腹腔镜与微创小切口手术治疗小儿腹股沟疝的临床疗效比较

The clinical effects of laparoscopic or small incision minimally invasive surgery for pediatric inguinal hernia

目的:探讨脐部切口腹腔镜手术与腹横纹下微创小切口治疗小儿腹股沟疝的临床疗效及安全性。方法:回顾分析200例单侧小儿腹股沟疝患儿的临床资料,将其分为实验组(n=104)与对照组(n=96),实验组行腹腔镜下疝囊高位结扎术,对照组采用腹横纹下小切口行疝囊高位结扎术,对比两组手术时间、术中失血量、术中对侧隐匿性疝发现率、术后下床活动时间、术后并发症、住院时间及住院总费用,门诊随访12～18个月,比较两组患儿术后疝的复发情况。结果:两组手术时间、术后下床活动时间及复发率差异无统计学意义(P>0.05);而实验组术中失血量、对侧隐匿性疝发生率、术后并发症及住院时间方面均优于对照组,但住院总费用稍高于对照组,差异有统计学意义(P<0.05)。结论:与腹横纹下小切口手术相比,腹腔镜手术治疗小儿腹股沟疝具有损伤小、术后康复快及住院时间短等优势,且便于术中发现存在的对侧隐匿性疝,具有良好的应用前景。

Objective： To explore the clinical effects and security of laparoscopic or small incision minimally invasive surgery for pediatric inguinal hernia. Methods： Two hundred children with unilateral inguinal hernia were divided into the experimental group （104 cases） and control group （96 cases）. The control group underwent high ligation of hernia sac via lower abdominal small transverse incision,and the experimental group was given laparoscopic high ligation of hernia sac. The operation time,intraoperative blood loss,discovery rate of contralateral concealed hernia,postoperative ambulation time,postoperative complications,the hospital stay and the total cost in hospital were compared between the two groups. The outpatient follow-up survey had been made for 12-18 months,the postoperative hernia recurrence in the two groups were compared. Results： There were no statistically significant difference between the two groups in operation time,postoperative ambulation time and hernia recurrence rate （P 〉 0. 05）. The experimental group was superior over the control group in intraoperative blood loss,incidence of the contralateral occult hernia,postoperative complications and hospital stay （P 〈 0. 05）. While the hospital total cost was higher than that of control group,there was statistically significant difference between the two groups （P 〈 0. 05）. Conclusions： Compared with the small transverse incision surgery,laparoscopic surgery in the treatment of pediatric inguinal hernia is associated with small trauma,rapid recovery and short hospital stay,and the contralateral concealed hernia is easily found,laparoscopic surgery has good prospects for application.