二孔法腹腔镜与开腹手术治疗小儿腹股沟斜疝的比较  

Two-port laparoscopy versus open high ligation for indirect inguinal hernia in children

作　　者：赵英敏[1] 李龙[1] 马继东[1] 张军[1] 王淑琴[2] 

机构地区：[1]首都儿科研究所外科,北京100020 [2]北京大学第一医院小儿外科,北京100034

出　　处：《中国微创外科杂志》2006年第8期595-596,共2页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的比较腹腔镜与开腹手术治疗小儿腹股沟斜疝的疗效。方法2001年4月～2006年1月，我们采用微型腹腔镜二孔法治疗小儿腹股沟斜疝410例（腹腔镜组），并与2004年9月～2006年1月408例开腹疝囊高位结扎术（开腹组）进行疗效比较。腹腔镜组脐窝置入1个5mm trocar，探查双侧内环口，在患侧相当于麦氏点的稍上方置入另1个5mm trocar并导入持针器，在疝囊颈外上方穿入一带线缝针，术者单手持针，在疝囊入口水平腹膜下缝合鞘突入口一周，收紧缝线，结扎鞘突。开腹组经腹股沟外环处横切口行疝囊高位结扎术。结果腹腔镜组手术顺利，单侧手术时间（33．4±9．6min）显著少于开腹组（38．0±7．6min）（t=-7．596，P=0．000）。腹腔镜组无阴囊水肿、切口下积血积液、感染等并发症．平均随访23．2月（1～55个月），早期3例复发，再次腹腔镜手术修补成功，其余无睾丸萎缩、医源性隐睾及肠粘连等远期并发症。开腹组平均随访10个月（1～18个月），18例复发，8例经腹腔镜、10例经开腹手术治愈；医源性阴睾9例，再次开腹手术治愈。结论二孔法腹腔镜手术治疗小儿腹股沟斜疝较开腹手术恢复快，创伤小，无须伤口拆线，同时可用于处理腹股沟隐性疝和双侧腹股沟疝，不适用于心功能不全及新生儿嵌顿疝。Objective To compare curative effects between laparoscopic and open surgery in the treatment of pediatric indirect inguinal hernia. Methods A group of 410 children with indirect inguinal hernia underwent micro-laparoscopic operation （Laparoscopic Group） from April 2001 to January 2006. This group was compared with another group of 408 children with indirect inguinal hernia, treated with open high ligation of the hernial sac （ Open Group） from September 2004 to January 2006. In the Laparoscopic Group, a 5-mm trocar was inserted at the umbilicus for the exploration of bilateral internal rings. Another 5-mm trocar was inserted at the site slightly superior to the McBurney＇ s point for introducing a needle holder. At the level of the neck of the hernial sac, the orifice of the vaginal process was circumferentially sutured and ligated. In the Open Group, high ligation of the hernial sac was conducted through a transversal incision at the external ring. Results The operations in the Laparoscopic Group were smoothly completed. The operative time for one side of hernia was significantly shorter in the Laparoscopic Group （33.4 ± 9.6 min） than in the Open Group （38.0 ±7.6 rain） （ t = - 7. 596, P = 0. 000）. In the Laparoscopic Group, no edema of the scrotum, subcutaneous hydrops, or infection occurred. The patients were followed for 1 -55 months （mean, 23.2 months）. Short-term recurrence was observed in 3 children, who required a re-operation of laparoscopic repair. No testicular atrophy, iatrogenic retained testis, intestinal adhesion, or other long-term complications happened. In the Open Group, follow-up observations for 1 - 18 months （mean, 10 months） revealed recurrence in 18 children, 8 of whom were then cured with laparoscopic surgery and 10 of whom with open surgery. Iatrogenic retained testis happened in 9 children and a re-operation of open surgery was carried out. Conclusions Two-port laparoscopic high ligation of hernial sac for pediatric indirect inguinal hernia is minimally inva

关 键 词：腹腔镜 腹股沟斜疝 小儿 

分 类 号：R726.5[医药卫生—儿科]