不同手术方式治疗小儿腹股沟嵌顿斜疝的疗效对比研究

Efficacies of different surgical approaches for pediatric incarcerated inguinal hernia

目的探讨经脐单部位腹腔镜与传统开腹手术治疗小儿腹股沟嵌顿性斜疝的疗效。方法回顾性收集2014年1月至2017年2月由山西省儿童医院收治的58例经脐单部位腹腔镜手术治疗小儿腹股沟嵌顿性斜疝患儿作为经脐单部位腹腔镜组;选择同期55例经传统开放手术治疗的小儿腹股沟嵌顿斜疝患儿作为开腹手术组进行比较。结果经脐单部位腹腔镜组中57例在腹腔镜下完成手术,早期1例腹腔镜下复位困难,转传统开放手术。经脐单部位腹腔镜组手术时间平均为(25.5±10.5)min,开腹手术组平均为(37.0±15.2)min,差异有统计学意义(t=-5.756,P<0.05);切口长度经脐单部位腹腔镜组平均为(0.5±0.2)cm,开腹手术组平均为(3.5±1.5)cm,差异有统计学意义(t=-18.487,P<0.05);术中出血量经脐单部位腹腔镜组平均为(2.5±2)mL,开腹手术组平均为(16.5±10.5)mL,差异有统计学意义(t=-11.772,P<0.05);术后排气时间经脐单部位腹腔镜组平均为(10.8±6.3)h,开腹手术组平均为(20±11.4)h,差异有统计学意义(t=-6.547,P<0.05);住院天数经脐单部位腹腔镜组平均为(2.5±1.5)d,开腹手术组平均为(4.5±1.5)d,差异有统计学意义(t=-8.676,P<0.05);并发症发生率经脐单部位腹腔镜组为1.7%,开腹手术组为9.09%,差异有统计学意义(χ^2=0.081,P<0.05)。结论经脐单部位腹腔镜手术治疗小儿腹股嵌顿性斜疝是一种安全有效的微创手术方法。

Objective To explore the clinical application value of transumbilical laparoendoscopic single-site surgery(LESS)vs traditional open surgery for infantile incarcerated inguinal hernia(IIH).Methods Transumbilical laparoendoscopic single-site herniorrhaphy was performed in 58 pediatric IIH patients from January 2014 to February 2017.And another 55 pediatric patients underwent traditional open operation.The surgical outcomes of IIH patients were retrospectively analyzed and compared.Results Among them,57 children undertook laparoscopy while one converted into traditional open operation.The average operative duration was(25.5±10.5)min in transumbilical single-site laparoscopic group versus(37.0±15.2)min in open surgery group.And the difference was statistically significant(t=-5.756,P<0.05).The average incision length was(0.5±0.2)cm in transumbilical single-site laparoscopic group versus(3.5±1.5)cm in open surgery group.The difference was statistically significant(t=-18.487,P<0.05).The average volume of intraoperative blood loss was(2.5±2)mL in transumbilical single site laparoscopic group and(16.5±10.5)mL in laparotomy control group.And the difference was statistically significant(t=-11.772,P<0.05).The average postoperative exhaust time was(10.8±6.3)h in transumbilical single-site laparoscopic group versus(20±11.4)h in open surgery group.The difference was statistically significant(t=-6.547,P<0.05).The average length of hospital stay was(2.5±1.5)days in transumbilical single site laparoscopic group versus(4.5±1.5)days in open surgery control group.There were statistically significant differences(t=-8.676,P<0.05).The incidence of complications was 1.7%in transumbilical single-site laparoscopic group versus 9.09%in control group.There was statistically significant difference(χ^2=0.081,P<0.05).Conclusion Transumbilical laparoendoscopic single-site surgery is safe,effective and mini-invasive for pediatric inguinal incarcerated hernia.