腹腔镜下单孔完全腹膜外结扎法与单切口腹内缝扎法治疗小儿腹股沟疝并发症的比较

Comparison of Complications Between Single-port Extraperitoneal Closure and Single-site Intracorporeal Purse-suturing for Laparoscopic Pediatric Inguinal Hernia Repair

目的比较单孔腹腔镜疝钩针法完全腹膜外内环结扎术与经脐单切口腹腔镜内环缝扎术治疗小儿腹股沟疝的并发症情况。方法回顾性分析2013年7月~2017年7月我院小儿外科341例小儿腹股沟斜疝患儿的临床资料,其中213例采用疝钩针法经脐单孔腹腔镜监视下完成腹膜外内环结扎术(腹膜外结扎组),128例在腹腔镜监视下采用经脐单切口多通道套管(Triport)内环缝扎术(腹内缝扎组),对比2组并发症发生情况。结果341例患儿均顺利完成手术,无术中并发症发生。腹膜外结扎术组术后随访24~42个月,线结异物反应3例,鞘膜积液形成1例,对侧异时疝1例;腹内缝扎术组术后随访28~60个月,腹股沟局部血肿2例,鞘膜积液形成2例,疝复出1例;2组术后并发症发生率无统计学差异(χ^2=0.245,P=0.621)。所有男性患儿术后无一例出现医源性隐睾或睾丸萎缩。结论单孔腹腔镜疝钩针法完全腹膜外内环结扎术与经脐单切口腹腔镜内环缝扎术均安全可行,疗效可靠,2种方法并发症发生率无统计学差异。

Objective To compare the surgical complications of single-port extraperitoneal closure(EC)using a latch needle and transumbilical single-site intracorporeal purse-suturing(IP)for laparoscopic pediatric inguinal hernia(IH)repair.MethodsA retrospective analysis was made on the clinical data of 341 children with laparoscopic IH repair who were admitted to pediatric surgery in our hospital from July 2013 to July 2017,including 213 cases treated by single-port EC using a latch needle(EC group)and 128 cases by transumbilical single-site IP(IP group).The surgical complications of the two groups were compared and analyzed.Results All the 341 children underwent operation successfully.There was no intraoperative complication.The IP group was followed up for 24-42 months,during which there were 3 cases of subcutaneous knot granulomas,1 case of postoperative hydrocele,and 1 case of metachronous contralateral hernia.The EC group was followed up for 28-60 months,during which there were 2 cases of intraoperative hematomas,2 cases of postoperative hydrocele,and 1 case of hernial recurrence.There was no statistical difference between the two groups in postoperative complications(χ^2=0.245,P=0.621).No complications such as iatrogenic cryptorchidism or testicular atrophy occurred in all male patients after operation.Conclusions Both EC and IP laparoscopic procedures are safe and feasible.The curative effects of the two methods are reliable.There is no statistical difference between the two methods in complication rate.