自制穿刺带线针辅助单孔腹腔镜疝囊高位结扎术治疗小儿腹股沟疝

Single-port laparoscopic high hernia sac ligation assisted by self-made thread-attached puncturing needle for pediatric inguinal hernia

目的:探讨自制穿刺带线针辅助单孔腹腔镜下疝囊高位结扎术中治疗小儿腹股沟疝的可行性与疗效。方法:回顾性分析2012年1月—2014年11月期间收治的47例小儿腹股沟疝患者资料,其中23例行自制穿刺带线针辅助单孔腹腔镜下疝囊高位结扎术(腹腔镜组),采用全身麻醉;24例行传统开放性疝囊高位结扎术(开放组),采用连续硬膜外麻醉。比较两组患者的相关临床指标。结果:腹腔镜手术均获成功,无中转开腹。与开放组比较,腹腔镜组手术时间缩短(8.26 min vs.36.54 min),术中出血量降低(0.63 m L vs.4.15 m L)、术后住院时间减少(1.39 d vs.3.75 d),但住院费用增加(6 682.18元vs.4 385.93元),差异均有统计学意义(均P<0.05);腹腔镜组无术后并发症,开放组术后发生并发症5例,其中阴囊血肿3例,皮下血肿2例,两组总并发症发生率差异有统计学意义(0 vs.20.8%,P<0.05)。两组随访期间均无复发病例。结论:自制穿刺带线针辅助下单孔腹腔镜治疗小儿腹股沟疝安全有效、具有微创、无明显瘢痕、并发症少等优点。

Objective： To investigate the feasibility and efficacy of single-port laparoscopic high hernia sac ligation with assistance of a self-made thread- attached puncturing needle in treatment of inguinal hernia in children. Methods： The clinical data of 47 pediatric patients with inguinal hernia treated during January 2012 to November 2014 were retrospectively analyzed. Of the patients, 23 cases underwent single-port laparoscopic high hernia sac ligation assisted by self-made thread- attached puncturing needle （laparoscopic group）, with general anesthesia; 24 cases were subjected to conventional open hernia sac ligation （open surgery group）, with continuous epidural anesthesia. ＂lhe main clinical variables between the two groups of patients were compared. Results： All laparoscopic procedures were successfully performed, without any conversion to open surgery. In laparoscopic group compared with open surgery group, the operative time was shortened （8.26 min vs. 36.54 min）, intraoperative blood loss was decreased （0.63 mL vs. 4.15 mL）, length of postoperative hospital stay was reduced （1.39 d vs. 3.75 d）, while the hospitalization cost was increased （6 682.18 yuan vs. 4 385.93 yuan）, and all the difference had a statistical significance （all P〈0.05）. Postoperative complications occurred in none of the cases in laparoscopic group, but in 5 cases in open surgery group, which included scrotal hematoma in 3 cases and subcutaneous hematoma in 2 cases, and the overall incidence of postoperative complications had a statistical difference between the two groups （0 vs. 20.8%, P〈0.05）. No recurrence was found in either of the groups during follow-up period. Conclusion： Single-port laparoscopic high hernia sac ligation assisted by self-made thread- attached puncturing needle in treatment of pediatric inguinal hernia is safe and effective, with the advantages of minimal invasion, no visible scar and less complications.