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目的探讨改良的腹腔镜经皮腹膜外结扎内环辅助治疗小儿腹股沟疝的疗效。方法选择2009年1月-2011年10月本科收治的小儿腹股沟疝患儿29例。年龄7个月～13岁,平均2岁。29例患儿中,术前诊断右侧腹股沟疝26例,左侧腹股沟疝6例,其中双侧腹股沟疝3例,复发性腹股沟疝2例。29例均经脐部穿刺后进入改良的腹腔镜,在监视下,在疝环相应的体表腹部,经直径2 mm的皮肤切口,分别用一个弯曲的硬膜外麻醉导管针和一自制的钩针套管刺入疝环(疝囊内环口)腹膜外,避开精索血管和输精管将内环结扎。结果患儿手术操作均顺利,手术时间为15～52(32.2±11.6)min,无严重术中和术后并发症发生。随访5～24(16.0±2.5)个月,无精索损伤、睾丸萎缩、术后疝复发和鞘膜积液等并发症发生。结论腹腔镜经皮腹膜外结扎内环辅助治疗小儿腹股沟疝简单、安全、微创、效果好,并发症少,复发率低。
Objective To explore the effect of modified laparoscopic percutaneous ligation of the peritoneal ring in the treatment of children with inguinal hernia. Methods Twenty-nine children with inguinal hernia admitted to our hospital from January 2009 to October 2011 were enrolled. Aged 7 months to 13 years old, average 2 years old. Of the 29 children, 26 cases of right inguinal hernia and 6 cases of left inguinal hernia were diagnosed preoperatively, including 3 cases of bilateral inguinal hernia and 2 cases of recurrent inguinal hernia. Twenty-nine patients who had penetrated the umbilical cord into the modified laparoscope. Under monitoring, the corresponding abdominal surface of the hernia ring was covered with a 2 mm diameter skin incision, respectively with a curved epidural catheter and a self-made Crochet casing into the hernia ring (hernia sac annulus) peritoneal, to avoid the spermatic vessels and vas deferens ligation of the inner ring. Results The operation was successful in all patients. The operation time ranged from 15 to 52 (32.2 ± 11.6) min without serious intraoperative and postoperative complications. All cases were followed up for 5 to 24 months (16.0 ± 2.5) months without complications such as spermatic cord injury, testicular atrophy, hernia recurrence and hydrocele. Conclusion Laparoscopic percutaneous ligation of the peritoneal ring assisted treatment of children with inguinal hernia simple, safe, minimally invasive, effective, less complications, low recurrence rate.