一步法与二步法腹壁穿刺行腹腔镜小儿疝囊高位结扎术临床对比分析

目的对比分析腹腔镜疝囊高位结扎术治疗小儿腹股沟斜疝术中采用钳式穿刺针一步法腹壁穿刺(一步法)与采用硬膜外穿刺针二步法腹壁穿刺(二步法)的安全性及临床效果。 方法回顾性分析2015年3月至2018年6月身高≤120 cm、疝囊颈前后直径≤1.5 cm的小儿单侧腹股沟斜疝患者147例临床资料，64例患儿为二步法组，83例患儿为一步法组，应用SPSS 17.0软件进行统计学分析，术中术后各项指标采用( ±s)表示，采用独立t检验；1年复发率采用χ²检验，P<0.05为差异有统计学意义。 结果一步法组与二步法组相比，手术时间分别为(11.8±3.2) min和(12.4±2.9) min，术中出血量分别为(1.7±1.3) ml和(1.9±1.3) ml，发现对侧隐匿性疝例数分别为10例(12.0%)和8例(12.5%)，术后24 h疼痛评分分别为(1.2±0.6)分和(1.3±0.5)分，发生阴囊(阴唇)肿胀分别为0例和1例(1.6%)，住院时间分别为(2.1±1.1) d和(2.2±1.1) d，术后1年复发率分别为2.4%(2/83)和3.1%(2/64)，上述7项指标两组差异均无统计学意义(均P>0.05)。 结论对身高≤120 cm、疝囊颈前后直径≤1.5 cm的小儿单侧腹股沟斜疝施行腹腔镜疝囊高位结扎术，无论采用一步法或是二步法腹壁穿刺，均可获得良好的临床治疗效果，两组术后1年复发率相当。

Comparative analysis between one-step and two-step puncture assisted laparoscopic high ligation of hernia sac in the treatment of indirect inguinal hernia in children

Objective To assess the clinical efficacy and safety of one-step puncture method(using clamp type needle) versus two-step puncture method(using epidural needle) in pediatric laparoscopic high ligation of indirect inguinal hernia sac. Methods Retrospect review was conducted to 147 pediatric patients(≤120 cm in height) with unilateral indirect inguinal hernia(≤1.5 cm in diameter of hernial neck) in our hospital from March 2015 to June 2018, in which 64 cases were performed with epidural needle(two-step puncture method), and 83 cases were done with clamp type needle(one-step puncture method). Perioperative data were presented as (x±s), and compared via independent two sample t test. One-year recurrence rates were analyzed using the χ^2 test. SPSS statistical software(version 17.0) was used for all the analysis, at a significance level of P<0.05. Results There was no difference between the two groups in regard to the duration of surgery (11.8±3.2) min vs.(12.4±2.9) min], intraoperative blood loss (1.7±1.3) ml vs.(1.9±1.3) ml], incidence of occult contralateral hernia n=10(12.0%) vs. n=8(12.5%)], pain score at 24 hours after surgery (1.2±0.6) vs.(1.3±0.5)], incidence of scrotal or labial edema n = 0(0%) vs. n = 1(1. 6%)],hospitalization time (2. 1 ± 1. 1) d vs.(2. 2 ± 1. 1) d],and one-year recurrence rates 2. 4%(2/83) vs. 3. 1%(2/64)]. Conclusion For pediatric patients(≤120 cm in height) with unilateral indirect inguinal hernia(≤1. 5 cm in diameter of hernial neck) who underwent laparoscopic high ligation of indirect inguinal hernia sac,both one-step puncture method and two-step puncture method can achieve satisfactory clinical effects,with similar one-year recurrence rates.