经脐单孔腹腔镜疝修补术治疗嵌顿性腹股沟斜疝的效果及安全性

Effect and safety of transumbilical single-port laparoscopic herniorrhaphy for incarcerated indirect inguinal hernia

目的探讨经脐单孔腹腔镜疝修补术治疗嵌顿性腹股沟斜疝的临床效果和安全性。方法选择2015年10月至2017年10月西安市儿童医院收治的120例嵌顿性腹股沟斜疝患儿为研究对象,根据手术方法分为开放性手术组和腹腔镜手术组,开放性手术组30例患儿行传统开放性疝修补术,腹腔镜手术组90例患儿行经脐单孔腹腔镜疝修补术;记录2组患儿的手术时间、术中出血量、术后排气时间、住院时间及并发症发生情况;术后1个月进行手术切口美观满意度评分;所有患儿术后随访2a,观察同侧及对侧疝复发情况。结果腹腔镜手术组患儿手术时间、术后排气时间及住院时间显著短于开放性手术组(t=13.200、5.150、4.092,P<0.05);术中出血量显著少于开放性手术组(t=12.000,P<0.05);腹腔镜手术组和开放性手术组患儿并发症发生率分别为4.44%(4/90)、20.00%(6/30),腹腔镜手术组患儿并发症发生率显著低于开放性手术组(χ^2=6.378,P<0.05);腹腔镜手术组和开放性手术组患儿手术切口美观满意度评分分别为3.47±0.96、1.97±0.85,腹腔镜手术组患儿手术切口美观满意度评分显著高于开放性手术组(t=0.158,P<0.05);术后2a内,腹腔镜手术组和开放性手术组患儿疝复发率分别为1.11%(1/90)、13.33%(4/30),腹腔镜手术组患儿疝复发率显著低于开放性手术组(χ^2=5.633,P<0.05)。结论经脐单孔腹腔镜疝修补术治疗嵌顿性腹股沟斜疝具有手术时间短、创伤小、术后恢复快、复发率低、安全性良好等优势。

Objective To explore the clinical effect and safety of transumbilical single-port laparoscopic hernioplasty for incarcerated indirect inguinal hernia. Methods A total of 120 children with incarcerated indirect inguinal hernia admitted to Xi′an Children′s Hospital from October 2015 to October 2017 were selected as the research objects,and they were divided into open operation group and laparoscopic operation group according to the operation methods.Thirty children in the open operation group underwent traditional open herniorrhaphy,while ninety children in the laparoscopic operation group underwent transumbilical single-port laparoscopic herniorrhaphy.The operation time,intraoperative bleeding volume,postoperative exhaust time,hospitalization time and complications were recorded.The aesthetic satisfaction of the incision was scored one month after operation.All children were followed up for two years to observe the recurrence of ipsilateral and contralateral hernia. Results The operation time,postoperative exhaust time and hospitalization time in the laparoscopic operation group were significantly shorter than those in the open operation group ( t =13.200,5.150,4.092;P <0.05).The intraoperative bleeding volume in the laparoscopic operation group was significantly less than that in the open operation group ( t =12.000, P <0.05).The incidence of complications in the laparoscopic operation group and open operation group was 4.44%(4/90) and 20.00%(6/30),respectively.The incidence of complications in the laparoscopic operation group was significantly lower than that in the open operation group (χ^2=6.378, P <0.05).The score of aesthetic satisfaction of the incision in the laparoscopic operation group and open operation group was 3.47±0.96 and 1.97±0.85,respectively.The score of aesthetic satisfaction of the incision in the laparoscopic operation group was significantly higher than that in the open operation group ( t = 0.158, P <0.05).Within two years after operation,the recurrence rate of hernia in the laparoscopic operation group and open operation group was 1.11%(1/90) and 13.33%(4/30),respectively.The recurrence rate of hernia in the laparoscopic operation group was significantly lower than that in the open operation group (χ^2=5.633, P <0.05). Conclusion Transumbilical single-port laparoscopic hernioplasty for incarcerated indirect inguinal hernia has the advantages of short operation time,less trauma,quick recovery,low recurrence rate and good safety.