一步法腹壁穿刺行腹腔镜小儿疝囊高位结扎术临床效果观察  

Clinical effect of one-step puncture using clamp type needle assisted laparoscopic high ligation of hernia sac in the treatment of indirect inguinal hernia in children

作　　者：翟佳琪 尚培中[1] 苗建军[1] 刘冰[1] 石德光[2] 李晓武[1] 杜欣[1] 郭宏荣 ZHAI Jia-qi;SHANG Pei-zhong;MIAO Jian-jun;LIU Bing;SHI De-guang;LI Xiao-wu;DU Xin;GUO Hong-rong(Department of General Surgery,the Hospital of PLA 81st Group Army,Zhangjiakou 075000,China;Department of General Surgery,the Air Force Hospital of PLA Central Theater Command,Datong 037006,China)

机构地区：[1]中国人民解放军陆军第八十一集团军医院普通外科,河北张家口075000 [2]中国人民解放军中部战区空军医院普通外科,山西大同037006

出　　处：《中国现代普通外科进展》2020年第9期688-691,共4页Chinese Journal of Current Advances in General Surgery

基　　金：张家口市科学技术研究与发展计划项目(1921123H)。

摘　　要：目的:探讨采用钳式针一步法腹壁穿刺行腹腔镜疝囊高位结扎术治疗小儿腹股沟斜疝的安全性及临床效果。方法:回顾性分析2013年1月-2018年6月131例身高≤120 cm、疝囊颈前后直径≤1.5 cm的单侧腹股沟斜疝患儿的临床资料,其中2013年1月-2015年2月采用传统方法行开放手术的48例作为对照组,2015年3月-2018年6月采用钳式针一步法腹壁穿刺行腹腔镜手术的83例作为观察组,对比分析两组手术时间、术中出血量、发现对侧隐匿性疝例数、术后24 h疼痛评分、阴囊(阴唇)肿胀、住院时间及术后1年复发情况。结果:观察组与对照组相比,手术时间分别为(11.8±3.2)min和(16.4±4.6)min,术中出血量分别为(1.7±1.3)mL和(2.5±1.5)mL,发现对侧隐匿性疝例数分别为10例(12.0%)和0例,术后24 h疼痛评分分别为(1.2±0.6)分和(2.7±0.5)分,发生阴囊(阴唇)肿胀分别为0例和4例(8.3%),住院时间分别为(2.1±1.1)d和(4.2±1.3)d,上述6项指标两组差异均有统计学意义(均P<0.05);术后1年复发率两组分别为2.4%(2/83)和4.2%(2/48),差异无统计学意义(P>0.05)。结论:与开放手术相比,采用钳式针一步法腹壁穿刺行腹腔镜疝囊高位结扎术,可缩短手术及住院时间,减少失血量及阴囊(阴唇)肿胀,尤其在发现和同期处理对侧隐匿性疝方面具有明显优势,但术后复发率两术式相当。Objective:To evaluate the clinical efficacy and safety of one-step puncture using clamp type needle assisted laparoscopic high ligation of hernia sac in the treatment of indirect inguinal hernia in children.Methods:The clinical data of 131 patients(≤120 cm in height)with indirect inguinal hernia(≤1.5 cm in diameter of hernial neck)treated from January 2013 to June 2018 were retrospectively analyzed.Among them,48 patients underwent traditinal open surgery from January 2013 to February 2015(control group).83 patients underwent laparoscopic surgery from March 2015 to June 2018(observation group).The time of operation,intraoperative blood loss,the number of cases of contralateral occult hernia was found,pain score 24 hour after surgery,the incidence of scrotal or labial swelling,hospitalization time and recurrence rate 1 year after surgery were compared between the two groups.Results:The time of operation,intraoperative blood loss,the number of cases of contralateral occult hernia was found,pain score 24 hour after surgery,the incidence of scrotal or labial swelling,hospitalization time were(11.8±3.2)min,(1.7±1.3)mL,10(12.0%),(1.2±0.6)points,0,(2.1±1.1)d in observation group and(16.4±4.6)min,(2.5±1.5)mL,0,(2.7±0.5)points,4(8.3%),(4.2±1.3)d in control group respectively.The difference above was statistically significant(all P<0.05).The recurrence rate 1 year after surgery(2/83 vs 2/48)between the two groups were not statistically significant(P>0.05).Conclusion:Laparoscopic surgery for pediatric indirect inguinal hernia could reduce the time of operation and hospitalization,intraoperative blood loss,postoperative pain score,the incidence of scrotal or labial swelling and hospitalization time.It has obvious advantages in the detection and management of contralateral occult inguinal hernia.There was no statistically significant difference in recurrence rate 1 year after surgery between the two groups.

关 键 词：疝 腹股沟 儿童 腹腔镜检查 疝囊高位结扎术 

分 类 号：R656.21[医药卫生—外科学]