单纯经脐腹腔镜在小儿复杂性腹股沟斜疝中的应用

Transumbilical laparoscopic surgery for the management of complex inguinal hernias

目的探讨单纯经脐腹腔镜在小儿复杂性腹股沟斜疝（复发疝、巨大疝、嵌顿疝）中的应用价值。方法收集2009年3月至2011年5月间在我院治疗复杂性腹股沟斜疝的患儿资料共52例，其中19例采用传统开放手术，33例采用单纯经脐腹腔镜手术。通过比较手术时间，术后住院时间，手术瘢痕，术后并发症的情况，评价两种手术方式在治疗该类儿童斜疝中的优劣。结果开放手术与单纯经脐腹腔镜手术平均手术时间分别为21．3min和23．2min；术后平均住院时间分别为2．3d和2．7d，两者差异均无统计学意义。开放手术平均瘢痕长度为3cm，而单纯经脐腹腔镜手术无明显瘢痕。开放手术术后阴囊水肿12例（63．2％），血肿1例，复发1例；单纯经脐腹腔镜手术仅有3例阴囊水肿（9．1％），无复发、血肿病例。结论在儿童嵌顿疝、复发疝、巨大疝的治疗中，单纯经脐腹腔镜与传统手术相比，手术时间与术后住院时间均无明显增加，但前者局部创伤小，手术效果可靠，并且术后几乎可达到无瘢痕的效果。

Objective To evaluate the feasibility of transumbilical laparoseopic surgery for the management of complex inguinal hernias in children. Methods Between March 2009 and May 201 l, a series of 52 patients with complex inguinal hernia including recurrent hernia, giant hernia and incarcer- ated hernia were enrolled in this study. Nineteen of them underwent open surgery, while the other 33 underwent transumbilical laparoscopic surgery. To evaluate the safety and efficacy of the 2 proce- dures, we retrospectively analyzed and compared the operating time, hospital stay after surgery, length of scars and complications between the two groups. Results There was no significant difference in operating time and length of hospital stay after surgery between the two groups. The average scar length of open surgery was 3 cm, whereas no obvious abdominal wall scar could be seen on patients with transumbilical laparoscopic surgery. Of the patients with open surgery, scrotal edema was,noted on 12, haematoma was noted on 1, and recurrence of inguinal hernia on 1. Of the patients with tran- sumbilical laparoscopic surgery, scrotal edema was noted on 3, no haematoma and hernia recurrence was observed. Conclusions Transumbilical laparoscopic surgery is safe and feasible for complex ingui- nal hernias, and leaves no obvious scar on body surface.