儿童复发性腹股沟斜疝的腹腔镜内环结扎术治疗
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摘要
目的探讨腹腔镜内环结扎术治疗儿童复发性腹股沟斜疝的优势及手术经验。方法选择2013年1月至2018年1月,广州市妇女儿童医疗中心收治的34例复发性腹股沟斜疝患儿为研究对象。回顾性分析其临床病例资料。根据本次入院采取的手术治疗方式,将其分为腹腔镜组(n=19,采用腹腔镜内环结扎术)和开放手术组(n=15,采用疝囊高位结扎术)。采用独立样本t检验及χ~2检验,对2组患儿一般临床资料、术中及术后情况等,进行统计学分析。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》要求,所有患儿监护人均于术前签署手术治疗知情同意书。结果①开放手术组患儿术后,3例出现阴囊血肿,1例出现医源性隐睾。2组患儿术后均未发生伤口感染、睾丸萎缩、阴囊积液及再次复发等其他并发症。②2组患儿中,男性患儿所占比例、月龄及初次手术为腹腔镜手术所占比例比较,差异均无统计学意义(P>0.05)。腹腔镜组患儿的手术时间、术中出血量、住院时间及术后并发症发生率分别为(30.0±10.7) min、(1.0±0.3) mL、(1.2±0.4) d、0,均显著短于或少于开放手术组的(44.7±24.5) min、(2.3±1.3) mL、(3.3±1.0) d、26.7%;其住院费用为(7 547±820)元,则显著高于开放手术组的(5 488±1 218)元,并且差异均有统计学意义(t=-2.347、P=0.044,t=-3.859、P=0.002,t=-8.171、P<0.001,P=0.029,t=5.580、P<0.001)。结论腹腔镜内环结扎术治疗儿童复发性腹股沟斜疝,具有安全有效、术中情况良好、术后并发症少等优势,但住院费用相对偏高。
Objective To evaluate the advantages and surgical experience of laparoscopic internal loop ligation in treatment of recurrent indirect indirect inguinal hernia in children. Methods From January 2013 to January 2018, a total of 34 children with recurrent indirect inguinal hernia admitted to the Guangzhou Women and Children′s Medical Center were selected as research subjects. Clinical cases data were analyzed retrospectively. According to the surgical treatment adopted this time, they were divided into laparoscopic group(n=19, by laparoscopic internal loop ligation) and open surgery group(n=15, by high ligation of hernia sac). Independent-samples t test and chi-square test were used to compare the general clinical data, intraoperative and postoperative situation between two groups of children. This study was in line with World Medical Association Declaration of Helsinki revised in 2013. All guardians of the children signed informed consents for surgery before surgery. Results ①There were 3 patients developed scrotal hematoma, and 1 patient developed iatrogenic cryptorchidism after operation in open surgery group. None of the other complications such as wound infection, testicular atrophy, scrotal hydrocele and recurrence occurred in two groups. ②There were no significant differences between two groups in the proportion of male children, age and the proportion of laparoscopic surgery for the first time(P>0.05). The duration operation, intraoperative blood loss volume, duration of hospital stay and postoperative complication rate in laparoscopic group were(30.0±10.7) min,(1.0±0.3) mL,(1.2±0.4) d, and 0, respectively, which were shorter or less than those of(44.7±24.5) min,(2.3±1.3) mL,(3.3±1.0) d and 26.7% in open surgery group; while the hospitalization costs of(7 547±820) yuan in laparoscopic group was higher than that of(5 488±1 218) yuan in open surgery group, and these differences were statistically significant(t=-2.347, P=0.044; t=-3.859, P=0.002; t=-8.171, P<0.001; P=0.029; t=5.580, P<0.001). Conclusions Laparoscopic internal loop ligation for the treatment of recurrent inguinal hernia in children has the advantages of safe and effective, good intraoperative condition and less postoperative complications, but the hospitalization cost was higher.
