经脐单部位腹腔镜治疗腹股沟斜疝术后复发疝的经验

Experience of transumbilical single-site laparoscopic treatment for recurrent inguinal hernia in children

目的总结经脐单部位腹腔镜内环口结扎术治疗腹股沟斜疝术后复发疝的临床经验。方法2015年6月至2021年6月,山西省儿童医院普外科实施了7918例经脐单部位腹腔镜内环口结扎术治疗腹股沟斜疝,其中20例患儿术后腹股沟斜疝复发。回顾性分析20例复发患儿的临床资料,其中男19例,女1例;患儿初次手术年龄为(2.24±1.99)岁,范围在6个月至9.25岁。20例患儿均再次接受经脐单部位腹腔镜内环口结扎术,分析患儿复发时间、再次手术术中及术后情况,患儿于术后1、3、12个月随访,后每2年随访一次。结果所有复发患儿再次手术顺利完成,并于术后1 d出院。初次术后(11.25±9.65)个月复发,范围在0.5~40.0个月。再次手术与初次手术间隔(19.55±17.26)个月,范围在3.0~60.0个月。初次手术年龄段不同的患儿复发率不同,各年龄阶段复发率比较,差异有统计学意义(χ^(2)=10.771,P=0.009)。患儿再次手术内环口直径为(1.06±0.46)cm,范围在0.5~2.0 cm。再次手术后随访(31.20±15.22)个月,范围在6~53个月。20例患儿未再出现复发,无鞘膜积液形成,无阴囊血肿、睾丸萎缩,手术部位几乎无可见瘢痕。结论复发疝再次手术以腹腔镜手术为宜,再次手术方式依据内环口直径及腹横筋膜是否缺损来选择。

Objective To summarize the experience of recurrent inguinal hernia after transumbilical single-site laparoscopic herniorrhaphy.Methods From June 2015 to June 2021,7918 cases of inguinal hernia underwent transumbilical single-site laparoscopic inguinal ring ligation.In such instances,the recurrence was documented in 20 cases.There were 19 boys and 1 girl.Mean age of initial surgery was(2.24±1.99)(0.5-9.25)years.General profiles and perioperative status were statistically analyzed.Follow-ups were conducted at Mouth 1/3/12 postoperatively and then every 2 years thereafter.ResultsAll recurrent cases were reoperated and discharged the next day postoperatively.Recurrence time was(11.25±9.65)(0.5-40.0)months.Interval between reoperation and initial surgery was(19.55±17.26)(3.0-60.0)months.Recurrence rate varied among children in different age groups of initial surgery.There were statistically significant differences(χ^(2)=10.771,P=0.009).Diameter of internal ring was(1.06±0.46)(0.5-2.0)cm.During follow-ups,there was no onset of recurrent hernia,hydrocele,scrotal hematoma,testicular atrophy or visible scar at the site of reoperation.Conclusions Transumbilical single-site laparoscopic herniorrhaphy is both safe and efficacious for recurrent inguinal hernia.And the reoperative mode is based upon size of internal ring and defect of transversalis fascia.