经脐单部位腹腔镜手术治疗小儿腹股沟嵌顿疝的探讨

目的：探讨经脐单部位腹腔镜手术治疗小儿腹股沟嵌顿疝的临床疗效。方法：回顾分析我院2010年1月—2014年8月收治的105例腹股沟嵌顿疝患儿临床资料。按手术方法不同分组，将其中56例经脐单部位腹腔镜手术（单部位腹腔镜组）和49例传统开放手术（开放手术组）对比分析。两组术后随访6-36月。结果：两组均完成手术。开放手术组手术时间为(33.73±4.41)min，单部位腹腔镜组中48例手术时间为(25.13±4.82)min，较前显著缩短，两组比较差异有统计学意义（p<0.01）；单部位腹腔镜组中其他8例发现对侧隐性疝，行双侧疝囊高位结扎，手术时间(32.25±2.18)min。开放手术组和单部位腹腔镜组术中出血量为(3.18±2.90)ml和(1.73±0.88)ml，住院时间为(4.22±1.16)d和(3.50±0.97)d，两组差异均有统计学意义（p<0.01）。开放手术组术后并发症发生率为24.5%（12/49)，单部位腹腔镜组为8.9%（5/56）。两组术后随访，均无隐睾，无疝复发。结论：经脐单部位腹腔镜手术治疗小儿腹股沟嵌顿疝，可直视下探查嵌顿疝内容物损伤情况，高位结扎疝囊且不破坏腹股沟管解剖结构，并探查对侧有无隐性疝并处理。该技术安全，有效，微创，为小儿腹股沟嵌顿疝的治疗提供一种新的选择。

Role of single-site umbilical laparoscopy in the treatment for inguinal incarcerated hernia in children

Objective To evaluate clinical effect of single-site umbilical laparoscopy in the treatment for inguinal incarcerated hernia in children. Methods Retrospective reviews were conducted for the clinical data of the 105 children of inguinal incarcerated hernia during January 2010 to August 2014. According to different operative approach, single-site laparoscopic surgery group(SLS ,n=56) and open surgery group(OS，n=49) were assigned and compared .The follow –up period was 6-36 month. Results Operation underwent successfully in both groups .The average operative duration had significant difference , which was (33.73±4.41)min for OS versus (25.13±4.82)min for 48 cases in SLS(p<0.01) ; the operative duration of other 8 cases in SLS was(32.25±2.18)min, because of discovery occult inguinal hernia and treating bilateral hernia. The average operative blood loss was (3.18±2.90)ml for OS versus (1.73±0.88)ml for SLS(p<0.01).The hospitalization duration was (4.22±1.16)d for OS versus (3.50±0.97)d for SLS(p<0.01). The postoperative complication were 24.5% for OS and 8.9% for SLS. Conclusion Single-site umbilical laparoscopy is safe and efficacious for inguinal incarcerated hernia in children .It offers many advantages such as mini-invasiveness , quick recovery ,fewer complication and discovery of occult inguinal hernia.