儿童腹腔镜疝囊高位结扎术与传统疝囊高位结扎术的疗效对比分析

摘要

Objective Laparoscopic hernia repair in infancy and childhood has remained controversial.The present study was intended to compare laparoscopic assisted hernia repair (LH) versus open hemiotomy (OH) regarding operative duration,postoperative complications,recurrence rate and contralateral metachronous hernia rate.Methods A total of 2280 children with inguinal hernia were operated from January 1,2015 to December 31,2016.Laparoscopic inguinal hernia repair (n =906) and open herniotomy (n =1374) were performed.Patient records were reviewed to the data of operative duration,postoperative hydrocele formation and presence of contralateral patent processus vaginalis (CPP).And parental telephone interviews were conducted to identify the unilateral and contralateral recurrences and testis status.Results During the study period,the losing follow-up rate was 9.4％ in laparoscopic group versus 12.1％ in open surgery group.The mean follow-up period was 15.2 monhs.The operative duration was longer in LH group than that in OH group [boy:(39.9± 14.8) rnin,girl(29.8±8.5) min vs.boy:(50.2 ± 17.2) min,girl:(47.5 ± 19.2) min] (P＜0.01).The recurrence rate was 0.42％ in laparoscopic group versus 0.69％ in open surgery group.For unilateral hernia,none had a contralateral metachronous hernia (MH) in laparoscopic group versus 10.6％ in open surgery group (P＜0.001).And 65％ MH occurred at 3 months after initial repair.Girls and those with initial left-sided hernia tended to have a contralateral MH after initial open hernia repair.Conclusions Laparoscopic hernia repair is both safe and effective in children,especially for girls and those with initial left-sided hernia.CPP repair is recommend simultaneously during laparoscopy.%目的 腹腔镜在儿童腹股沟斜疝治疗中的应用仍存在争议.本研究拟通过对比手术时长、术后复发率、术后阴囊水肿发生率、伤口外观以及对侧腹股沟斜疝发生率等来比较腹腔镜与开放手术在儿童腹股沟斜疝治疗中的优缺点.方法 回顾性分析2015年1月1日至2016年12月31日在上海市儿童医院普外科治疗的所有腹股沟斜疝患儿资料,并对其家长进行电话回访.共有2 280例患儿,其中行腹腔镜手术的患儿为906例,行传统开放手术的患儿为1 374例.电话回访内容包括手术侧斜疝有无复发、对侧有无新发、是否可于阴囊内触及睾丸及对伤口是否满意.结果 我们对所有的病例均进行了电话回访,失访率在腹腔镜组为9.4％,在传统手术组为12.1％.平均随访时长为15.2个月.双侧斜疝患儿手术时长腹腔镜组[男:(39.9±14.8)min,女:(29.8±8.5)min]小于传统手术组[男:(50.2±17.2) min;女:(47.5±19.2)min],P＜0.01.腹腔镜组的术后复发率为0.42％,传统手术组的术后复发率为0.69％,两组差异无统计学意义.腹腔镜组单侧斜疝患儿中45.5％的患儿术中发现双侧鞘状突未闭,传统手术组单侧斜疝患儿中10.6％的患儿第一次手术后出现对侧腹股沟斜疝,65％的患儿于术后3个月内出现,需再次行手术治疗.女性患儿及左侧斜疝患儿更易出现对侧斜疝.结论 腹腔镜在儿童腹股沟斜疝治疗中的应用是安全有效的,特别是在女性患儿及初发为左侧斜疝患儿中优势更明显.腹腔镜手术的另一大优点是可同时探查双侧鞘状突的闭合情况,如发现双侧鞘状突未闭,可同时行双侧疝囊高位结扎术,以避免患儿需二次麻醉、手术及发生腹股沟斜疝嵌顿的风险.