腹腔镜治疗新生儿嵌顿性腹股沟斜疝的临床研究

Clinical Research of Laparoscopic Surgery for Incarcerated Inguinal Hernia in Neonates

目的探讨腹腔镜手术治疗新生儿嵌顿性腹股沟斜疝的临床效果。方法回顾性分析2017年1月至2019年10月我科收治的44例新生儿嵌顿性腹股沟斜疝的临床资料,其中行腹腔镜手术23例(LG组),开放手术21例(OG组)。比较两组患儿手术时间、住院时间、围术期应激指标及术后并发症。结果两组患儿术中心率、血气分析结果均在正常范围;LG组手术时间及住院时间均短于OG组,差异有统计学意义(P<0.05)。疝囊内容物:LG组卵巢6例,小肠14例,回盲部2例,乙状结肠1例;OG组卵巢4例,小肠16例,回盲部1例。两组均无肠管坏死。LG组65.2%(15/23)患儿对侧合并潜在腹股沟斜疝,均行内环口结扎。术后两组患儿均获得随访,时间12~24个月。术后阴囊血肿共7例,其中LG组2例,OG组5例,术后3个月内均自行消失;LG组无睾丸萎缩,OG组睾丸萎缩1例;两组间阴囊血肿、睾丸萎缩率比较,差异均无统计学意义(P>0.05)。术后LG组同侧复发1例,对侧无腹股沟斜疝发生,OG组同侧复发2例,对侧发生腹股沟斜疝4例,均再次行手术治疗。两组间同侧疝复发率比较差异无统计学意义(P>0.05);LG组对侧腹股沟斜疝发生率低于OG组,差异有统计学意义(P<0.05)。LG组术后24 h CRP、IL-6及TNF-α水平均低于OG组,差异有统计学意义(P<0.05)。结论腹腔镜手术治疗新生儿嵌顿性腹股沟斜疝具有创伤小、手术时间短、术后恢复快的优点,可以同时发现并治疗对侧潜在的腹股沟斜疝。

Objective To explore the clinical effect of laparoscopic surgery of incarcerated inguinal hernia in neonates.Methods From January 2017 to October 2019,the clinical data of 44 neonates with incarcerated inguinal hernia performed surgical intervention in our hospital were analyzed retrospectively,including 23 cases by laparoscopic surgery(as LG group)and 21cases by open surgery(as OG group).The operation time,hospitalization time,peri-operative stress indicators and complications were compared between the two groups.Results The intra-operative heart rate,PaCO2 and pH were normal in both groups.Both the operation time and hospitalization time were shorter in the LG group than those in the OG group,and the differences were significant(P<0.05).The strangulated hernia was ovary in 6 cases,small intestine in 14 cases,ileocecal region in 2 cases and sigmoid colon in 1 case in the LG group,and ovary in 4 cases,small intestine in 16 cases and ileocecal region in 1 case in the OG group.No bowel necrosis was found in both groups.65.2%cases of LG group were found contralateral inguinal hernia and performed ligation.All cases were followed up for 12 to 24 months.Poster-operative scrotal hematoma occurred in 7 cases(2 in LG group and 5 in OG group),which disappeared in 3 months after the operation.There was no testicular atrophy in LG group and one case in OG group.There were no significant differences in the incidence of scrotal hematoma and testicular atrophy between the two groups after the operation(P>0.05).Ipsilateral hernia recurrence was in one case of LG group and in 2 cases of OG group,and contralateral hernia incidence was in 4 cases of the OG group.There was no significant difference in ipsilateral hernia recurrence rate between the two groups(P>0.05),but the contralateral hernia incidence was lower in LG group than that in OG group,and the difference was statistically(P<0.05).The levels of C reactive protein,interleukin-6 and tumor necrosis factor-αof the LG group were lower than those of the OG group,and all differences were remarkably(P<0.05).Conclusion Laparoscopic surgery of incarcerated inguinal hernia has the advantages of mini-trauma,short operation time and fast recovery for neonates,and it will not increase post-operative complications and can simultaneously detect and treat potential indirect inguinal hernia in contralateral side.