经脐单部位腹腔镜鞘状突环扎术治疗小儿鞘膜积液临床研究

Clinical research of hydrocele of testis treated by single port laparoscopic percutaneous extraper-itoneal processus cerclage

目的：观察经脐单部位腹腔镜鞘状突环扎术治疗小儿鞘膜积液的临床效果。方法选择2014年1月至2015年3月接受治疗的鞘膜积液的男性患儿60例作为研究对象，随机分成两组，每组30例。对照组患儿接受开放性横切口鞘状突高位结扎术治疗。观察组患儿接受经脐单部位腹腔镜鞘状突环扎术治疗。比较两组患儿的手术情况，主要包括单侧和双侧手术时间、切口长度和出血量；观察两组患儿对侧隐匿性开放鞘状突、无开放鞘状突、积液自行回流、挤压回流和穿刺抽液情况；对比两组患儿的住院情况，包括住院时间、麻醉手术费和治疗总费用；同时观察住院期间两组患儿并发症的发生情况。结果单侧手术观察组和对照组手术时间比较差异未见统计学意义（P〉0.05），双侧手术观察组时间少于对照组，且观察组切口长度短于对照组、出血量低于对照组，差异有统计学意义（P〈0.05）。观察组的切口长度短于对照组，出血量低于对照组，差异有统计学意义（P〈0.05）。两组对侧隐匿性开放鞘状突、无开放鞘状突、积液自行回流、挤压回流和穿刺抽液情况比较差异未见统计学意义（P〉0.05）。观察组的麻醉手术费、治疗总费用高于对照组，住院天数短于对照组，差异有统计学意义（P〈0.05）。两组并发症的发生率比较差异未见统计学意义（P〉0.05），经对症处理后均康复预后。结论经脐单部位腹腔镜鞘状突环扎术在小儿鞘膜积液的治疗中具有很高的应用价值，具有创伤小、出血量低、术后预后快的优点，同时能发现对侧未闭鞘状突并予以处理，从而降低术后对侧复发率。

Objective To observe the clinical effect of hydrocele of testis treated by single port laparoscopic percutaneous extraperitoneal processus cerclage. Methods Selected 60 male children with hydrocele of tunica vaginalis from January 2014 to March 2015 as the objects,and they were randomly di-vided into two groups,with 30 cases in each group. Observation group：the 30 patients were treated by open operative high ligation of sheath of transverse cutting. Treatment group：the 30 patients were treated by single port laparoscopic percutaneous extraperitoneal processus cerclage. Compared the operation situ-ation,mainly included the time of operation,length of incision and amount of bleeding of the unilateral and bilateral. Observed the contralateral occult inguinal indirect hernia,no open processus vaginalis,hy-drops reflux by itself,extruding reflux and the situation of tapping of them. Compared the hospitalization condition of the two groups,which mainly included hospital stays,operation fee of anesthesia and total cost of treatment. At the sametime,the incidence of complications between the two groups were ob-served. Results Therewas no significant difference in the aperation time between the two groups（P〉0. 05）. The operation time of the treatment group was less than the bilateral operation observation group, and the length of incision of the treatment group was shorter than that of the lonhtrol group,the amount of bleeding was less than that of the control group,there were significant differences（ P〈 0. 05）. The length of incision of the treatment group was shorter than that the control group,there was significant difference（P〈 0. 05）. There were no significant differences in the contralateral occult inguinal indirect hernia,no open processus vaginalis,hydrops reflux by itself,extruding reflux and the situation of tapping （P〉 0. 05）. The operation fee of anesthesia and total cost of the treatment group was higher than control＆amp;nbsp;group,there were significant difference（P〈 0. 05）. There was no significant diflerence in the incidence of complications of them （ P〉 0. 05 ）, and they had rehabilitation after expectant treatment. Conclusions It has very high application value of hydrocele of testis treated by single port laparoscopic percutaneous extraperitoneal processus cerclage,and with the advantage such as less trauma,lower bleeding and faster prognosis after operation,so it is worthy of promotion.