Objective To evaluate the advantages and surgical experience of laparoscopic internal loop ligation in treatment of recurrent indirect indirect inguinal hernia in children. Methods From January 2013 to January 2018, a total of 34 children with recurrent indirect inguinal hernia admitted to the Guangzhou Women and Children′s Medical Center were selected as research subjects. Clinical cases data were analyzed retrospectively. According to the surgical treatment adopted this time, they were divided into laparoscopic group(n=19, by laparoscopic internal loop ligation) and open surgery group(n=15, by high ligation of hernia sac). Independent-samples t test and chi-square test were used to compare the general clinical data, intraoperative and postoperative situation between two groups of children. This study was in line with World Medical Association Declaration of Helsinki revised in 2013. All guardians of the children signed informed consents for surgery before surgery. Results ①There were 3 patients developed scrotal hematoma, and 1 patient developed iatrogenic cryptorchidism after operation in open surgery group. None of the other complications such as wound infection, testicular atrophy, scrotal hydrocele and recurrence occurred in two groups. ②There were no significant differences between two groups in the proportion of male children, age and the proportion of laparoscopic surgery for the first time(P>0.05). The duration operation, intraoperative blood loss volume, duration of hospital stay and postoperative complication rate in laparoscopic group were(30.0±10.7) min,(1.0±0.3) mL,(1.2±0.4) d, and 0, respectively, which were shorter or less than those of(44.7±24.5) min,(2.3±1.3) mL,(3.3±1.0) d and 26.7% in open surgery group; while the hospitalization costs of(7 547±820) yuan in laparoscopic group was higher than that of(5 488±1 218) yuan in open surgery group, and these differences were statistically significant(t=-2.347, P=0.044; t=-3.859, P=0.002; t=-8.171, P<0.001; P=0.029; t=5.580, P<0.001). Conclusions Laparoscopic internal loop ligation for the treatment of recurrent inguinal hernia in children has the advantages of safe and effective, good intraoperative condition and less postoperative complications, but the hospitalization cost was higher.
引文
[1] Miltenburg DM, Nuchtern JG, Jaksic T, et al. Laparoscopic evaluation of the pediatric inguinal hernia: a Meta-analysis[J]. J Pediatr Surg, 1998, 33(6): 874-879.
[2] Esposito C, St Peter SD, Escolino M, et al. Laparoscopic versus open inguinal hernia repair in pediatric patients: a systematic review[J]. J Laparoendosc Adv Surg Tech A, 2014, 24(11):811-818.
[3] Yang C, Zhang H, Pu J, et al. Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and Meta-analysis[J]. J Pediatr Surg, 2011, 46(9): 1824-1834.
[4] 林芩, 钱彬, 姚玉笙. 超声引导下腹横肌平面阻滞对腹股沟斜疝患儿术后疼痛的影响[J/CD]. 中华妇幼临床医学杂志(电子版), 2014, 10(1): 44-47.
[5] Xiang B, Jin S, Zhong L, et al. Reasons for recurrence after the laparoscopic repair of indirect inguinal hernia in children[J]. J Laparoendosc Adv Surg Tech A, 2015, 25(8): 681-683.
[6] Ein SH, Njere I, Ein A. Six thousand three hundred sixty-one pediatric inguinal hernia: a 35-year review[J]. J Pediatr Surg, 2006, 41(5): 980-986.
[7] Shalaby R, Ismail M, Gouda S, et al. Laparoscopic management of recurrent inguinal hernia in childhood[J]. J Pediatr Surg, 2015, 50(11): 1903-1908.
[8] Yilmaz E, Afsarlar CE, Senel E,et al. A novel technique for laparoscopic inguinal hernia repair in children: single-port laparoscopic percutaneous extraperitoneal closure assisted by an optical forceps[J]. Pediatr Surg Int, 2015, 31(7): 639-646.
[9] Bruzoni M, Jaramillo JD, Kastenberg ZJ, et al. Long-term follow-up of laparoscopic transcutaneous inguinal herniorraphy with high transfixation suture ligature of the hernia sac[J]. J Pediatr Surg, 2015, 50(10): 1767-1771.
[10] Treef W, Schier F. Characteristics of laparoscopic inguinal hernia recurrences[J]. Pediatr Surg Int, 2009, 25(2): 149-152.
[11] Miyake H, Fukumoto K, Yamoto M, et al. Risk factors for recurrence and contralateral inguinal hernia after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia[J]. J Pediatr Surg, 2017, 52(2): 317-321.
[12] Esposito C, Alicchio F, Giurin I, et al. Technical standardization of laparoscopic direct hernia repair in pediatric patients[J]. J Laparoendosc Adv Surg Tech A, 2012, 22(1): 113-116.
[13] Weber-Sanchez A, Weber-Alvarez P, Garteiz-Martinez D, et al. Recurrent inguinal hernia in a preschool girl treated laparoscopically with a preperitoneal transabdominal technique and polypropylene mesh: an alternative in complex cases[J]. Hernia, 2012, 16(1): 99-102.
[14] Yildiz A, ?elebi S, Akin M, et al. Laparoscopic hernioraphy: a better approach for recurrent hernia in boys? [J]. Pediatr Surg Int, 2012, 28(5): 449-453.
[15] Chan KL. Laparoscopic repair of recurrent childhood inguinal hernias after open herniotomy[J]. Hernia, 2007, 11(1): 37-40.
[16] Schier F. The laparoscopic spectrum of inguinal hernias and their recurrences[J]. Pediatr Surg Int, 2007, 23(12): 1209-1213.
[17] Shalaby R, Ismail M, Samaha A, et al. Laparoscopic inguinal hernia repair; experience with 874 children[J]. J Pediatr Surg, 2014, 49(3): 460-464.
