[1]刘雪来**程毅菁①马亚②刘军廷①范世莹陈震许坚吉.小儿坏疽穿孔性阑尾炎或阑尾周围脓肿腹腔镜术后腹腔镜疝囊高位结扎术12例[J].中国微创外科杂志,2025,01(2):120-124.
　Liu Xuelai*,Cheng Yiqing,Ma Ya,et al.Laparoscopic High Ligation of Hernia Sac After Laparoscopic Appendectomy in Children With Gangrenous Perforated Appendicitis or Periappendicular Abscess: Report of 12 Cases[J].Chinese Journal of Minimally Invasive Surgery,2025,01(2):120-124.
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小儿坏疽穿孔性阑尾炎或阑尾周围脓肿腹腔镜术后腹腔镜疝囊高位结扎术12例()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年2期
页码:
120-124
栏目:
经验交流
出版日期:
2025-02-25

文章信息/Info

Title:
Laparoscopic High Ligation of Hernia Sac After Laparoscopic Appendectomy in Children With Gangrenous Perforated Appendicitis or Periappendicular Abscess: Report of 12 Cases
作者:
刘雪来**程毅菁①马亚②刘军廷①范世莹陈震许坚吉
(首都儿科研究所附属儿童医院普通外科，北京100020)
Author(s):
Liu Xuelai*;  Cheng Yiqing;  Ma Ya;  et al.
*Department of General Surgery, Capital Institute of Pediatrics Affiliated Children Hospital, Beijing 100020, China
关键词:
阑尾炎; 大网膜粘连; 斜疝; 疝囊高位结扎术
Keywords:
Appendicitis; Greater omentum adhesion; Indirect hernia; High ligation of hernia sac
文献标志码:
B
摘要:
目的探讨坏疽穿孔性阑尾炎或阑尾周围脓肿腹腔镜阑尾切除术后行腹腔镜疝囊高位结扎术的安全性、可行性，总结手术技巧。方法2015年2月~2024年5月，9例坏疽穿孔性阑尾炎和3例阑尾周围脓肿腹腔镜术后4个月~3年8个月(平均1年4个月)行腹腔镜疝囊高位结扎术。回顾上述病例资料。结果12例大网膜均粘连于右侧未闭的鞘膜腔，内环口皱褶冗厚。其中3例大网膜粘连于内环口，两孔法松解粘连，体外丝线牵拉辅助腹腔镜内环缝扎闭合内环口，手术时间分别为18 min、21 min和22 min；8例大网膜粘连于鞘膜腔壁，1例粘连于鞘膜腔底部，三孔法松解粘连，操作钳牵拉冗厚腹膜辅助腹腔镜内环缝扎闭合内环口，手术时间(45.5±5.7)min。无并发症，均在术后6 h内出院。11例术后随访4~20个月，平均7.5月。1例术后1年7个月出现对侧腹股沟斜疝，再次行疝囊高位结扎术。无切口感染、鞘膜积液、医源性隐睾或睾丸萎缩。结论腹腔镜阑尾炎术后行腹腔镜疝囊高位结扎术时，存在大网膜粘连于腹股沟管的可能。术中酌情增加trocar辅助离断大网膜，充分显露内环口和后腹膜，在保护好精索血管、输精管以及睾丸的前提下，松解和离断大网膜，行疝囊高位结扎，操作具有安全性、可行性。
Abstract:
ObjectiveTo investigate the safety, feasibility, and surgical skills of laparoscopic high ligation of the hernia sac after laparoscopic appendectomy in children with gangrenous perforated appendicitis or periappendiceal abscess. MethodsBetween February 2015 and May 2024, laparoscopic high ligation of the hernia sac was conducted in 9 cases of gangrenous perforated appendicitis and 3 cases of periappendiceal abscess who had undergone laparoscopic appendectomy for 4 months to 3 years and 8 months (mean, 1 year and 4 months). Clinical data of these patients was retrospectively reviewed and summarized.ResultsAll the 12 patients were found to have adhesion of greater omentum to the patent tunica vaginalis with folded peritoneum around inner ring orifice. For 3 cases of adhesion to the inner ring orifice, the greater omentum adhesion was released followed by twoport laparoscopic inner ring closure assisted by extracorporeal suture traction, the operative time being 18 min, 21 min, and 22 min, respectively. For 8 cases of adhesion to the wall of the tunica vaginalis and 1 case of adhesion to bottom of the tunica vaginalis, the greater omentum adhesion was released and disconnected by using an electric hook followed by threeport laparoscopic inner ring closure assisted by forceps pulling the thick peritoneum, the operative time being (45.5±5.7) min. No intraoperative complications were found and the patients were discharged within 6 h postoperatively. A total of 11 patients were followed up for 4-20 months (mean, 7.5 months). One patient was found contralateral inguinal hernia at 1 year and 7 months postoperatively, and high ligation of the hernia sac was conducted after readmission. No incision infection, hydrocele, iatrogenic cryptorchidism, or testicular atrophy.ConclusionsAfter laparoscopic appendectomy, there is a possibility of the greater omentum adhesion to the inguinal canal during laparoscopic high ligation of the hernia sac. During the operation, it is advisable to add a trocar for assisting the detachment of the greater omentum and fully exposure of the inner ring orifice and retroperitoneum. While protecting the spermatic cord blood vessels, vas deferens, and testes, the greater omentum can be loosened and detached, and high ligation of the hernia sac can be performed. This operation is safe and feasible.

参考文献/References:

[1] 中华医学会小儿外科学分会内镜外科学组. 小儿腹股沟疝腹腔镜手术操作指南(2017版)(上篇). 中华疝和腹壁外科杂志(电子版), 2018, 12(1):1-5.
[2] 中华医学会小儿外科学分会内镜外科学组. 小儿腹股沟疝腹腔镜手术操作指南(2017版)(下篇). 中华疝和腹壁外科杂志(电子版), 2018, 12(2):81-85.
[3] 刘雪来, 李龙, 李索林, 等. 输精管-髂外血管间隙在免水分离SPLPEC手术治疗内环皱褶明显儿童斜疝中的应用. 临床小儿外科杂志, 2020, 19(5):426-431.
[4] 刘雪来, 叶茂, 丁柏匀, 等. 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. 中国微创外科杂志, 2024, 24(1):7-12.
[5] Grech G, Shoukry M. Laparoscopic inguinal hernia repair in children: article review and the preliminary Maltese experience. J Pediatr Surg, 2022, 57(6):1162-1169.
[6] Zhao J, Yu C, Lu J, et al. Laparoscopic versus open inguinal hernia repair in children: a systematic review. J Minim Access Surg, 2022, 18(1):12-19.
[7] 刘雪来, 李龙. 连续性脾性腺融合症1例报告并文献复习. 发育医学电子杂志, 2020, 8(3):286-288.
[8] Balogh B, Hajnal D, Kovács T, et al. Outcomes of laparoscopic incarcerated inguinal hernia repair in children. J Minim Access Surg, 2020, 16(1):1-4.

备注/Memo

备注/Memo:
基金项目：北京市自然科学基金(7222015)；北京市卫生健康委员会2024-2025年度“一带一路”国际卫生健康合作项目和世界卫生组织合作中心项目；首都儿科研究所所级课题(LCYJ-2023-07)**通讯作者，Email：liuxuelai_steven@163.com①(首都儿科研究所儿童健康大数据研究中心，北京100020)②(首都儿科研究所附属儿童医院超声科，北京100020)
更新日期/Last Update: 2025-04-29