腹腔镜与开腹手术治疗新生儿嵌顿性腹股沟斜疝的比较

Comparison of Laparoscopic and Open Surgery for Neonatal Incarcerated Inguinal Hernia

目的 探讨腹腔镜疝针治疗新生儿嵌顿性腹股沟斜疝的疗效。方法 2016年6月~2018年6月我科对47例新生儿嵌顿性腹股沟斜疝使用腹腔镜疝针行疝囊高位结扎术(LG组),2013年9月~2016年5月对41例新生儿嵌顿性腹股沟斜疝行开放手术(OG组),比较2组手术时间、损伤血管比例、p H值及动脉血二氧化碳分压(Pa CO2)等术中安全指标和术后复发率、睾丸萎缩率等。结果 2组术中均未损伤髂血管、精索血管及输精管。2组术中p H值、Pa CO2和心率均在正常值范围。LG组单侧[(17.6±1.5)min vs.(37.7±2.8)min,t=40.908,P=0.000]和双侧[(27.6±3.4)min vs.(46.7±2.3)min,t=30.915,P=0.000]手术时间明显短于OG组。LG组住院时间短[(4.6±1.3)d vs.(5.2±1.1)d,t=2.237,P=0.022]、对侧复发率低(0%vs.12.2%,P=0.019)、阴囊血肿发生率低(6.4%vs.22.0%,χ^2=4.507,P=0.034),与OG组有统计学差异。2组术后随访6~12个月,睾丸萎缩率(0%vs.4.9%,P=0.214)和同侧复发率(2.1%vs.2.4%,P=1.000)差异无显著性。结论 腹腔镜下疝针治疗新生儿嵌顿性腹股沟斜疝安全有效,有望代替传统开放手术。

Objective To investigate the effect of laparoscopy with hernia needle for neonatal incarcerated inguinal hernia.Methods From June 2016 to June 2018,a total of 47 cases of neonatal incarcerated inguinal hernia were treated in our hospital.All the patients underwent high-grade ligation of the hernia sac by double-port laparoscopic surgery as a laparoscopic group(LG).From September 2013 to May 2016,a total of 41 cases of neonatal incarcerated inguinal hernia were treated by traditional procedure in our hospital as an open group(OG).Intraoperative safety measures,such as operation time,proportion of damaged blood vessels,pH value and arterial carbon dioxide pressure(PaCO 2),and efficacy measures,such as postoperative recurrence rate and testicular atrophy rate,were compared between the two groups.Results The iliac vessels,spermatic vessels and vas deferens were not damaged in both groups.The intraoperative pH,PaCO 2 and heart rate were within the normal range.The operation time in the LG group was significantly less than that in the OG group,both unilaterally[(17.6±1.5)min vs.(37.7±2.8)min,t=40.908,P=0.000]and bilaterally[(27.6±3.4)min vs.(46.7±2.3)min,t=30.915,P=0.000].The hospitalization time,contralateral recurrence rate and incidence of scrotal hematoma were significantly less in the LG group than those in the OG group:the hospital stay[(4.6±1.3)d vs.(5.2±1.1)d,t=2.237,P=0.022],the rate of contralateral recurrence(0% vs.12.2%,P=0.019),the incidence of scrotal hematoma(6.4% vs.22.0%,χ^2=4.507,P=0.034).During the follow-ups,the LG group showed lower testicular atrophy rate(0%vs.4.9%,P=0.214)and lower ipsilateral recurrence rate(2.1%vs.2.4%,P=1.000),but without significant difference between the two groups.Conclusions Laparoscopy with hernia needle is safe and effective in the treatment of neonatal incarcerated inguinal hernia.It can replace traditional open surgery.