[18] Saranga Bharathi R, Arora M, Baskaran V. Minimal access surgery of pediatric inguinal hernias: a review[J]. Surg Endosc, 2008, 22(8): 1751-1762.
[19] Schier F. Laparoscopic inguinal hernia repair: a prospective personal series of 542 children[J]. J Pediatr Surg, 2006, 41(6): 1081-1084.
[20] Chen K, Xiang G, Wang H, et al. Towards a near-zero recurrence rate in laparoscopic inguinal hernia repair for pediatric patients[J]. J Laparoendosc Adv Surg Tech A, 2011, 21(5): 445-448.
[2] Esposito C, St Peter SD, Escolino M, et al. Laparoscopic versus open inguinal hernia repair in pediatric patients: a systematic review[J]. J Laparoendosc Adv Surg Tech A, 2014, 24(11):811-818.
[3] Yang C, Zhang H, Pu J, et al. Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and Meta-analysis[J]. J Pediatr Surg, 2011, 46(9): 1824-1834.
[4] 林芩, 钱彬, 姚玉笙. 超声引导下腹横肌平面阻滞对腹股沟斜疝患儿术后疼痛的影响[J/CD]. 中华妇幼临床医学杂志(电子版), 2014, 10(1): 44-47.
[5] Xiang B, Jin S, Zhong L, et al. Reasons for recurrence after the laparoscopic repair of indirect inguinal hernia in children[J]. J Laparoendosc Adv Surg Tech A, 2015, 25(8): 681-683.
[6] Ein SH, Njere I, Ein A. Six thousand three hundred sixty-one pediatric inguinal hernia: a 35-year review[J]. J Pediatr Surg, 2006, 41(5): 980-986.
[7] Shalaby R, Ismail M, Gouda S, et al. Laparoscopic management of recurrent inguinal hernia in childhood[J]. J Pediatr Surg, 2015, 50(11): 1903-1908.
[8] Yilmaz E, Afsarlar CE, Senel E,et al. A novel technique for laparoscopic inguinal hernia repair in children: single-port laparoscopic percutaneous extraperitoneal closure assisted by an optical forceps[J]. Pediatr Surg Int, 2015, 31(7): 639-646.
[9] Bruzoni M, Jaramillo JD, Kastenberg ZJ, et al. Long-term follow-up of laparoscopic transcutaneous inguinal herniorraphy with high transfixation suture ligature of the hernia sac[J]. J Pediatr Surg, 2015, 50(10): 1767-1771.
[10] Treef W, Schier F. Characteristics of laparoscopic inguinal hernia recurrences[J]. Pediatr Surg Int, 2009, 25(2): 149-152.
[11] Miyake H, Fukumoto K, Yamoto M, et al. Risk factors for recurrence and contralateral inguinal hernia after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia[J]. J Pediatr Surg, 2017, 52(2): 317-321.
[12] Esposito C, Alicchio F, Giurin I, et al. Technical standardization of laparoscopic direct hernia repair in pediatric patients[J]. J Laparoendosc Adv Surg Tech A, 2012, 22(1): 113-116.
[13] Weber-Sanchez A, Weber-Alvarez P, Garteiz-Martinez D, et al. Recurrent inguinal hernia in a preschool girl treated laparoscopically with a preperitoneal transabdominal technique and polypropylene mesh: an alternative in complex cases[J]. Hernia, 2012, 16(1): 99-102.
[14] Yildiz A, ?elebi S, Akin M, et al. Laparoscopic hernioraphy: a better approach for recurrent hernia in boys? [J]. Pediatr Surg Int, 2012, 28(5): 449-453.
[15] Chan KL. Laparoscopic repair of recurrent childhood inguinal hernias after open herniotomy[J]. Hernia, 2007, 11(1): 37-40.
[16] Schier F. The laparoscopic spectrum of inguinal hernias and their recurrences[J]. Pediatr Surg Int, 2007, 23(12): 1209-1213.
[17] Shalaby R, Ismail M, Samaha A, et al. Laparoscopic inguinal hernia repair; experience with 874 children[J]. J Pediatr Surg, 2014, 49(3): 460-464.
[18] Saranga Bharathi R, Arora M, Baskaran V. Minimal access surgery of pediatric inguinal hernias: a review[J]. Surg Endosc, 2008, 22(8): 1751-1762.
[19] Schier F. Laparoscopic inguinal hernia repair: a prospective personal series of 542 children[J]. J Pediatr Surg, 2006, 41(6): 1081-1084.
[20] Chen K, Xiang G, Wang H, et al. Towards a near-zero recurrence rate in laparoscopic inguinal hernia repair for pediatric patients[J]. J Laparoendosc Adv Surg Tech A, 2011, 21(5): 445-448.