腹腔镜手术治疗小儿嵌顿性腹股沟斜疝

摘要

目的：探讨腹腔镜手术治疗小儿腹股沟嵌顿疝的近远期疗效。方法回顾分析57例接受腹腔镜手术治疗患儿（腹腔镜组）的围手术期情况及术后随访情况，并与同期60例传统手术患儿（对照组）进行比较。结果腹腔镜组患儿手术时间为15～75 min，平均（38．7±12．9） min；术中有7例见疝出肠管坏死，扩大脐部切口或经右下腹小切口提出切除并吻合，再行腹腔镜疝囊高位结扎术；术后仅有5例发生阴囊水肿，术后住院时间2～7天，平均3．6天；随访6个月～1年未见本组患儿有复发或继发性睾丸萎缩现象。腹腔镜组手术时间、住院时间均短于对照组（P＜0．05），术后阴囊水肿发生率、切口感染发生率及复发率均低于对照组（P＜0．05）。结论腹腔镜手术治疗小儿腹股沟嵌顿疝具有创伤小、手术及住院时间短等优点，较传统手术有明显优势。%Objective To discuss the efficacy of the laparoscopic approach to incarcerated inguinal hernia ( IIH) in children.Methods Clinical data from 57 IIH patients receiving laparoscopic surgery were analyzed retrospectively . Meanwhile , another 60 IIH patients treated with traditional methods in our hospital were set as a control group .Results The duration of laparoscopic surgery ranged from 15 to 75 min, with an average of (38.7 ±12.9) min.Seven of the pa-tients developed intestine or ileocecum necrosis , which part was removed followed by end -to-end anastomosis through expansion of an umbilical incision or a small right lower quadrant incision .After surgery, only five patients reported scro-tal edema.The duration of hospitalization ranged from 2 to 7 days, with an average of 3.6 days.All child patients receiv-ing laparoscopic approach were followed up from 6 months to 1 year, without recurrence or secondary testicular atrophy . The laparoscopic group presented remarkably shorter duration of operation and hospitalization , as well as lower incidences of postoperative scrotal edema and incision infection , compared with the control (P<0.05).Conclusion Laparoscopic approach to incarcerated inguinal hernia shows obvious advantages due to its small incision , and shorter duration of opera-tion and hospitalization , compared with traditional methods .