开放手术与腹腔镜手术治疗小儿腹股沟斜疝的疗效比较

Treatment of pediatric inguinal hernia: open versus laparoscopic surgery

目的:比较开放手术与腹腔镜手术治疗小儿腹股沟斜疝的疗效。方法:121例腹股沟斜疝患儿,行开放疝囊高位结扎术73例(A组),采用18G套管针经二孔腹腔镜辅助腹膜外疝囊高位环扎术48例(B组),比较两组疗效及并发症发生情况。结果:A组并发症发生率3.9%,B组无并发症发生。B组术中发现对侧存在开放鞘状突18例(38%),同时行对侧开放鞘状突高位结扎。单侧手术时间、术后24 h内出院率两组比较差异均无统计学意义(P>0.05)。双侧手术时间两组比较差异有统计学意义(P<0.05)。术后随访两组均无复发、睾丸萎缩、肠黏连等。结论:小儿腹股沟斜疝采用腹腔镜手术安全有效,较开放手术在对侧开放鞘状突处理方面更具优势。

Objective： To investigate and compare the outcomes of open and laparoscopic surgery in treating inguinal hernia in children. Methods： One hundred and twenty-one cases of inguinal hernia underwent surgeries, including 73 children who received open hernia repair （ group A） and 48 children who underwent complete extraperitoneal ligation of the patencies of processus vaginalis （PPV） by laparoseopic technique using 18 G vasocan （group B）. Results： Complication rate of open surgery was 3.9 %. No complication happened in laparoscopic group. Eighteen cases （38 % ） in group B had contralateral patencies of proeessus vaginalis （CPPV）. There was no significant difference in unilateral operation time and discharge rate within 1 postoperation day between the two groups, while bilateral operation time showed significant difference. No patient had recurrence, testicular atrophy or peritoneum adhesion in follow-up. Conclusions： Laparoscopic herniorrhaphy is simple, safe, and effective as open surgery and has more advantages in cases with CPPV.