[1]李胜 杨文光 樊林*①.腹腔镜下钩针法疝环闭合术在腹股沟嵌顿疝中的应用[J].中国微创外科杂志,2020,01(1):23-25.
　Li Sheng*,Yang Wenguang*,Fan Lin..Application of Laparoscopic Closure of Hernia Ring With Crochet Needle Method in the Treatment of Inguinal Incarcerated Hernia[J].Chinese Journal of Minimally Invasive Surgery,2020,01(1):23-25.
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腹腔镜下钩针法疝环闭合术在腹股沟嵌顿疝中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年1期
页码:
23-25
栏目:
临床研究
出版日期:
2020-03-25

文章信息/Info

Title:
Application of Laparoscopic Closure of Hernia Ring With Crochet Needle Method in the Treatment of Inguinal Incarcerated Hernia
作者:
李胜 杨文光 樊林*①
（甘肃省金昌市中西医结合医院普外二科，金昌737100）
Author(s):
Li Sheng*;  Yang Wenguang*;  Fan Lin.
*Second Department of General Surgery, Jinchang Hospital of Integrated Traditional Chinese and Western Medicine, Jinchang 737100, China
关键词:
腹股沟嵌顿疝; 钩针法; 腹腔镜; 疝环闭合术
Keywords:
Inguinal incarcerated hernia; Crochet needle method; Laparoscopy; Closure of hernia ring
文献标志码:
A
摘要:
目的探讨腹腔镜下钩针法疝环闭合术治疗腹股沟嵌顿性斜疝的可行性及效果。方法选择我院2013年3月~2017年9月因腹股沟嵌顿性斜疝行急诊手术46例。均在全麻后行腹腔镜探查，手法复位或肠钳辅助牵拉复位疝内容物成功者行钩针法疝环闭合术；复位困难者，腹腔镜下用电凝钩或超声刀切开内环口狭窄环，还纳嵌顿肠管，在腹腔内置入针线缝合内环切开处后行钩针法疝环闭合术，若肠管已坏死，在相应部位腹壁做小切口约4 cm行坏死小肠切除术。结果均顺利完成手术。31例通过手法复位或肠钳辅助复位后单纯行钩针法疝环闭合术；15例腹腔镜下切开内环口松解后复位，缝合内环切开处后行钩针法疝环闭合术，其中5例嵌顿肠管坏死，辅助小切口行坏死小肠切除术。3例发现无症状的隐匿疝，同时行对侧钩针法疝环闭合术。术后血清肿2例(4.3%)，经局部穿刺痊愈，均无出血、感染。随访9~36个月，平均20.6月，无慢性疼痛，医源性隐睾或睾丸萎缩，1例(2.2%)复发。结论腹腔镜下钩针法疝环闭合术治疗腹股沟嵌顿性斜疝是安全、可行的，临床疗效确切，可同时发现及处理对侧隐匿性疝。
Abstract:
ObjectiveTo explore the feasibility and clinical effect of laparoscopic closure of hernia ring by using crochet needle in the treatment of inguinal incarcerated hernia.MethodsA total of 46 patients with inguinal incarcerated hernia who underwent emergency operation were retrospectively reviewed between March 2013 and September 2017. All the patients underwent laparoscopic exploration under general anesthesia. Laparoscopic closure of hernia ring was performed by using crochet needle in patients who had successful manipulative reduction or forcepsassisted reduction of hernia contents. For those with difficulty in reduction, laparoscopic incision of inner ring orifice was performed with electrocoagulation hook or ultrasound knife for reduction of incarcerated segments of intestine. Laparoscopic closure of hernia ring was performed by using crochet needle after the incision of inner ring was sutured. Resection of the necrotizing intestine would be added through a small incision (about 4 cm in length) on the abdominal wall.ResultsAll the patients received operations of laparoscopic closure of hernia ring with crochet needle method successfully. Among them, 31 cases were performed after direct reduction of hernia contents, and 15 cases were performed with laparoscopic incision of inner ring orifice to help the reduction of hernia contents. Five cases with incarcerated necrotizing intestine underwent additional bowel resection. Three cases with asymptomatic occult hernia underwent laparoscopic closure of hernia ring with crochet needle method on the contralateral hernia. Postoperative seroma occurred in 2 cases (4.3%), and patients recovered after local puncture. No bleeding or infection occurred after operation. Patients were followed for 9-36 months, with an average of 20.6 months. There was 1 case of recurrence (2.2%). No chronic pain, iatrogenic cryptorchidism, or testicular atrophy was found in all the patients.ConclusionsLaparoscopic closure of hernia ring with crochet needle method is safe and feasible for the treatment of inguinal incarcerated oblique hernia. This method has definite clinical effect and can simultaneously detect and treat contralateral occult hernia.

参考文献/References:

[1]魏建波.腹腔镜术与开放性手术治疗腹股沟疝的疗效及安全性分析.中国实用医药,2018,13(9):46-48.
[2]唐健雄,郑民华,陈杰,等.腹腔镜腹股沟疝手术操作指南(2017版).中华疝和腹壁外科杂志(电子版),2017,11(6):401-406.
[3]张晨波,李健文.应用腹腔镜技术治疗腹股沟嵌顿疝争议与挑战.中国实用外科杂志,2015,35(5):502-505.
[4]中华医学会外科学分会疝和腹壁外科学组. 成人腹股沟疝诊疗指南(2014年版). 中国实用外科杂志，2014,34(6):484-486.
[5]李健,高峰,肖志文.腹腔镜治疗腹股沟嵌顿疝的争议.外科理论与实践,2018,23(4):329-332.
[6]李胜,杨文光.钳夹式疝环闭合针辅助腹腔镜钩针法疝环闭合术治疗成人腹股沟斜疝.中国微创外科杂志,2018,18(8):728-731.
[7]Bessa SS, Abdelfattah MR, AlSayes IA,et al. Results of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated groin hernias: a 10year study. Hernia,2015,19(6):909-914.
[8]何智勇,苏志坚.老年嵌顿性腹股沟疝患者肠缺血坏死的危险因素.中国老年学杂志,2016,36(20):5092-5093.
[9]李乐,李鑫,李洪涛.无张力疝修补术治疗腹股沟嵌顿疝的体会.中国微创外科杂志,2018,18(1):86-88.
[10]杨林华,陈涛,王坚.腹股沟嵌顿疝术后手术部位感染因素分析.中国实用外科杂志,2012,32(12):1043-1045.
[11]唐朝权.腹腔镜下疝囊高位结扎术治疗腹股沟嵌顿疝的临床效果.中国实用医药,2015,10(22):64-65.
[12]蔡凤林,汤劲松,陈平.腹腔镜探查在腹股沟嵌顿疝治疗中的临床价值.中华疝和腹壁外科杂志(电子版),2016,10(3):219-220.
[13]陶卫东,王艳,许文娟,等. 腹腔镜下隐匿疝患病率观察. 中国现代普通外科进展,2011,14(8):669-670.

备注/Memo

备注/Memo:
*通讯作者，Email：linnet@mail.xjtu.edu.cn ①（西安交通大学第一附属医院普外科，西安710000）
更新日期/Last Update: 2020-04-16