悬吊免气腹腹腔镜手术治疗小儿腹股沟疝的临床研究

The value of suspension pneumoperitoneum-free laparoscopic surgery in the treatment of inguinal hernia in children

目的探讨悬吊免气腹腹腔镜手术治疗小儿腹股沟疝的临床应用价值。方法选取2018年10月—2020年12月于嘉兴市中医院普外科就诊的年龄为1~12岁的72例腹股沟疝患儿作为研究对象,按照随机数字表法将患儿分为观察组和对照组,每组纳入36例。对照组患儿采用传统腹腔镜下疝囊高位结扎术,观察组采用悬吊免气腹腹腔镜手术,观察2组患儿的术后疼痛评分优良率、手术时间、住院时间、术后3个月复发率以及应激指标的变化。结果观察组的疼痛评分优良率明显高于对照组(χ^(2)=4.571,P=0.033)。观察组的手术时间和住院时间与对照组相比有所缩短[(13.63±3.66)min vs.(16.25±2.17)min,(3.38±0.65)d vs.(4.06±0.23)d,均P<0.01]。术后观察组患儿的皮质醇、IL-6、IL-10水平以及TNF-α低于对照组,差异均有统计学意义(均P<0.05);2组患儿术后3个月复发率差异无统计学意义(P=0.999)。结论应用悬吊免气腹腹腔镜手术治疗小儿腹股沟疝,可缩短手术时间和术后恢复时间,减轻患儿术后疼痛程度,降低应激反应,值得应用和推广。

Objective To discuss the value of suspension pneumoperitoneum-free laparoscopic surgery in the treatment of inguinal hernia in children.Methods Seventy-two patients with inguinal hernia aged between 1 and 12 who were treated in the Department of General Surgery of Jiaxing Hospital of Traditional Chinese Medicine from October 2018 to December 2020 were selected as the research object.According to random number table method,the patients were divided into observation group and control group,with 36 cases in each group.The children in the control group were treated with high ligation of hernia sac under traditional laparoscopy,while the children in the observation group were treated with suspension pneumoperitoneum-free laparoscopic surgery.The excellent and good rate of postoperative pain score,operation time,discharge time,recurrence rate 3 months after operation and stress index were observed in the two groups.Results The excellent rate of pain score in the observation group was significantly higher than that in the control group(χ^(2)=4.571,P=0.033).The duration of surgery and hospital stay in the observation group were shorter than those in the control group[(13.63±3.66)min vs.(16.25±2.17)min,(3.38±0.65)d vs.(4.06±0.23)d,all P<0.01].After operation,the observation group had lower levels of cortisol,IL-6,IL-10 and TNF-αthan the control group,and the difference had statistical significance(all P<0.05).There was no significant difference in recurrence rate 3 months after surgery between the two groups(P=0.999).Conclusion The application of suspension pneumoperitoneum-free laparoscopic surgery in the treatment of inguinal hernia in children can shorten the operation time and postoperative recovery time,and reduce the degree of postoperative pain,and relieve stress response,which is worth applying and popularizing.