摘要
目的:探讨水分离技术在腹腔镜疝囊高位结扎术治疗交通性鞘膜积液术中游离腹膜和结扎疝囊的作用。方法:2017年7月~2018年7月有33例交通性鞘膜积液患儿(1岁5个月~9岁8个月)在我科接受腹腔镜疝囊高位结扎术手术治疗。术中采用硬膜外麻醉穿刺针经皮在腹膜外游离内环口处腹膜,穿刺针潜行至输精管边缘时,以注射器经穿刺针尾部注入3~5 ml生理盐水形成水床,分离输精管及腹膜间隙,穿刺针贴近腹膜顺利穿过此间隙,随后常规操作完成精索与腹膜的游离,在腹壁外完成未闭疝囊口的结扎。结果:33例患儿共接受腹腔镜下疝囊高位结扎41次,单次疝囊高位结扎时间2.5~14.0 min,平均(7.1±3.3)min;随访1~12个月,平均7.0个月,无复发,切口愈合良好。结论:利用水分离技术在穿刺针游离内环腹膜时避开输精管时加宽腹膜与输精管之间的距离,穿刺时能顺利避开输精管,在收紧疝囊口的结扎线时,减少了输精管被勾入到结扎线圈内的可能性,避免了输精管的扭曲及成角,有效减少手术并发症的发生。
Objective: To investigate the application of hydrodissection in peritoneal dissection and hernia sac ligation during the laparoscopic surgery of pediatric communicating hydrocele. Method: A total of 33 children(1 year 5 months old-9 years 8 months old) diagnosed with communicating hydrocele underwent laparoscopic high ligation of hernia sac in our department from Jul. 2017 to Jul. 2018. An 18-gauge epidural needle was inserted percutaneously over the internal inguinal ring, and 3-5 ml saline was injected into the subperitoneal plane when the needle reached the margin of vas deferens, hydrodissecting the peritoneum off the vas deferens and spermatic vessels and creating a safe space through which the needle could pass without compromising these structures. The inguinal ring was ligated extracorporeally. Result: Thirty-three patients received 41 laparoscopic high ligation of hernia sac procedures, and the mean operation time was 7.1±3.3(range, 2.5-14.0) min. The mean follow-up period was 7.0(range, 1-12) months. There was no recurrence or complication. Conclusion: Hydrodissection facilitates the needle circumferentially pass the internal inguinal ring at the subperitoneal plane by increasing the distance between the peritoneum and the vas deferens and vessels. Using this technique, the incidence rate of surgical complications related to the injury or distortion of the vas deferens and vessels could be remarkably reduced.
作者
石瑛
韩晓敏
黄超
彭景涛
程永彪
彭叔彬
陈敏
SHI Ying;HAN Xiaomin;HUANG Chao;PENG Jingtao;CHENG Yongbiao;PENG Shubin;CHEN Min(Department of Urology,Wuhan Union Hospital,Tongji Medical College,Huazhong University of Science&-Technology,Wuhan,430022,China;Department of Urology,West Division of Wuhan Union H ospital,Tongji Medical College,Huazhong University of Science&-Technology)
出处
《临床泌尿外科杂志》
2019年第11期905-907,共3页
Journal of Clinical Urology
关键词
睾丸鞘膜积液
腹腔镜疝囊高位结扎术
水分离
testicular hydrocele
laparoscopic high ligation of henia sac surgery
hydrodissection
