腹腔镜下脐内侧襞荷包缝合联合内环口高位结扎治疗小儿巨大腹股沟疝的效果观察

The effect of suturing medial umbilical fold purse combined with inner mouth mouth high ligation of laparoscopic on children with huge inguinal hernia

目的探讨腹腔镜下脐内侧襞荷包缝合联合内环口高位结扎治疗小儿巨大腹股沟疝的临床效果。方法选择我院2012年2月~2014年6月收治的单侧巨大腹股沟疝患儿80例,按照随机数字法分为两组,各40例,对照组实施开放疝囊高位结扎或修补术,观察组实施腹腔镜双荷包加缝脐内侧襞内环口高位结扎术。对所有患儿随访1年,比较两组手术时间、术中出血量及总住院时间,统计两组并发症情况、术后肛门排气时间、下床时间及术后复发情况。结果观察组手术时间短于对照组（P〈0.05）,术中出血量少于对照组（P〈0.05）,总住院时间短于对照组（P〈0.05）,观察组发生术后腹膜后血肿、鞘膜积液、阴囊肿胀及皮下气肿等的总发生率显著低于对照组（P〈0.05）,观察组术后肛门排气时间、下床时间均早于对照组（P〈0.05）,术后复发率显著低于对照组（P〈0.05）。结论腹腔镜下双荷包加缝脐内侧襞内环口高位结扎术治疗小儿巨大腹股沟疝,手术时间短,术中出血少,且能显著减少并发症,提高患者术后恢复效率,尤其适用于巨大腹股沟疝患儿。

Objective To evaluate the effect of suturing medial umbilical fold purse combined with inner mouth mouth high ligation of laparoscopic on children with huge inguinal hernia.Methods 80 cases with pediatric huge unilateral inguinal hernia in our hospital from February 2012 to June 2014 were randomly divided into two groups according to the method of random numbers,with each group 40 cases.In the control group were implemented with open high ligation of hernia sac or neoplasty,in the observation group laparoscopic double slit pockets plus medial umbilical fold with inner mouth high ligation were used.All patients were followed for one year,then operative time,intraoperatve blood loss and total hospitalization time were compared,complications,postoperative anal exhaust time,time of leaving bed and postoperative recurrence were statisticed in two groups.Results The operative time in the observation group was shorter than that in the control group（P〈0.05）,intraoperatve blood loss in the observation group was less than that in the control group（P〈0.05）,total hospitalization time in the observation group was shorter than that in the control group（P〈0.05）,the overall incidence rate of postoperative retroperitoneal hematoma,hydrocele of tunica vaginalis,scrotal swelling and subcutaneous emphysema in the observation group was lower than that in the control group respectively（P〈0.05）,postoperative anus exhaust time and time of leaving bed in the observation group was earlier than that in the control group respectively（P〈0.05）,recurrence rate in the observation group was lower than that in the control group（P〈0.05）.Conclusion Laparoscopic double slit pockets plus medial umbilical fold the inner mouth high ligation in treatment of children with huge inguinal hernia can shorten operative time,and it has less intraoperate blood loss and it can reduce complications and improve postoperative recovery efficiency,so it is suitable especially for huge inguinal hernia in children.