儿童腹股沟直疝腹腔镜手术治疗探讨

Laparoscopic surgery of direct inguinal hernia in children

目的探讨儿童腹股沟直疝的腹腔镜手术方法及安全性。方法回顾性分析2010年7月至2019年1月,广东省佛山市第一人民医院收治的小儿腹股沟疝中,经腹腔镜探查发现直疝患儿的临床资料。根据不同修补方式分为A组(单纯疝囊高位结扎组)和B组(疝囊高位结扎+同侧脐内侧韧带覆盖肌耻骨孔组)。结果6157例腹股沟疝患儿中,共完成32例小儿直疝手术。其中A组14例,B组18例,2组手术时间、术中出血量、住院时间比较,差异无统计学意义(P>0.05)。A组术后3个月有3例复发,6个月有1例新复发,12个月有6例(71.4%)新复发;B组12个月内仅1例(5.6%)复发,差异有统计学意义(P<0.05)。2组均未出现其他并发症。结论对于小儿腹股沟直疝,腹腔镜单纯行疝囊高位结扎手术效果不理想,术后复发率高,疝囊高位结扎后再将同侧脐内侧韧带覆盖盖直疝三角可增加腹壁强度,明显降低复发率,是一种安全有效简易的腹腔镜方法。

Objective To investigate the laparoscopic surgical approach and safety of direct inguinal hernia in children.Methods A retrospective analysis was conducted on the children with direct inguinal hernia who underwent laparoscopy in the First People's Hospital of Foshan Hospital from July 2010 to January 2019.According to the method of operation,they were divided into the group A(high ligation of hernial sac)and the group B(high ligation of hernial sac and covering pubic foramen with medial umbilical ligament).Results Among 6157 patients of inguinal hernia,32 cases of pediatric direct hernia surgery were completed.There were 14 patients in group A and 18 patients in group B.There were no significant differences in operation time,intraoperative blood loss and hospitalization time between the two groups(P>0.05).In group A,there were 3 cases of recurrence in 3 months,1 patient in 6 months and 6 patients in 1 year.The recurrence rate was 71.4%.In group B,only 1 patient developed recurrence in 1 year.The recurrence rate was 5.6%,and the recurrence rate were significantly lower than that of group A(P<0.05).There were no other complications occurred in either group.Conclusion The operative method of laparoscopic high ligation of hernia sac was not ideal for direct inguinal hernia of children,the recurrence rate was high.Covering triangle of direct hernia with ipsilateral medial umbilical ligament can increase the strength of the abdominal wall.It can significantly reduce the recurrence rate,which was a safe,effective and simple method of laparoscopy.