髂耻束和凹间韧带在腹腔镜小儿腹股沟斜疝修补中的应用

摘要

目的:探讨髂耻束和凹间韧带在腹腔镜小儿疝修补术中的应用价值.方法:将180例(201例次)患儿随机分为实验组(103例次)和对照组(98例次),实验组在内环结扎的基础上缝合髂耻束和凹间韧带,对照组仅行腹腔镜内环结扎术.随访半年,对比两组患儿手术时间,住院时间,术后下床时间,阴囊积液血肿、复发、睾丸萎缩、腹壁神经损伤等并发症情况.结果:180例(201例次)患儿均顺利完成手术,与对照组相比,实验组复发率降低,手术时间、住院时间、术后下床时间及阴囊积液血肿、睾丸萎缩、腹壁神经损伤等并发症无增加.结论:髂耻束及凹间韧带是腹股沟管后壁的重要结构,在疝修补术中具有重要作用.小儿斜疝,特别是内环口直径≥1.5 cm及年长患儿,其内环口周围腹横筋膜同样存在缺损,髂耻束及凹间韧带的缝合可修复或缩小内环口周围缺损的腹横筋膜.腹腔镜小儿疝修补术中在结扎内环口的基础上缝合髂耻束和凹间韧带更牢靠,可减少复发.%Objective:To investigate the application value of iliopubic tract and interfoveolar ligament in laparoscopic indirect inguinal hernia hernioplasty in children. Methods;The patients were randomly divided into two groups:experimental(103 case-times) and control group(98 case-times). Experimental group;the indirect inguinal deep ring was ligated followed by iliopubic tract and interfoveolar ligament suturing under laparoscopy. Control group;the indirect inguinal deep ring was ligated under iaparoseopy alone. The clinical data including mean operation time,hospital stay.ambulation time and scrotal hydrops,scrotal hematoma,recurrence,testicular atrophy,neurological complications such as damage to the abdominal wall nerve were compared between the two groups. Results; All 180 eases(201 case-times) had successfully received laparoscopic surgery. The relapse rate of experimental group was less than that of control group (P <0.05). And there were no statistical differences in operation time,average hospital stay,mean postoperative ambulation time, hematoma or hydrops of scrotum, testicular atrophy .neurological and other concurrent abdominal injury between the two groups(Prn>0.05). Conclusions;Iliopubic tract and interfoveolar ligament are important structures of the inguinal canal posterior wall which play an important role in the pediatric indirect inguinal hernioplasty. Especially for the indirect inguinal hernia in which deep ring diameter isrn≥1.5 cm and older children ( ≥ 5 years old) ,the defect of transversalis fascia around the deep ring may exist. Iliopubic tract and interfoveolar ligament suture can repair or decrease the defective transversalis fascia around the inguinal hemia deep ring. Laparoscopic indirect inguinal hernia hernioplasty in children through ligation of the deep ring and followed by iliopubic tract and interfoveolar ligament suture can be more solid with lower recurrence rate.