二步法腹壁穿刺行腹腔镜手术与开放手术治疗小儿腹股沟斜疝对比分析  

Comparative Analysis between Laparoscopic Two-step Puncture Method and Traditinal Open Surgery in the Treatment of Indirect Inguinal Hernia in Children

作　　者：张静[1] 翟佳琪 尚培中[2] 苗建军[2] 刘冰[2] 石德光[3] 李晓武[2] 杜欣[2] 郭宏荣 ZHANG Jing;ZHAI Jia-qi;SHANG Pei-zhong;MIAO Jian-jun;LIU Bing;SHI De-guang;LI Xiao-wu;DU Xin;GUO Hong-rong(Department of Anesthesiology,The 81 st Group Army Hospital of the PLA,Zhangjiakou,Hebei 075000,China;Department of General Surgery,The 81 st Group Army Hospital of the PLA,Zhangjiakou,Hebei 075000,China;Department of General Surgery,The Air Force Hospital of PLA Central Theater,Datong,Shanxi 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麻醉科,河北张家口075000 [2]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 [3]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：《河北北方学院学报（自然科学版）》2020年第12期10-13,17,共5页Journal of Hebei North University:Natural Science Edition

基　　金：张家口市科学技术研究与发展计划项目(No.1921123H)。

摘　　要：目的对比分析二步法腹壁穿刺行腹腔镜疝囊高位结扎术与传统方法施行开放手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2013-03-2018-06月身高≤120 cm、内环口疝囊颈直径≤1.5 cm的小儿单侧腹股沟斜疝患者112例临床资料,2013-03-2015-02月采用传统方法施行开放手术的48例作为开放组,2015-03-2018-06月采用硬膜外针二步法腹壁穿刺施行腹腔镜手术的64例作为腹腔镜组。结果腹腔镜组与开放组相比,手术时间分别为(12.4±2.9)min和(16.4±4.6)min,术中出血量分别为(1.9±1.3)mL和(2.5±1.5)mL,发现对侧隐匿性疝例数分别为8例(12.5%)和0例,术后24 h疼痛评分分别为(1.3±0.5)分和(2.7±0.5)分,住院时间分别为(2.2±1.1)d和(4.2±1.3)d,上述5项指标组间差异均有统计学意义(均P<0.05);2组术后发生阴囊(阴唇)肿胀分别为1例(1.6%)和4例(8.3%),1年复发率分别为3.1%(2/64)和4.2%(2/48),上述2项指标差异均无统计学意义(P>0.05)。结论对身高≤120 cm、内环口疝囊颈直径≤1.5 cm的小儿单侧腹股沟斜疝采用硬膜外针二步法腹壁穿刺施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,减轻术后疼痛,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1年复发率与开放手术相当。Objective To evaluate the clinical efficacy and safety of laparoscopic two-step puncture method using epidural needle versus traditinal open surgery in pediatric high ligation of indirect inguinal hernia sac.Methods Retrospect review was conducted to 112 pediatric patients(≤120 cm in height)with unilateral inguinal hernia(≤1.5 cm in diameter of hernial neck)in our hospital from March 2013 to June 2018,in which 64 cases were performed with epidural needle(laparoscopic group)from March 2015 to June 2018,and 48 cases were done with traditinal open surgery from March 2013 to February 2015(open group).Results There was significant difference between the two groups(laparoscopic group vs.open group)in regard to the duration of surgery[(12.4±2.9)min vs.(16.4±4.6)min],intraoperative blood loss[(1.9±1.3)mL vs.(2.5±1.5)mL],incidence of occult contralateral hernia[n=8(12.5%)vs.n=0],pain score at 24 hours after surgery[(1.3±0.5)vs.(2.7±0.5)],hospitalization time[(2.2±1.1)d vs.(4.2±1.3)d](all P<0.05).There was no difference between the two groups in regard to the incidence of scrotal or labial edema[n=1(1.6%)vs.n=4(8.3%)]and one-year recurrence rates[3.1%(2/64)vs.4.2%(2/48)](both P>0.05).Conclusions For pediatric patients(≤120 cm in height)with unilateral inguinal hernia(≤1.5 cm in diameter of hernial neck)who underwent laparoscopic high ligation of indirect inguinal hernia sac by two-step puncture method can reduce the time of operation and hospitalization,intraoperative blood loss and postoperative pain score.It has obvious advantages in the detection and management of occult contralateral hernia.There was no significant difference with one-year recurrence rates 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：R656.2+1[医药卫生—外科学] R726.1[医药卫生—临床医学]