单孔腹腔镜疝囊高位结扎术对腹股沟斜疝患儿机体微环境、切口美观满意度及经济学效益的影响

Effects of Single-port Laparoscopic High Ligation of Hernia Sac on Body Microenvironment,Satisfaction of Incision Aesthetics and Economic Benefits in Treatment of Children with Indirect Inguinal Hernia

目的探讨单孔腹腔镜与传统疝囊高位结扎术对腹股沟斜疝患儿机体微环境、切口美观满意度及经济学效益的影响。方法选取2018年1月—2019年12月我院收治的腹股沟斜疝患儿91例,依据治疗术式的不同分为腔镜组46例和传统组45例。传统组予传统疝囊高位结扎术治疗,腔镜组予单孔腹腔镜疝囊高位结扎术治疗。比较2组围术期指标、切口美观满意度、经济学效益、术后并发症发生情况,以及术前、术后24 h、术后36 h机体微环境指标[前列腺素E_(2)(PGE_(2))、神经肽Y(NPY)、超氧化物歧化酶(SOD)、丙二醛(MDA)]和术后6、12、24、36 h疼痛程度[视觉模拟评分法(VAS)评分]。结果腔镜组手术时间、术后下床活动时间、术后肛门排气时间、住院时间及切口长度均较传统组短,术中出血量较传统组少,切口美观满意度、住院费用较传统组高(P<0.05,P<0.01)。2组术后24、36 h血清PGE_(2)、NPY、MDA水平均升高,SOD水平降低(P<0.05);且术后24、36 h腔镜组血清PGE_(2)、NPY、MDA水平较传统组低,SOD水平较传统组高(P<0.01)。腔镜组术后6、12、24、36 h VAS评分较传统组降低(P<0.01)。2组术后并发症总发生率比较差异无统计学意义(P>0.05)。结论单孔腹腔镜疝囊高位结扎术治疗可减轻腹股沟斜疝患儿手术创伤与术后疼痛感,促进术后恢复,提高切口美观满意度,对机体内环境影响小,但住院费用较高。

Objective To investigate effects of single-port laparoscopic high ligation of hernia sac on body microenvironment,satisfaction of incision aesthetics and economic benefits in treatment of children with indirect inguinal hernia(IIH).Methods A total of 91 children with IIH admitted between January 2018 and December 2019 were selected and divided into endoscopic group(n=46)and traditional group(n=45)according to different therapeutic methods.Traditional group was treated with traditional high ligation of hernia sac,while endoscopic group was treated with single-port laparoscopic high ligation of hernia sac.In two groups,perioperative indexes,satisfaction of incision aesthetic,economic benefits,incidence rate of postoperative complications,body microenvironment indexes[prostaglandin E2(PGE2),neuropeptide Y(NPY),superoxide dismutase(SOD),malondialdehyde(MDA)]before and after operation for 24 and 36 h,and pain degree[visual analogue scale(VAS)]scores after operation for 6,12,24 and 36 h were compared.Results In endoscopic group,operative duration,postoperative time of off-bed activity,postoperative time of anal exhaust,length of stay and incision length were significantly shorter,and volume of intraoperative bleeding was less,while satisfaction of incision aesthetics and hospitalization expenses were higher than those in traditional group(P<0.05,P<0.01).After operation for 24 and 36 h,serum levels of PGE2,NPY and MDA were significantly increased,while SOD levels were significantly decreased in two groups(P<0.05).Compared with those in traditional group,serum levels of PGE2,NPY and MDA were significantly lower,while SOD level was significantly higher in endoscopic group after operation for 24 and 36 h(P<0.01).AS scores in endoscopic group were significantly lower than those in traditional group after operation for 6,12,24 and 36 h(P<0.01).There was no significant difference in the total incidence rate of postoperative complications between two groups(P>0.05).Conclusion Single-port laparoscopic high ligation of hernia sac in treatment of children with IIH may reduce surgical trauma and postoperative pain,promote postoperative recovery and improve satisfaction of incision aesthetics with little effect on the body microenvironment,but its hospitalization expenses are high.