小儿腹腔镜单部位腹内缝扎与单孔腹膜外结扎关闭腹股沟内环的疗效对比  

Single-site intracorporeal purse.string stitching versus single.port extracorporeal knotting for laparoscopic inguinal inner ring closure in children： a comparative study

作　　者：刘雪来[1] 费川[1] 张永婷[1] 孙驰[1] 方燕彬 杨晓锋[1] 刘琳[1] 李索林[1] Liu Xuelai Fei Chuan Zhang Yongting Sun Chi Fang Yanbin Yang Xiaofeng Liu Lin Li Suolin.(Department of Pediatric Surgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Chin)

机构地区：[1]河北医科大学第二医院小儿外科,石家庄050000

出　　处：《中华普通外科杂志》2017年第4期328-331,共4页Chinese Journal of General Surgery

基　　金：国家卫生与计划生育委员会公益性行业科研专项资助项目（201402007）

摘　　要：目的比较经脐单部位两孔腹腔镜内环缝扎术与单孔腹腔镜监视下双钩套扎针腹膜外内环结扎术治疗小儿腹股沟疝的临床效果。方法回顾性分析2008年6月至2014年12月间河北医科大学第二医院完成的358例小儿腹腔镜腹股沟疝临床资料，其中126例经腹壁带人缝合针线完成经脐单部位腹腔内疝环缝扎术，232例采用双钩套扎针经脐单孔腹腔镜监视下完成腹膜外内环结扎术。结果腹内缝扎术组手术时间比腹膜外结扎术组长[单侧：（20．4±2．1）min比（9．4±1．3）min，t=-5．23。P〈0．01；双倾4：（31．3±2．9）min比（15．2±1．7）min，t=-4．22，P〈0．011。两组患儿住院时间相比差异无统计学意义[（2．35±0．25）d比（2．38±0．18）d，t=-0．062。P〉0．05）]。腹内缝扎术组5例术中出现血肿，1例疝复发，3例形成鞘膜积液；腹膜外结扎术组6例因网膜粘连或痛环宽大松弛需要在脐旁放入辅助钳完成手术，2例术后出现线结反应，1例疝复发，1例形成鞘膜积液。结论经脐单部位两孔腹腔镜内疝环缝扎术与单孔腹腔镜监视下双钩套扎针腹膜外内环结扎术均是安全可行的隐瘢痕手术。借助注水分离精索结构与腹膜间隙使得双钩套扎针在单孔腹腔镜监视下更便于套扎内环，手术时间短，易于掌握。Objective To compare the surgical and functional outcomes of single-site （transumbilical two-port） intracorporeal purse-suturing （IP） and single-port extracorporeal knotting （EK） for laparoscopic pediatric inguinal hernia （PIH） repair. Methods Between June 2008 and December 2014, 358 PIH children underwent laparoscopic inguinal herniorrhaphy, including 126 treated by single-site intracorporeal purse string stitching using a needle-holder （IP group） , and 232 by single-port extracorporeal knotting using an inner two-hook needle with preperitoneal hydrodissection （EK group）. Results In all patients laparoscopic procedures were completed successfully without conversion. The operating time in IP group was significantly longer than that in EK group [ unilateral ： （20. 4 ± 2. 1 ） rain vs. （9.4 ± 1.3 ） min, t= -5.23,P〈0.01; bilateral： （31.3±2.9） min vs. （15.2±1.7） min, t= -4.22, P〈0.01）]. The hospital stay were similar between the two groups [ （2. 35 ±0. 25） d vs. （2. 38 ±0. 18） d, t = -0. 062, P 〉 0. 05 ]. Five cases had intraoperative hematoma in the IP group while none in the EK group. One each suffered from recurrence in IP group and EK group. Three postoperative hydroceles were seen in IP group and one in EK group. Subcutaneous knot granulomas were seen in two in EK group. Conclusions Both IP and EK laparoseopic procedures are safe and feasible. With the assistance of preperitoneal hydrodissection technique, single-port laparoscopic EK hemiorraphy is superior to single-site IP repair in easy performance and shorter operation time.

关 键 词：疝 腹股沟 疝修补术 腹腔镜 

分 类 号：R726.5[医药卫生—儿科]