探讨儿童Pantaloon疝的诊断及腹腔镜手术治疗效果。

回顾性分析2019年3月至2024年4月厦门市儿童医院（复旦大学附属儿科医院厦门医院）诊治的4例Pantaloon疝患儿的临床资料并文献复习。

本组患儿均为男性，年龄2岁1月至4岁5月（平均3岁3月）。患儿1，2岁1个月，初次斜疝手术后当天复发，二次手术中见原斜疝疝囊结扎完全，提拉腹股沟区皮肤后同侧可见直疝疝囊，确诊为Pantaloon疝，腹腔镜下行直疝疝囊高位结扎后，利用同侧脐内侧韧带覆盖直疝三角，术后随访4年无复发。患儿2，2岁3个月，初次手术（外院）后1个月复发，二次手术中见原斜疝疝囊结扎完全，提拉腹股沟区皮肤后同侧可见直疝疝囊，二次手术中确诊为Pantaloon疝，腹腔镜下行直疝疝囊高位结扎后，利用同侧脐内侧韧带覆盖直疝三角，术后随访3年无复发。患儿3，4岁5个月，初次手术中确诊为Pantaloon疝，腹腔镜下行斜疝疝囊高位结扎及直疝疝囊高位结扎后，利用同侧脐内侧韧带覆盖直疝三角，手术治疗后随访18个月无复发。患儿4，3岁1个月，初次手术中确诊为Pantaloon疝，腹腔镜下行斜疝疝囊高位结扎及直疝疝囊高位结扎后，利用同侧脐内侧韧带覆盖直疝三角，手术治疗后随访6个月无复发。

儿童pantaloon疝术前诊断困难，易漏诊，腹腔镜下行斜疝疝囊高位结扎及直疝疝囊高位结扎加同侧脐内侧韧带覆盖直疝三角治疗儿童Pantaloon疝是可行的。

To investigate the diagnostic features of pediatric pantaloon hernia and to evaluate the outcomes of laparoscopic surgical treatment.

The clinical data of four children diagnosed with pantaloon hernia and treated at Xiamen Children's Hospital (Xiamen Hospital of the Pediatric Hospital Affiliated to Fudan University) between March 2019 and April 2024 were retrospectively reviewed, and the relevant literature was analyzed.

All four patients were male, aged from 2 years and 1 month to 4 years and 5 months, with a mean age of 3 years and 3 months. Patient 1, aged 2 years and 1 month, experienced recurrence on the day of the initial operation for indirect inguinal hernia. During the second operation, the original indirect hernia sac was found to be completely ligated, and a direct hernia sac was identified on the same side after traction of the inguinal skin, leading to the diagnosis of pantaloon hernia. Laparoscopic high ligation of the direct hernia sac was performed, followed by coverage of the direct hernia triangle using the ipsilateral medial umbilical ligament. No recurrence was observed during 4 years of follow-up. Patient 2, aged 2 years and 3 months, developed recurrence 1 month after the initial operation performed at another hospital. At reoperation, the original indirect hernia sac was completely ligated, and a direct hernia sac was detected on the same side after traction of the inguinal skin. Pantaloon hernia was diagnosed intraoperatively. Laparoscopic high ligation of the direct hernia sac with coverage of the direct hernia triangle using the ipsilateral medial umbilical ligament was performed. No recurrence was observed during 3 years of follow-up. Patient 3, aged 4 years and 5 months, was diagnosed with pantaloon hernia during the initial operation. Laparoscopic high ligation of both the indirect and direct hernia sacs was performed, followed by coverage of the direct hernia triangle using the ipsilateral medial umbilical ligament. No recurrence was observed during 18 months of follow-up. Patient 4, aged 3 years and 1 month, was diagnosed with pantaloon hernia during the initial operation. Laparoscopic high ligation of both the indirect and direct hernia sacs was performed, with coverage of the direct hernia triangle using the ipsilateral medial umbilical ligament. No recurrence was observed during 6 months of follow-up.

Preoperative diagnosis of pantaloon hernia in children is challenging and the condition is prone to missed diagnosis. Laparoscopic high ligation of both indirect and direct hernia sacs combined with coverage of the direct hernia triangle using the ipsilateral medial umbilical ligament is a feasible and effective treatment for pediatric pantaloon hernia.