四种手术方法治疗巨大小儿疝的临床对比分析(附412例报告)

目的 探讨不同腹腔镜方法 治疗巨大小儿疝的疗效.方法 2007年5月至2009年8月我院对412例巨大小儿疝随机分成4组进行腹腔镜修补,主要通过术后复发率来比较疗效.A组:单纯疝囊高位结扎(147例);B组:疝囊高位结扎并用脐内侧韧带覆盖内环口(94例);C组:双重结扎内环口(82例);D组:疝囊高位结扎同时将髂耻束与弓状缘缝合缩窄内环(89例).结果 患者均随访2～4年,A组复发3例,分别于术后6、7、9个月;B组术后1年复发1例;C组及D组均无复发患者.A、B组与C、D组的复发率比较差异有统计学意义(P＜0.05).结论 对于巨大小儿疝腹腔镜单纯高位结扎疝囊是不可靠的,腹腔镜下修补是有必要的,而且将髂耻束与弓状缘缝合缩窄内环作修补的方法 更可靠.

Comparison of four Laparoscopic Methods for Pediatric Huge Indirect Hernia Repair(Report of 412 Cases)

Objective To evaluate different methods of laparoscopic hernioplasty in pediatric huge indirect hernia.Methods From May 2007 to August 2009,a total of 412 patients with huge indirect hernia in children,applied laparoscopic hernioplasty with 4 different procedures.Those cases were classified into 4 groups:Group A:147 cases with single ligating the inguinal ring;Group B:94 cases with ligating the inguinal ring besides suturing the lateral umbilical ligament to cover the inguinal ring;Group C:82 cases with double ligating the inguinal ring;Group D:89 cases with ligating the inguinal ring besides suturing the iliopubic tract to the conjoint tendon.Results A follow-up was 2 to 4 years,and there were 3 cases of recurrence in 6 months,7 months,9 months after the surgery in Group A and 1 case in 1 year after the operation in Group B.There was no recurrence in Group C and D.The recurrence rate of Group A and B was higher than those in the other groups(P < 0.05).Conclusions High ligation of hernia sac for pediatric huge hernia by laparoscopy is not reliable.The laparoscopic repair is necessary.Iliopubi beam and the arcuate edge of the suture narrowing of the inner ring for repair method is more reliable.