预防腹腔镜小儿腹股沟疝术后复发的手术策略

Surgical strategy of preventing recurrence of laparoscopic pediatric inguinal hernia

目的探讨预防腹腔镜小儿腹股沟疝术后复发的手术策略。方法用前瞻性的随机对照研究方法将入组的480例腹股沟疝患儿分为实验组和对照组。实验组240例，根据疝环大小及脐内侧襞情况采取不同手术方式。疝环直径≤1.5 cm，行单纯疝囊高位结扎术；疝环直径〉1.5 cm，若疝同侧脐内侧襞明显，则行疝囊高位结扎＋脐内侧襞缝合覆盖内环口，若脐内侧襞不明显，则行双重疝囊高位结扎术。对照组240例，全部行腹腔镜单纯疝囊高位结扎术。结果实验组共修补疝323侧，对照组321侧。实验组的手术时间为（12.1±7.4）min，对照组为（11.2±5.5）min；术后第1天VAS疼痛评分实验组为2.6±1.8，对照组为2.3±1.7；实验组发生5例阴囊血肿，1例伤口感染，对照组8例阴囊血肿，无伤口感染病例发生。实验组1侧复发，复发率为0.31%，而对照组为4侧，复发率为1.25%；以上两组之间的差异均无统计学意义（P〉0.05）。对于疝环〉1.5 cm的患儿，实验组共修补疝128侧，对照组107侧，实验组的手术时间为（14.2±6.2）min长于对照组的（11.5±4.8）min（P〈0.05）；实验组无复发病例，对照组为4侧，实验组复发率小于对照组（P〈0.05）。结论腹腔镜治疗小儿腹股沟疝，疝环≤1.5 cm的患儿可行单纯疝囊高位结扎术，疝环〉1.5 cm的患儿，根据脐内侧襞情况行脐内侧襞缝合覆盖内环口或双重疝环结扎等方法加强疝环，可有效防止术后复发。

ObjectiveTo explore the surgical strategy of preventing recurrence of laparoscopic pediatric inguinal hernia.MethodsA total of 480 children with inguinal hernia were divided randomly into experimental （n=240） and control （n=240） groups. Different surgical approaches were adopted on the basis of size of hernia ring and medial umbilical fold. For hernia ring diameter ≤1.5 cm, simple hernia sac high ligation was performed; for hernia ring diameter 〉1.5 cm, if hernia ipsilateral medial umbilical folds were obvious, high ligation of hernia sac and medial umbilical folds suturing inner ring was performed; if umbilical medial folds not obvious, double high ligation of hernia sac was performed. Laparoscopic simple hernia sac ligation was performed in all children. ResultsThe number of repaired sides was 323 in experimental group and 321 in control group. The operative duration was （12.1±7.4） min in experimental group and （11.2±5.5） min in control group. VAS pain score was 2.6±1.8 in experimental group and 2.3±1.7 in control group at Day 1 postoperatively. In experimental group, there were scrotal hematoma （n=5）, wound infection （n=1）; in control group, scrotal hematoma （n=8） and wound infection （n=0）. In experimental group, there was one recurrent side with a recurrence rate of 0.31%; in control group, there were 4 recurrent sides with a recurrence rate of 1.25%; There was no statistically significant inter-group difference （P〉0.05）. For hernia ring〉1.5 cm, experimental group repaired hernia 128 sides and control group 107 sides. The operative duration was （14.2±6.2） min in experimental group and it was longer than that of control group （11.5±4.8） min （P〈0.05）. There were no recurrent case in experimental group and 4 sides in control group. The recurrence rate in experimental group was lower than that in control group （P〈0.05）.ConclusionsLaparoscopic treatment of inguinal hernia in children, high ligation of hernial sac may be performed for hernia ring≤1.5 cm. For hernia ring 〉1.5 cm, based upon medial umbilical folds, medial umbilical folds suture covering inner ring or double hernia ring ligation may be employed for strengthening hernia ring and preventing recurrent hernia.