单孔腔镜与开放手术治疗小儿鞘膜积液疗效比较

Curative effact comparison between single port laparoscopy and open surgery for treatment of pediatric hydrocele

目的比较单孔腹腔镜经皮腹膜外鞘状突环扎术和开放性横切口鞘状突高位结扎术两种方法对小儿鞘膜积液的治疗效果。方法将2010年1月~2014年3月何贤纪念医院泌尿外科收治的566例确诊鞘膜积液的患儿按数字表法随机分为腔镜组297例和开放组269例,分别接受单孔腹腔镜经皮腹膜外鞘状突环扎术和开放性横切口鞘状突高位结扎手术。比较两组患儿的手术情况、住院情况和术后并发症的发生情况。结果腔镜组手术顺利进行,无中转开放,发现对侧开放性鞘状突（PPV）16例（5.39%）、患侧无PPV 10例（3.37%）,积液自行回流136例（45.79%）、挤压回流52例（17.51%）、需穿刺抽液109例（36.70%）,与开放组比较各指标差异无统计学意义（P〉0.05）。腔镜组单侧手术时间（17.9±2.8）min,双侧手术时间（24.6±2.7）min,出血量（2.1±0.5）ml,切口长度（3.0±0.1）mm,各手术指标均少于开放组,差异有统计学意义（P〈0.05）。腔镜组住院时间（2.1±0.1）天、总治疗费用（5 383.6±198.5）元、麻醉手术费（2 035.6±126.3）元,腔镜组住院时间短于开放组,而治疗费用高于开放组,差异有统计学意义（P〈0.05）。两组并发症发生率比较差异无统计学意义（P〉0.05）。结论单孔腹腔镜经皮腹膜外鞘状突环扎术与开放性手术相比切口小、创伤小、手术时间短、恢复快、美容效果好,有腹腔镜手术条件的医院可作为治疗小儿鞘膜积液首选方法。

Objective： To compare the curative effect between single port laparoscopic percutaneous extraperitoneal processus cerclage and open operative high ligation of sheath of transverse cutting for treatment of pediatric hydrocele. Methods： From January 2010 to March 2014,a total of 566 male pediatric patients who were admitted to Department of Urinary Surgery in Hexian Memorial Hospital and were diagnosed as hydrocele were included in this study. According to random number table,these male pediatric patients were divided into laparoscopic group including 297 cases and open surgery group including 269 cases,and single port laparoscopic percutaneous extraperitoneal processus cerclage and open operative high ligation of sheath of transverse cutting were conducted respectively in each group. Operation condition,hospitalization status and postoperative complications between the two groups were compared. Results： In the laparoscopic group,all cases were successfully performed without changing into open operation,among which 16 patients（ 5. 4%） with patent process vaginalis（ PPV） on the contralateral side,10 patients（ 3. 4%） without PPV,136 patients（ 45. 8%） with hydrops automately reflow,52 patients（ 17. 5%） with hydrops extrused to reflow,and 109 patients（ 36. 7%） that needed to aspire. There was no statistically significant difference compared with open surgery group（ P〈0. 05）. The average operation time in laparoscopy group was（ 17. 9±2. 8） minutes for unilateral lesions and（ 24. 6±2. 7） minutes for bilateral lesions,the amount of bleeding was（ 2. 1±0. 5） ml and the length of incision was（ 3. 0±0. 1） mm. The above operation indicators were all lower than those in open surgery group with significant difference（ P〈0. 05）. The length of stay was（ 2. 1±0. 1） days,and total hospitalization cost was（ 5 383. 6±198. 5） RMB,anesthesia and operation cost was（ 2 035. 6±126. 3） RMB in laparoscopy group. The length of stay in laparoscopy group was shorter than that in open surgery group,while treatment cost was higher,and there was statistically significant difference between them（ P〈0. 05）. With regard to occurrence of complications,there was no statistically significant difference between the two groups（ P〈0. 05）. Conclusion： Compared with open surgery,single port laparoscopic percutaneous extraperitoneal processus cerclage has smaller incision,milder invasion,shorter operation time,quicker recovery,and better cosmetic outcomes. Single port laparoscopic can be considered as the first choice for pediatric hydrocele in hospitals that have laparoscopic condition.