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目的探讨采用单纯经脐切口及腹腔内打结技术行疝囊高位结扎术的安全性及手术效果。方法 2013年10月至2014年6月,我们采用单纯经脐切口及腹腔内打结技术行腹股沟斜疝手术86例,其中双侧30例,单纯左侧15例,单纯右侧41例。具体方法为:经脐5 mm Trocar置镜,脐环免Trocar置入3 mm针持。内环口上外3 cm腹壁外以2-0不可吸收带针缝线自腹壁穿入腹腔,线尾留置在腹壁外侧,环形缝合内环口一周,避开精索血管及输精管。采用腹腔内绕线、腹腔外牵拉尾线辅助打结,腹壁外剪线。皮肤胶粘合伤口。结果单侧病例平均手术时间18.7 min,双侧病例平均手术时间23.5 min。无精索血肿、腹腔脏器损伤、腹壁气肿及术后阴囊水肿的发生。术后第1天自由活动率为99%。随访时间7~15个月,目前无复发病例,无一例出现腹股沟区异物感或异物反应;术后1个月腹壁基本无可视疤痕。结论采取单纯经脐腹腔镜技术、常规器械腹腔内打结方法进行疝囊高位结扎术治疗小儿腹股沟斜疝,安全有效,腹壁皮肤外观好,无皮下异物感或异物反应。
Objective To investigate the safety and operative effect of high ligation of hernia sac by simple umbilical incision and intra-abdominal knotting. Methods From October 2013 to June 2014, we performed 86 cases of indirect inguinal hernia surgery with simple incision through the umbilical cord and intra-abdominal knotting technique. There were 30 bilateral cases, 15 cases left simple and 41 cases simple right. The specific method is: the umbilical 5 mm Trocar lens, umbilical ring free Trocar into the 3 mm needle holder. The inner and outer 3 cm abdominal wall outside the 2-0 non-absorbable suture needle into the abdominal cavity from the abdominal wall, line tail lodging in the abdominal wall, the inner ring suture a week to avoid spermatic vessels and vas deferens. Using intraperitoneal wound, extra-abdominal traction tail threading knot, abdominal wall cut line. Skin glue to bind the wound. Results The average operation time was 18.7 min in unilateral patients and 23.5 min in bilateral patients. No suture hematoma, abdominal organ damage, abdominal wall emphysema and postoperative scrotal edema occurred. The first day postoperative free activity rate was 99%. The follow-up time ranged from 7 to 15 months. There were no recurrences at present, and no foreign body sensation or foreign body reaction occurred in the inguinal region. There was no visible scar in the abdominal wall at 1 month after operation. Conclusions Simple umbilical laparoscopic technique and conventional intra-abdominal knot method for ligation of hernia sac for treatment of inguinal indirect inguinal hernia in children are safe and effective. The skin appearance of the abdominal wall is good and there is no subcutaneous foreign body sensation or foreign body reaction.