微创小切口疝囊高位结扎术在儿童中的疗效研究

摘要

目的：评价外环口下方精索(子宫圆韧带)定位小切口手术治疗小儿腹股沟斜疝的临床疗效及安全性。方法腹股沟斜疝患儿78例，随机分为观察组和对照组，各39例。其中观察组采用微创小切口疝囊高位结扎术治疗，对照组采用传统手术切口治疗，观察并比较两组患儿临床疗效、手术时间、切口长度、术后下床活动时间、住院时间及并发症的发生情况。结果观察组近期疗效指标(手术时间、术中出血量、切口长度、术后下床活动时间、住院时间)均优于对照组，差异有统计学意义(P<0.05)；两组术后伤口愈合情况相比较差异有统计学意义(P<0.05)；观察组治疗后经B超等检查证实无复发，站立及活动后腹股沟区无任何症状，皮肤切口未见明显瘢痕；对照组3例(7.69%)患儿术后可触及腹股沟区肿块，经B超等检查确认复发，全部患儿术后可见腹股沟区明显瘢痕，较周围皮肤颜色深，复发者再次行手术治疗；两组发生的并发症包括阴囊肿胀、尿潴留、切口感染，观察组并发症发生率为2.56%，对照组并发症发生率为12.82%，两组患儿并发症发生率相比较差异有统计学意义(P<0.05)。结论采用外环口下方精索(子宫圆韧带)定位小切口手术治疗小儿腹股沟斜疝疗效好，术后瘢痕隐匿，且无明显并发症发生，值得在临床上予以推广。%Objective To evaluate the clinical effect and safety of spermatic cord below outer ring (round ligament of uterus) located small incision operation in the treatment of children with indirect inguinal hernia. Methods A total of 78 children with indirect inguinal hernia were randomly divided into observation group and control group, and each group contained 39 cases. The observation group received small incision minimally invasive high ligation of hernial sac for treatment, and the control group was treated by traditional operation. Comparisons were made on clinical effects, operation time, incision length, postoperative activity time, hospital stays, and complications condition between the two groups. Results The observation group had better short-term indexes (operation time, intraoperative bleeding volume, incision length, postoperative activity time, hospital stays) than the control group, and the difference had statistical significance (P<0.05). The difference of incision healing condition between the two group had statistical significance (P<0.05). After treatment, examination by B ultrasound showed there were no relapse in the observation group and no case with symptoms in groin after standing and exercise, and obvious scar on skin incision. There were 3 cases (7.69%) in the control group had groin lump, which was shown as relapse by B ultrasound. All the patients had obvious scar and dark color skin in groin, and they underwent operation again. Complications in the two groups included scrotum swelling, uroschesis, and incision infection. The incidence of complications was 2.56%in the observation group, and that in the control group was 12.82%. The difference between the two groups had statistical significance (P<0.05). Conclusion Application of spermatic cord below outer ring (round ligament of uterus) located small incision operation has precise effect in the treatment of children with indirect inguinal hernia, with concealed scar and no obvious complications. This method is worthy of clinical promotion.