两种经脐单孔腹腔镜手术治疗小儿腹股沟斜疝的对比研究

Comparative study on two kinds of transumbilical single-port laparoscopic approaches for the treatment of inguinal hernia in children

目的:探讨两种经脐单孔腹腔镜手术治疗小儿腹股沟斜疝的临床价值。方法:2013年1月至2014年12月选取600例腹股沟斜疝患儿,随机分为完全腹腔镜组(n=300)与硬膜外穿刺针组(n=300)。完全腹腔镜组于脐部放置Trocar,置入单孔带操作孔道的腹腔镜,由操作孔道置入持针器,1-0带针丝线由腹壁穿入腹腔,荷包缝合未闭内环口,腹腔内打结。硬膜外穿刺针组同样于脐部放置Trocar,以硬膜外针分别缝合内半圈及外侧半圈内环口,由硬膜外穿刺针导入丝线,线结打在腹膜外。结果:两组出血量、复发率、住院时间差异无统计学意义,完全腹腔镜组手术时间较长,硬膜外穿刺针组线结反应较大。结论:两种方式行疝囊高位结扎术微创、术后复发率低。采用硬膜外穿刺针手术时间更短,更容易掌握,但线结反应不可避免。完全腹腔镜组完全无疤痕,手术难度稍大,但无线结反应。

Objective：To explore the clinical value of two kinds of transumbilical single-port laparoscopic approaches for the treatment of inguinal hernia in children. Methods ：The clinical data of 600 children with indirect inguinal hernia who underwent laparo- scopic high ligation of hernia sac from Jan. 2013 to Dec. 2014 were analyzed. They were divided into two groups randomly. 300 cases performed total laparoscopy （TL group） and the other 300 cases performed epidural needle operation （EN group）. In the TL group, Troear was put through umbilicus. A laparoscope with an operating channel was inserted. The needle-holder was inserted through the op- erating channel. A needle with 1-0 non-absorbable suture was introduced into the peritoneal cavity through the anterior abdominal wall. The orifice of the hernia sac was closed around the internal inguinal ring, and then intraperitoneal knot-tying was performed. In the EN group, the Trocar was put as TL group. The epidural needle was used to suture the medial side of the internal ring and the lateral side. A silk suture was introduced into the peritoneal cavity by epidural needle. The internal ring was closed by knotting outside of peritone- um. Results：There were no significantly statistical differences between two groups in blood loss, recurrence incidence, and hospital stay. Operation time was longer in TL group than EN group, suture reaction was more obvious in EN group. Conclusions：Total laparoscopy and epidural needle approaches for the treatment of inguinal hernia in children are minimally invasive with low recurrence rate. The op- eration time is shorter in EN procedure,the operation skill can be mastered easily, but the knotting reaction cannot be avoided. There is totally no scar in total laparoscopy, the operation is a little difficult, but suture reaction will not happen.