龙 谢向辉 李索林 杨晓锋 崔钊  张创 葛晓丽.
免水分离完全腹膜外改良钩针辅助单孔腹腔镜内环闭合术治疗儿童腹股沟斜疝
[J]. 发育医学电子杂志, 2020, 8(4): 333-337.
Liu Xuelai , Li Long, Xie Xianghui, et al.
Application of single-port laparoscopic percutaneous completely extraperitoneal internalring closure using an inner grappler without hydrodissection in treatment of inguinal hernia in children
. Journal of Developmental Medicine(Electronic Version), 2020, 8(4): 333-337.
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http://www.fyyxzz.com/CN/10.3969/j.issn.2095-5340.2020.04.009  或          http://www.fyyxzz.com/CN/Y2020/V8/I4/333
[1] 高鹏 张旭光 单颖君 等. 腹腔镜下单孔套扎和三孔缝扎治疗儿童精索鞘膜积液对肠道黏膜屏障功能的影响[J]. 发育医学电子杂志, 2020, 8(2): 145-150.
[2] 刘雪来 李龙 李索林 王文博 杨晓锋 葛晓丽. 经鞘突口腹腔镜抵入法在经阴囊入路睾丸引降固定术治疗腹股沟型隐睾中的应用[J]. 发育医学电子杂志, 2019, 7(4): 259-263.
[3] 刘雪来 张永婷 李索林. 免水分离改良钩针辅助单孔腹腔镜内环腹膜外闭合治疗儿童腹股沟斜疝[J]. 发育医学电子杂志, 2019, 7(2): 141-145.
[4] 刘雪来 张创 张永婷 刘林 李索林. 单孔腹腔镜完全腹膜外腹股沟疝环结扎术的临床应用[J]. 发育医学电子杂志, 2018, 6(2): 77-81.
[5] 陶天 周辉霞 王超 等. 小儿经脐单孔腹腔镜肾盂成形术经肠系膜途径与结肠旁途径的疗效比较[J]. 发育医学电子杂志, 2016, 4(3): 165-169.
[6] 胡啸天 彭澎 段支前. 经脐单孔腹腔镜下小儿重复肾半肾切除术的临床分析[J]. 发育医学电子杂志, 2016, 4(2): 99-103.
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