经脐单一部位切口腹腔镜治疗小儿精索静脉曲张

发布时间：2018-01-31 16:23

本文关键词： 腹腔镜精索静脉曲张经脐单一部位切口　出处：《中国微创外科杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的探讨经脐单一部位切口腹腔镜精索静脉高位结扎术治疗精索静脉曲张的疗效。方法 2014年1月~2015年1月对8例小儿精索静脉曲张行经脐单一部位切口腹腔镜手术。在脐窝内纵行切开1.0 cm皮肤,开放式置入5 mm trocar,气腹压力10 mm Hg,在脐窝偏左侧放置第2个trocar。观察精索静脉明显扩张、迂曲,表面颜色发暗提示静脉回流障碍。经操作孔道置入剪刀,距离内环口3~5 cm处沿后腹膜表面剪开精索附近的后腹膜约2 cm。钝性分离精索血管,区分精索动静脉,无创抓钳提起精索血管,进一步游离松解精索2~3 cm。经腹壁穿入2-0带针丝线,在腹腔内单手操作打结,高位结扎精索静脉2道,切断结扎部位之间的精索静脉。结果 8例患儿均在经脐单一部位切口腹腔镜下完成精索静脉高位结扎术,手术时间平均37 min(30~50 min)。脐部切口愈合好,无明显瘢痕形成。8例随访8~22个月,平均14个月,术后6个月复查左侧阴囊部位的静脉团块消失,阴囊下坠感及下腹不适症状消失,未见复发。结论经脐单一部位切口腹腔镜精索静脉高位结扎术治疗小儿精索静脉曲张,手术效果确切,腹部无可见瘢痕。
[Abstract]:Objective to investigate the effect of laparoscopic high ligation of spermatic vein through single incision of umbilical cord in the treatment of varicocele. From January 2014 to January 2015, 8 cases of varicocele in children were treated with laparoscopy through a single incision of umbilical cord, and 1. 0 cm skin incision was performed longitudinally in the umbilical fossa. Open placement of 5 mm trocara, pneumoperitoneum pressure of 10 mm Hg. placed the second trocaron on the left side of the umbilical fossa. The varicocele vein was obviously dilated and tortuous. The color of the surface indicated the obstruction of venous reflux. Scissors were inserted through the operating orifice, and the spermatoperitoneum was cut about 2 cm along the surface of the posterior peritoneum at a distance of 3 cm from the inner ring orifice. The spermatic cord vessels were obtuse. The artery and vein of spermatic cord were differentiated, the blood vessels of spermatic cord were lifted by non-invasive forceps, and the spermatic cord was further loosened 2 ~ 3 cm. Through the abdominal wall, 2-0 needle thread was inserted into the spermatic cord, and the knot was operated with one hand in the abdominal cavity, and 2 spermatic veins were ligated at the high position. Results the high ligation of spermatic vein was performed under laparoscope through a single incision of umbilical cord in 8 cases. The average operation time was 37 min(30~50. The incision healed well, and no obvious scar formation occurred in 8 cases (mean 14 months). Six months after operation, the venous lumps of the left scrotum disappeared, and the falling sensation and discomfort of the lower abdomen disappeared. Conclusion Laparoscopic high ligation of spermatic vein is effective in the treatment of varicocele in children.
【作者单位】：首都儿科研究所附属儿童医院普外科;
【基金】：卫生部行业专项课题(201402007)
【分类号】：R726.9
【正文快照】： 青少年精索静脉曲张是小儿外科的常见病,是精索的静脉回流受阻引起血液淤滞,导致精索蔓状静脉丛伸长、扩张及迂曲。腹腔镜精索血管结扎术已经成为治疗该病的经典方式。2014年1月~2015年1月我院对8例精索静脉曲张采用经脐单一部位切口腹腔镜精索静脉高位结扎术,现报道如下。1临

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