尽管T-LESS越来越多地用于治疗小儿腹股沟疝,没有关于T-LESS治疗小儿鞘膜积液的研究。
为了进一步评估T-LESS的可行性,并介绍我们单中心儿童鞘膜积液修复的经验。
从2016年1月至2016年7月,我们对所有在我们研究所接受T-LESS治疗的男孩进行了回顾性分析。在脐部引入了腹腔镜和持针钳。将带有丝线的圆形针穿过腹壁。沿顺时针方向连续缝合内环周围的腹膜。经过完整的荷包缝合后,使用单器械打结技术进行三重结。如果存在,则同时修复对侧阴道未闭突(PPV)。
总的来说,包括59名患有鞘膜积液的男孩(左侧22名,32在右边,和5双侧)(表)。在手术过程中,用PPV观察到所有鞘膜积液,但39名男孩需要吸液.24名单侧鞘膜积液男孩存在对侧PPV,最后进行了88次维修。单侧修复的平均手术时间为18.3min,双侧修复的平均手术时间为27.5min,分别。除了上腹部下血管受到轻微损伤外,所有手术均顺利。经过平均10.7个月的随访,未观察到复发或其他术后并发症。腹壁上没有可见的疤痕。
与开放修补术治疗小儿腹股沟疝和鞘膜积液相比,腹腔镜手术有几个优点,例如对侧PPV的探查,罕见疝的鉴定,术后疼痛减轻,改进的宇宙,更快的恢复,更少的并发症。与腹腔镜腹膜后入路不同,T-LESS在结扎线中不包括皮下组织,它的结完全在腹膜腔内,可以从根本上预防结扎区的剧烈疼痛和缝合肉芽肿。此外,T-LESS后的皮肤切口隐藏在脐中,可以达到极好的美容效果。通过对小儿鞘膜积液进行T-LESS,目前的研究显示出非常令人满意的结果,如高成功率,轻微并发症,和优秀的宇宙。然而,由于T-LESS的学习曲线困难,一些技术细节(例如避免精索损伤,完全缝合腹膜褶皱并减少器械之间的干扰)将来仍需要改进。
T-LESS似乎是修复小儿鞘膜积液的一种安全有效的方法。
Although T-LESS is increasingly being used to treat pediatric inguinal hernia, there is no study regarding T-LESS for pediatric
hydrocele.
To further evaluate the feasibility of T-LESS and present our single-center experience for repair of pediatric hydroceles.
From January 2016 to July 2016, all boys undergoing T-LESS for
hydrocele in our institute were retrospectively reviewed. A laparoscope and a needle-holding forceps were introduced at umbilicus. A round needle with silk suture was stabbed through the abdominal wall. The peritoneum around the internal ring was sutured continuously in a clockwise direction. After a complete purse-string suture, a triple knot was performed by using a single-instrument tie technique. The contralateral patent processus vaginalis (PPV) was repaired simultaneously if present.
Overall, 59 boys with
hydrocele were included (22 on the left side, 32 on the right side, and 5 bilaterally) (Table). During the procedure, all hydroceles were observed with a PPV but the fluid needed to be aspired in 39 boys. A contralateral PPV was present in 24 boys with unilateral
hydrocele, and finally 88 repairs were performed. Mean operative time was 18.3 min for unilateral repair and 27.5 min for bilateral repair, respectively. All procedures were uneventful besides a minor injury to the inferior epigastric vessels. After a mean follow-up of 10.7 months, neither recurrence nor other postoperative complication was observed. There were no visible scars on the abdominal wall.
Compared with open repair of pediatric inguinal hernia and
hydrocele, laparoscopic surgery had several advantages, such as exploration of contralateral PPV, identification of rare hernias, diminished postoperative pain, improved cosmesis, faster recovery, and fewer complications. Differing from the laparoscopic retroperitoneal approach, T-LESS included no subcutaneous tissue in the ligature, and its knot was completely in the peritoneal cavity which could radically prevent the severe pain and suture granuloma in the ligated region. Furthermore, the skin incisions after T-LESS were hidden in umbilicus, which could achieve an excellent cosmetic result. By performing T-LESS for pediatric hydroceles, the current study showed very satisfactory results, such as high success rate, minor complication, and excellent cosmesis. However, because of the difficult learning curve of T-LESS, some technical details (e.g. avoiding injury to the spermatic cord, completely suturing the peritoneal folds and reducing disturbance between the instruments) still need to be improved in the future.
T-LESS appears to be a safe and effective method for repair of pediatric hydroceles.