[1]刘雪来** 叶茂 丁柏匀 管考平 张震 魏延栋.体外丝线牵拉辅助两孔腹腔镜内环缝合在治疗内环口皱褶冗厚斜疝中的应用[J].中国微创外科杂志,2024,01(1):7-12.
　Liu Xuelai,Ye Mao,Ding Baiyun,et al.Application of Extracorporeal Suture Tractionassisted Twoport Laparoscopic Inner Ring Closure for Inguinal Hernia With Folded Peritoneum Around Orifice in Children[J].Chinese Journal of Minimally Invasive Surgery,2024,01(1):7-12.
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体外丝线牵拉辅助两孔腹腔镜内环缝合在治疗内环口皱褶冗厚斜疝中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2024年1期
页码:
7-12
栏目:
临床论著
出版日期:
2024-01-25

文章信息/Info

Title:
Application of Extracorporeal Suture Tractionassisted Twoport Laparoscopic Inner Ring Closure for Inguinal Hernia With Folded Peritoneum Around Orifice in Children
作者:
刘雪来** 叶茂 丁柏匀 管考平 张震 魏延栋
(首都儿科研究所附属儿童医院普通新生儿外科，北京100020)
Author(s):
Liu Xuelai;  Ye Mao;  Ding Baiyun;  et al.
Department of General (Neonatal) Surgery, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020, China
关键词:
斜疝; 腹膜皱褶冗厚; 内环缝扎; Doom三角区; 精索血管; 输精管
Keywords:
Indirect hernia; Folded peritoneum; Inner ring closure; Doom’s triangle; Spermatic vessels; The vas deferens
文献标志码:
A
摘要:
目的探讨体外丝线牵拉辅助两孔腹腔镜内环缝扎治疗内环皱褶冗厚斜疝的安全性、可行性。方法2019年10月~2023年2月，322例斜疝患儿接受两孔法腹腔镜内环缝扎，其中186例（292侧）内环皱褶冗厚患儿采用体外丝线牵拉法辅助。在腹腔镜监视下，针持持针经内环口外下缘入腹膜，于腹膜后间隙走行至精索血管外侧缘出针；于精索血管外侧缘进针，体外轻轻牵拉线尾，腹腔镜下见进针点附近后腹膜间隙增大，缝针顺势在后腹膜间隙跨越精索血管表面。相同方法牵拉和展开折叠在输精管-髂外血管间隙的腹膜皱褶，增大后腹膜间隙，缝针继续在后腹膜间隙贴近髂血管表面跨越Doom三角区冗厚的腹膜组织。相同方法于腹膜外间隙跨越输精管表面。继续直视下缝合内环口内侧壁和上壁腹膜组织，于最初进针处出针和打结，闭合内环口。结果292侧体外丝线牵拉冗厚腹膜后，缝针能顺利跨越精索血管、Doom三角区以及输精管表面。80例单侧手术时间(18.5±3.2)min，106例双侧手术时间(32.6±5.3)min。均无术中并发症发生，均在术后6 h内出院。122例术后随访3~18个月(平均8.5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。结论对于内环皱褶冗厚的儿童斜疝，体外丝线牵拉法可有效展开冗厚的后腹膜，降低两孔法腹腔镜内环口缝扎时缝针跨越精索血管、Doom三角区以及输精管表面的难度，具有安全性、可行性。
Abstract:
ObjectiveTo investigate the safety and feasibility of twoport laparoscopic inner ring closure assisted by extracorporeal suture traction for indirect inguinal hernia with folded peritoneum around inner orifice in children.MethodsBetween October 2019 and February 2023, a total of 322 children with indirect inguinal hernia underwent twoport laparoscopic inner ring closure, in which 186 cases (292 sides) with folded peritoneum around inner ring orifice were given assistance by extracorporeal suture traction. Under laparoscopic vision in the umbilicus, a needle with a nonabsorbable suture was inserted into the abdominal cavity through the outer lower edge of the inner ring, followed by inserted from the extraperitoneal space to the outer edge of the spermatic cord blood vessel. The needle was again inserted at the outer edge of the spermatic cord blood vessel, and the suture tail was gently pulled outside the body. Under direct laparoscopy, the retroperitoneal space near the insertion point was enlarged. Afterwards the suture was crossed the surface of the spermatic cord blood vessel in the retroperitoneal space. In the same way the extracorporeal suture traction was engaged to expand folded peritoneum and enlarge extraperitoneal space for convenience of needle passing through the Doom’s triangle, as well as the vas deferens. The inner wall and upper wall peritoneal tissue of the inner ring were continuously sutured under direct visualization. The needle was removed and a knot was made at the initial insertion point, with the inner ring opening being closed.ResultsIn 292 sides, after extracorporeal suture was used to stretch the folded peritoneum, the suture was able to smoothly cross the spermatic cord blood vessels, the Doom’s triangle, and the surface of the vas deferens. The operating time for unilateral hernia was (18.5±3.2) min in 80 cases and for bilateral hernia was (32.6±5.3) min in 106 cases. No intraoperative complications were found and all the patients were discharged from hospital within 6 hours. A total of 122 cases were followed up for 3-18 months (mean, 8.5 months) after surgery. No complications such as incision infection, iatrogenic cryptorchidism, or testicular atrophy were observed. There were no recurrent hernia or hydrocele.ConclusionFor indirect hernia with folded peritoneum around inner ring orifice, extracorporeal suture traction effectively expands the folded peritoneum, and assists the needle with suture passing through the surface of spermatic cord blood vessels, the Doom’s triangle, and the vas deferens in extraperitoneal space, and decreases the difficulty of surgery, presenting better safety and feasibility.

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备注/Memo

备注/Memo:
基金项目：北京市自然科学基金(7222015)；首都儿科研究所所级课题(LCYJ-2023-07)**通讯作者，Email：liuxuelai_steven@163.com
更新日期/Last Update: 2024-04-15