腹腔镜下疝囊高位结扎术对儿童腹股沟疝的临床治疗效果分析

Analysis of clinical therapeutic effect of laparoscopic high ligation of hernial sac in children with inguinal hernia

目的分析腹腔镜下疝囊高位结扎术对儿童腹股沟疝的临床治疗效果,探讨其临床价值。方法选取广东省清远市第二人民医院2011年11月至2013年11月收治的224例腹股沟疝患儿,按照随机数字表分为腹腔镜组及传统组,每组患儿112例,分别行腹腔镜下、传统疝囊高位结扎术治疗,比较二组患儿手术情况、并发症及随访复发、切口瘢痕情况。结果腹腔镜组切口长度、术中出血量、手术时间、术后疼痛时间、住院时间低于传统组,其治疗费用高于后者,差异均有统计学意义(P<0.05);腹腔镜组并发症发生率为6.3%,低于传统组的12.5%,差异有统计学意义(P<0.05),腹腔镜组阴囊血肿、鞘膜积液发生率均低于传统组,其戳孔处血肿发生率高于传统组,差异有统计学意义(P<0.05);二组患儿均获得有效随访,平均随访时间(11.4±2.8)个月,腹腔镜组患儿瘢痕率、复发率均低于传统组,差异均有统计学意义(P<0.05)。结论腹腔镜下疝囊高位结扎术具有手术时间短、切口小、术后恢复快、复发率低等多种优势,且能够保持较高的安全性及美观度,较传统术式体现了巨大优势,可作为儿童腹股沟疝的首选术式加以推广。

Objective To analyze clinical outcome of laparoscopic high ligation of hernia sac in children with inguinal hernia,and to explore its clinical value. Methods 224 cases of inguinal hernia admitted to the Second People＇ s Hospital of Qingyuan City from November 2011 to November 2013,were selected and randomly divided into laparoscopic group and traditional group,112 cases in each group,respectively. Operative parameters,complications,recurrence,and length of incisional scar were compared.Results The length of incision,intraoperative bleeding volume,operation time,postoperative pain,and hospitalization time in laparoscopic group were significantly lower than those in traditional group. While the former had higher cost of treatment than the latter（ P〈0. 05）; the incidence rate of complications in laparoscopic group was 6. 3%,significantly lower than that of traditional group 12. 5%（ P〈0. 05）; the incidence of scrotal hematoma and hydrocele of tunica vaginalis were significantly lower in laparoscopic group than that in traditional group; the hematoma in trocar site was significantly higher（ P〈0. 05）; both groups were followed up for a mean follow-up time of（ 11. 4 ± 2. 8） months,and the laparoscopic group had significantly lower scar and recurrence rate than those in traditional group（ P〈0. 05）. Conclusion Laparoscopic high ligation of hernia sac has various advantages of shorter operation time,incision,faster postoperative recovery and low recurrence rate,can keep a high security and cosmetic result,should be used and promoted as the preferred procedure of inguinal hernia in children.