腹腔镜探查在单侧腹股沟疝患儿LPEC术中的应用及对对侧异时性疝的预防价值*

Laparoscopic exploration in LPEC for children with unilateral inguinal hernia and the clinical value in preventing contralateral metachronous hernia*

摘要:

探讨腹腔镜探查在经皮腹膜外疝囊高位结扎术（LPEC）中的应用效果及对对侧异时性疝（MCH）的预防价值。方法 回顾性分析300例行开放疝囊修补术（对照组）、200例行LPEC治疗（观察组）的单侧腹股沟疝患儿，其中观察组术中通过腹腔镜探查对侧腹股沟情况，若有对侧鞘状突未闭（CPPV），则给予结扎处理，对照组术中未探查。比较各组手术指标、术后并发症及MCH发生率，并分析MCH发生率与CPPV、年龄的关系。结果 术后疼痛视觉模拟评分（VAS）、术后开始下床活动时间及住院时间方面，观察组均明显优于对照组（P <0.05）；手术时间、术后并发症总发生率方面两组比较差异无统计学意义（P >0.05）；观察组术后MCH发生率1.00%，明显低于对照组的4.67%（P <0.05）；观察组术中发现CPPV 72例，CPPV发生率36.00%，其发生率与观察组患儿年龄相关（P <0.05）；MCH/CPPV风险率比（RR）=0.03，1/RR≈33；所有患儿中2.0～4.0岁者（不包括2.0岁）MCH占43.75%，0.5～2.0岁占31.25%。结论 腹腔镜下LPEC相比开放疝囊修补术治疗单侧腹股沟疝具有术后疼痛轻、恢复快特点，能明显降低MCH发生率；腹腔镜探查能准确发现CPPV，结扎处理虽能减少MCH发生，但会过度医疗。

Abstract:

Abstract: Objective To investigate the application effect of laparoscopic exploration in laparoscopic percutaneous extaperitoneal closure (LPEC) and its value in preventing contralateral metachronous hernia (MCH). Methods The clinical data of 300 children with unilateral inguinal hernia treated by open herniorrhaphy (control group) and 200 children with unilateral inguinal hernia treated by LPEC (observation group) were analyzed retrospectively. In the observation group, the condition of contralateral groin was also explored by laparoscopy, and ligation of contralateral patent processus vaginalis (CPPV) was performed while in the control group, there was no exploration during operation. The operation indexes, postoperative complications and the incidence of MCH were compared between groups. The relationships between the occurrence of MCH and CPPV, age was analyzed. Results The postoperative pain visual analogue scale (VAS) score, postoperative ambulation time and hospitalization time of the observation group were significantly better than those of the control group (P < 0.05). There was no significant difference between the two groups in operation time and the total incidence of postoperative complications (P > 0.05). The incidence of postoperative MCH in the observation group was significantly lower than that in the control group (1.00% vs 4.67%) (P < 0.05). In the observation group, there were 72 cases of CPPV, the incidence rate of CPPV was 36.00%, and the incidence rate was related to age (P < 0.05). The MCH/CPPV risk ratio (RR) was 0.03, and
1/RR was about 33. Among all of the children, children with MCH and younger than 2 to 4 years old accounted for 43.75% while children of 0.5 to 2.0 years old accounted for 31.25%. Conclusion Compared with open herniorrhaphy, laparoscopic LPEC has characteristics of mild postoperative pain and faster recovery in the treatment of unilateral inguinal hernia, and it can significantly reduce the incidence of MCH. Laparoscopic exploration can accurately find CPPV. Ligation can reduce the incidence of MCH but it may cause excessive medical treatment.