探讨双钩疝针辅助单孔腹腔镜内环结扎术在治疗复发疝患儿中的诊疗体会。

回顾性分析2015年1月至2018年1月，郑州大学第一附属医院1 056例腹股沟疝患儿的临床资料，其中32例复发疝在单孔腹腔镜监视下，采用双钩疝针钩挂结扎线经腹横纹内环体表投影处穿刺至内环前壁腹膜外，借助水分离技术于腹膜外套扎内环。针对巨大疝行脐内侧襞遮盖术加强，套扎内环后疝针带线再次进针入腹，穿过同侧脐内侧襞后预置结扎线，疝针再返回内环外侧间隙至精索血管前穿透后腹膜、进入腹腔钩挂预置线牵出体外结扎，使脐内侧襞遮盖已经结扎内环区域加强修补。

32例复发疝38侧疝成功实施内环结扎，其中6例发现对侧隐性疝同时给予单纯内环结扎。6例巨大疝行脐内侧襞遮盖术。单侧和双侧腹股沟疝的手术时间分别为（12.2±2.3）min和（15.2±2.5）min，无相关手术并发症发生。全部患儿术后随访2个月至3年，无再复发。

应用双钩疝针腹膜外注水分离技术辅助单孔腹腔镜内环结扎术是一种安全有效、简便快捷的操作，是治疗小儿腹股沟复发疝优先选择的技术。

To explore the experience of single-port laparoscopic inner ring ligation using two-hooked core needle for recurrent inguinal hernia in children.

The clinical data of 1 056 children underwent laparoscopic inguinal hernia repair in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed from January 2015 to January 2018. 32 cases presented recurrent inguinal hernia, in which the two-hooked core needle with ligated suture was punctured into the extraperitoneal space and the inner ring of the peritoneum was ligated by water separation technique. In the huge hernias, after the inner ring closure was completed, the hernia needle with a suture was inserted at identical subcutaneous path and the suture was left after penetrating the ipsilateral medial umbilical fold, then the needle without suture was re-introduced into abdomen through lateral extraperitoneal space and the suture at bottom of medial umbilical fold was grabbed and extracorporeal ligated. So the closed orifice area was additionally reinforced.

38 hernias of 32 cases were successfully ligated, 6 cases of contralateral recessive hernia were done simple internal ligation at the same time. 6 cases with large hernia underwent internal ligation aditional umbilical medial fold covering. The operative time of unilateral and bilateral inguinal hernia was (12.2±2.3) minutes and (15.2±2.5) minutes respectively. No complications occurred. All patients were followed up during 2 months to 3 years, without recurrence.

Laparoscopic percutanous extraperitoneal closure using the two-hook hernia needle with hydrodissection is a safe and effective technique. It is the prior option procedure for recurrent inguinal hernia in childeen.