新型经脐腹腔镜术与常规三孔法治疗单侧巨大腹股沟斜疝的对比研究

A comparative study of the new transumbilical laparoscopy and the conventional three-port method in the treatment of unilateral huge indirect inguinal hernia

摘要:

目的 探究新型经脐腹腔镜术与常规三孔法治疗单侧巨大（≥15 mm）腹股沟斜疝的临床疗效。方法 回顾性分析2020年7月－2023年8月该院收治的213例单侧巨大（≥15 mm）腹股沟斜疝患儿的临床资料。按照手术方法不同，将患儿分为三孔组（107例，行三孔法腹腔镜疝囊高位结扎术）和新型组（106例，行新型经脐腹腔镜术）。比较两组患儿手术指标、儿童疼痛行为量表（FLACC）评分、家长对切口外观满意度、睾丸体积、术后并发症和复发率（术后1年内）。结果 新型组术中出血量和切口数量少于三孔组，切口长度、手术时间、术后切口愈合时间和住院时间短于三孔组，差异均有统计学意义（P < 0.05）；术后6、12、24和48 h，新型组FLACC评分低于三孔组，差异均有统计学意义（P < 0.05）；新型组患儿家长对切口外观满意度为100.00%，高于三孔组的88.79%，差异有统计学意义（P < 0.05）；两组患儿术前患侧睾丸体积小于健侧，术后1年，患侧睾丸体积大于术前，差异均有统计学意义（P < 0.05）；新型组术后1年健侧与患侧睾丸体积比较，差异无统计学意义（P > 0.05）；两组患儿并发症总发生率和总复发率比较，差异均无统计学意义（P > 0.05）。结论 与常规三孔法比较，新型经脐腹腔镜术具有操作便捷、创伤小、疼痛轻、术后恢复快和切口美观等特点，应用于≥15 mm的单侧巨大腹股沟斜疝的治疗中，更具优势。

Abstract:

Objective To explore the clinical efficacy of the new transumbilical laparoscopy and the conventional three-port method in the treatment of unilateral huge ( ≥ 15 mm) indirect inguinal hernia.Methods A retrospective analysis was conducted on the clinical data of 213 children with unilateral huge ( ≥ 15 mm) indirect inguinal hernia admitted to the hospital from July 2020 to August 2023. According to different surgical methods, the children were divided into the three-port group (107 cases, undergoing three-port laparoscopic high ligation of hernia sacs) and the new group (106 cases, undergoing new transumbilical laparoscopic surgery). The surgical indicators of the two groups of children, the face, legs, activity, cry, consolability (FLACC) score, parents’ satisfaction with the appearance of the incision, testicular volume, postoperative complications and recurrence rate (within 1 year after surgery) were compared.Results The intraoperative blood loss and the number of incisions in the new group were less than those in the three-port group, while the incision length, operation time, postoperative incision healing time and hospital stay were shorter than those in the three-port group. The differences were statistically significant (P < 0.05). At 6, 12, 24 and 48 hours after the operation, the FLACC score of the new group was lower than that of the three-port group, and the difference was statistically significant (P < 0.05). The satisfaction rate of parents of children in the new group with the appearance of the incision was 100.00%, which was higher than 88.79% in the three-port group, and the difference was statistically significant (P < 0.05). The volume of the affected testicle in both groups before the operation was smaller than that of the healthy side, and the volume of the affected testicle one year after the operation was larger than that before the operation. The differences were statistically significant (P < 0.05). One year after the operation in the new group, there was no statistically significant difference in the testicular volume between the healthy side and the affected side (P > 0.05). There was no statistically significant difference in the total incidence of complications and overall recurrence rate between the two groups (P > 0.05).Conclusion Compared with the conventional three-port method, the new transumbilical laparoscopic surgery has the characteristics of convenient operation, less trauma, less pain, faster postoperative recovery and a beautiful incision. It has more advantages when applied in the treatment of unilateral huge indirect inguinal hernia≥15 mm.