腹腔镜经脐单部位疝囊高位结扎术中输精管不同处理的对比研究

Clinical comparative study of different methods of internal ring closure for single-port laparoscopic high ligation of hernia sac

目的比较腹腔镜经脐单部位疝囊高位结扎术中输精管不同处理方案的临床疗效及并发症。方法回顾性分析安徽省儿童医院2013年1-11月收治的146例男性腹股沟斜疝患儿的临床资料,其中观察组72例,采用小范围旷置输精管周围腹膜的方法缝合关闭内环口,对照组74例,常规完整环绕缝合内环口处腹膜,比较二组手术时间、手术并发症、术后住院时间以及复发情况（随访2年）。结果二组患儿均顺利完成手术。观察组发生单侧精索血管损伤1例及腹壁下血管损伤1例,对照组术中发生单侧精索血管损伤2例。单侧疝观察组手术时间为（12.8±2.8）min,对照组为（15.4±4.8）min,差异有统计学意义（P=0.039）。双侧疝观察组手术时间（15±3）min,对照组为（20±4）min,差异有统计学意义（P=0.043）。二组术后住院时间差异无统计学意义（P=0.537）。术后随访2年,均无脐疝、睾丸萎缩、睾丸下降不全等并发症发生。观察组1例鞘膜积液,注射器抽吸后自行愈合,对照组无复发患者。结论单部位腹腔镜疝囊高位结扎术中采用小范围旷置输精管周围腹膜的方法缝合关闭内环口较传统方法操作简单,学习曲线短,手术时间缩短,避免了输精管损伤的可能,是一种安全、可靠、有效的手术方式,但因本研究临床例数偏少,其远期效果有待进一步观察。

Objective To investigate the clinical effect and complications of different methods to closure the peritoneum around deferent duct for single-port laparoscopic high ligation of hernia sac. Methods A total of 146 male cases with indirect inguinal hernia were collected from January 2013 to November 2013 in Anhui provincial children＇s hospital. They were divided into two groups： 72 cases in the observation group were treated by the slight exclusion of peritoneum around deferent duct,and 74 cases in the control group underwent the traditional method. Both of them were compared with operation time, complications,postoperative hospital stay and recurrence（ 2 years follow-up）. Results The operation was successfully completed in all of the cases. 1 case of unilateral spermatic cord vessel injury and 1 case of inferior epigastric vessel injury occurred in observation group,while 2 cases of unilateral spermatic cord vessel occurred in control group. The difference of operation time was significant for unilateral procedures between the observation group and control group（ 12. 8 ± 2. 8 minutes,15. 4 ± 4. 8 minutes,respectively,P = 0. 039）.The difference of operation time was significant for bilateral procedures between the two groups（ 15 ±3 minutes,20 ± 4 minutes,respectively,P = 0. 043）. No significant difference were found between the two groups in postoperative hospital stay（ P = 0. 537）. No umbilical hernia, orchiatrophy or incomplete orchiocatabasis was found at follow-up 2 years after surgery. 1 case of hydrocele occurred in the observation group,and no recurrence was found in control group. Conclusion Slight exclusion of peritoneum around deferent duct for single-port laparoscopic high ligation of hernia sac is associated with more simple procedure,shorter learning curve,shorter operative time,and avoiding deferent duct injury. It has been shown as a safe and effective procedure in clinical practice. But its long term effect should be further observed due to the small sample size.