脐内侧襞联合脐正中襞折叠覆盖技术在小儿腹股沟斜疝腹腔镜手术中的应用

Application of medial umbilical combined with median umbilical fold cover technology in laparoscopic surgery of pediatric oblique inguinal hernia

目的探讨脐内侧襞联合脐正中襞折叠覆盖技术在小儿腹股沟斜疝腹腔镜手术中的应用。方法选取2018年7月至2020年6月柳州市妇幼保健院小儿外科收治的692例腹股沟斜疝患儿作为研究对象,按照随机抽签法分为对照组(n=345)和治疗组(n=347)。对照组行经典腹腔镜腹股沟斜疝疝囊高位结扎术,治疗组在对照组基础上加用脐内侧襞联合脐正中襞折叠覆盖技术覆盖加强内环口。对比两组的各项手术指标、疼痛情况、并发症发生情况及复发率、血清炎症因子水平。结果两组手术时间、术中出血量、术后下床活动时间、住院时间比较,差异无统计学意义(P>0.05)。治疗组疼痛优良率高于对照组,差异有统计学意义(P<0.05)。治疗组阴囊水肿、切口感染、发热的并发症总发生率以及随访1年的复发率均低于对照组,差异有统计学意义(P<0.05)。术后24 h测定肿瘤坏死因子-α、超敏C反应蛋白、白介素-6、白介素-10,治疗组各项炎症因子水平均低于对照组,差异有统计学意义(P<0.05)。结论脐内侧襞联合脐正中襞折叠覆盖技术在小儿腹股沟斜疝腹腔镜手术中的应用价值显著,能有效提高治疗效果,术后炎症反应程度轻,降低了并发症发生率及复发率,具有积极的临床意义。

Objective To investigate the application of medial umbilical combined with median umbilical fold cover technology in laparoscopic surgery of pediatric oblique inguinal hernia.Methods A total of 692 children with oblique inguinal hernia admitted to the Department of Pediatric Surgery of Liuzhou Maternity and Child Healthcare Hospital from July 2018 to June 2020 were selected as the research objects.According to the random drawing method,they were divided into the control group(n=345)and the treatment group(n=347).The classic laparoscopic high ligation of indirect inguinal hernia sac was performed in the control group.On the basis of the control group,medial umbilical combined with median umbilical fold cover technology to cover and strengthen the internal orifice was added in the treatment group.The operation indexes,pain,complications,recurrence rate and serum inflammatory factors were compared between the two groups.Results There was no significant difference between the two groups in operation time,intraoperative bleeding,postoperative ambulatory time and hospitalization time(P>0.05).The pain improvement rate in the treatment group was higher than that in the control group,and the difference was statistically significant(P<0.05).The total incidence of scrotal edema,incision infection and fever and the recurrence rate of 1-year follow-up of the treatment group were lower than those of the control group,and the differences were statistically significant(P<0.05).The inflammatory factors such as tumor necrosis factor-α,hypersensitive C-reactive protein,interleukin-6 and interleukin-10 measured at 24 h after operation in the treatment group were lower than those in the control group,and the differences were statistically significa nt(P<0.05).Conclusion The medial umbilical combined with median umbilical fold cover technology has significant application value in the laparoscopic surgery of pediatric oblique inguinal hernia,which can effectively improve the treatment effect with mild degree of postoperative inflammatory response and reduction of incidence and recurrence rate of comp lications and has positive clinical significance.