开放手术与腹腔镜下手术治疗新生儿嵌顿性腹股沟斜疝的临床疗效比较

Comparative effectiveness research of laparoscopic and open surgery in treatment of incarcerated hernia in newborn

摘要:

比较开放与腹腔镜下腹股沟斜疝疝囊高位结扎术治疗新生儿嵌顿性腹股沟斜疝的临床疗效。方法 2014年3月－2018年9月该院共收治28例腹股沟斜疝嵌顿新生儿，其中13例行开放手术（开放组），15例行腹腔镜手术（腹腔镜组）。对两组患儿的手术时间、切口长度、术中出血量、术后住院时间、总住院费用及术后并发症进行对比分析。结果 腹腔镜组术中发现对侧隐匿性疝6例，3例行对侧鞘状突高位结扎术，腹腔镜组手术时间（16.00±4.68）min，开放组（34.54±5.30）min，两组比较，差异有统计学意义（t =15.14，P <0.05）；腹腔镜组切口长度、术中出血量、术后住院时间、总住院费用优于开放组，差异均有统计学意义（P <0.05）。在手术并发症方面，开放组出现1例伤口感染（7.69%），5例阴囊红肿（38.46%），3例阴囊血肿（23.08%），1例隐睾（7.69%）。腹腔镜组出现1例阴囊红肿（6.67%），两组并发症总发生率比较，差异有统计学意义（P <0.05）。随访2～56个月，两组均无复发及异时疝发生。结论 腹腔镜手术治疗新生儿腹股沟斜疝嵌顿，操作简便、疗效确切，与开放性手术相比，具有创伤小、手术时间短、切口美观、术后阴囊肿胀发生率低、住院时间短和总住院费用低等优点，术后恢复快，是安全、有效、可行的方法，值得临床推广应用。随着儿童的生长发育，鞘状突开口比较小或者鞘状突有腹膜遮挡的隐匿性疝有自愈的可能，这部分患者可以考虑观察。

Abstract:

To evaluate the clinical results of laparoscopic and open high ligation of the hernia sac for incarcerated hernia in newborn. Methods There were 28 cases with incarcerated hernia from Mar 2014 to Sept 2018, 15 patients who were underwent laparoscopy while other 13 underwent open surgery. Inter-group comparisons were made with regards to operative duration, intraoperative blood loss, hospitalization time after operation, total hospital expenditure, postoperative comparisons. Results 6 neonates with contralateral patent processus vaginalis (CPPV) were detected in laparoscopic group and 3 high ligated simultaneously. The average operative duration was short in laparoscopic group than that in open surgery group [(16.00 ± 4.68) min vs. (34.54 ± 5.30) min], the difference was statistically significant (P < 0.05). The length of incision, intraoperative blood loss, hospital stay, total hospital expenditure of laparoscopic group were less than that of open surgery group (P < 0.05). In terms of complications, there was 1 patient of wound infection, 5 patients of swelling of the scrotum, 3 patients with scrotal hematoma, and 1 patient with iatrogenic cryptorchidism after open surgery. There was 1 patient of swelling of the scrotum, and no cases with wound infection, scrotal hematoma and iatrogenic cryptorchidism in the laparoscopic group. Overall morbidities were 6.67% (1/15) in laparoscopic group, significantly less than 76.92% (10/13) in open surgery group (P < 0.05). After 2~56 months follow-up, no recurrence and no metachronous inguinal hernia (MIH) was found. Conclusion Laparoscopic high ligation of the hernia sac is safe, feasible, and effective in the treatment for incarcerated hernia in newborn. Compared with open surgery, it has the advantages of less invasive, shorter average operative duration, more beautiful of incision, shorter hospital stay, less total hospital expenditure, and fewer incidence of postoperative complications. It is worthy of clinical application. In cases with small processus vaginalis or covered by peritoneum. There is the possibility of self-healing as patient growth and development. These patients can be considered for observation.