单孔腹腔镜下经皮腹膜外结扎术治疗小儿交通性鞘膜积液的临床研究

Clinical study of single-hole laparoscopic percutaneous extraperitoneal ligation in the treatment of children with traffic hydrocele

目的分析单孔腹腔镜下经皮腹膜外结扎术(LPEC)治疗小儿交通性鞘膜积液的临床效果。方法交通性鞘膜积液患儿76例,均行单孔LPEC治疗,观察术后情况及收缩峰值血流速度(PSV)、舒张末期血流速度(EDV)和睾丸动脉阻力指数(RI)。结果 76例患儿均成功完成单孔LPEC手术,术中无中转开放手术病例;术后均无精索、输精管、睾丸、睾丸动脉及其他性腺血管损伤,局部感染1例(1.32%),阴囊轻度水肿2例(2.63%)。随访6个月,76例患儿的手术瘢痕基本消散,无切口疝形成或鞘膜积液复发,无输精管扭转或睾丸萎缩。64例单侧交通性鞘膜积液患儿术前的PSV、EDV和RI分别为(65.26±6.23)min/ml、EDV(48.06±4.68)min/ml和(0.55±0.09)ml/min·~2,术后1个月分别为(79.21±7.10)min/ml、EDV(55.29±5.61)min/ml和(0.59±0.12)ml/min·m^2,术后3个月分别为(104.59±8.72)min/ml、EDV(72.59±6.45)min/ml和(0.83±0.14)ml/min·m^2,术后6个月分别为(135.92±10.46)min/ml、(87.39±7.32)min/ml和(1.02±0.16)ml/min·m^2,术后6个月与术前、术后1个月、术后3个月比较,差异均有统计学意义(P<0.05);术后1个月RI与术前比较,差异无统计学意义(P>0.05)。12例双侧交通性鞘膜积液患儿术前的PSV、EDV和RI分别为(60.14±6.05)min/ml、(44.52±4.50)min/ml和(0.54±0.08)ml/min·m^2,术后1个月分别为(75.13±6.92)min/ml、(49.78±5.11)min/ml和(0.57±0.10)ml/min·m^2,术后3个月分别为(98.76±8.15)min/ml、(62.19±6.33)min/ml和(0.81±0.12)ml/min·m^2,术后6个月分别为(129.48±9.82)min/ml、(80.16±7.05)min/ml和(0.96±0.13)ml/min·m^2,术后6个月与术后3个月、术后1个月、术前比较,差异均有统计学意义(P<0.05);术后1个月的RI与术前比较,差异无统计学意义(P>0.05)。结论小儿交通性鞘膜积液采取单孔LPEC治疗,可显著改善睾丸的血供情况,并发症发生率低、手术切口小。

Objective To study the clinical study of single hole laparoscopic percutaneous extraperitoneal ligation(LPEC)in the treatment of children with traffic hydrocele.Methods The clinical data of 76 children with traffic hydrocele were retrospectively analyzed.The postoperative condition of end-diastolic phase of single-hole LPEC,peak systolic blood flow velocity(PSV),end-diastolic flow velocity(EDV),testicular artery resistance index(RI)were analyzed.Results All the 76 children successfully completed single-hole LPEC surgery,and no patients were transferred to open surgery during the operation.No spermatic cord,vas deferens,testicle,testicular artery and other gonadal vessels were damaged after operation.Local infection was found in 1 case(1.32%)and mild scrotal edema in 2 cases(2.63%).After 6 months of follow-up,the scar was basically dissipated in 76 children,and there was no incisional hernia formation or recurrence of hydrocele,no vasectomy torsion or testicular atrophy.The preoperative PSV,EDV and RI of 64 children with unilateral communicating hydrophilia were(65.26±6.23)min/ml,(48.06±4.68)min/ml,(0.55±0.09)ml·min·m^2,respectively;the data of 1 month after surgery was(79.21±7.10)min/ml,(55.29±5.61)min/ml,(0.59±0.12)ml/min·m^2,respectively;the dataof 3 month after surgery was(104.59±8.72)min/ml,(72.59±6.45)min/ml,(0.83±0.14)ml/min·m^2,respectively;the data of 6 month after surgery was(135.92±10.46)min/ml,(87.39±7.32) min/ml,(1.02±0.16)ml/min·m^2,respectively.There was significantly difference in children with unilateral traffic hydrocele at 6 months after operation than preoperative,postoperative,1 month,3 months(P<0.05);the RI of 1 month after operation had not significantly different than that before surgery(P>0.05).The preoperative PSV,EDV and RI of 12 children with bilateral communicating hydrocele were(60.14±6.05)min/ml,(44.52±4.50)min/ml,RI(0.54±0.08)ml/min·m^2,respectively;the data of 1 month after surgery was(75.13±6.92)min/ml,(49.78±5.11)min/ml,(0.57±0.10)ml/min·m^2,respectively;the data of 3 month after surgery was(98.76±8.15)min/ml,(62.19±6.33)min/ml,(0.81±0.12)ml/min·m^2,respectively;the data of 6 month after surgery was(129.48±9.82)min/ml,(80.16±7.05)min/ml,(0.96±0.13)ml/min·m^2,respectively.There was significantly difference in children with unilateral traffic hydrocele at 6 months after operation than preoperative,postoperative,1 month,3 months(P<0.05);the RI of 1 month after operation had not significantly different than that before surgery(P>0.05).Conclusion Pediatric traffic hydrocele is treated with single-hole LPEC,which can significantly improve the blood supply of the testis,and the incidence of complications is low,the surgical incision is small,and it has high clinical efficacy and safety.