不同微创术式治疗儿童腹股沟疝术后伤口恢复及外观情况比较

目的:探究腹腔镜全腹膜外腹股沟疝修补术(Totally extraperitoneal herniorrhaphy,TEP)与腹腔镜经腹腹膜前腹股沟疝修补术(Transabdominal preperitoneal herniorrhaphy,TAPP)治疗儿童腹股沟疝临床效果。方法:选取56例腹股沟疝患儿为研究对象,按照随机数表分为TEP组与TAPP组各28例,分别接受TEP、TAPP术式治疗,比较术后1h、6h、1d疼痛程度东大略儿童医院疼痛量表(Children’s hospital of eastern ontario pain scale,CHEOPS)]变化,分析两组围术期基本指标、术后6个月瘢痕严重程度温哥华瘢痕量表(Vancouver scar scale,VSS)]及并发症发生情况。结果:术后1h,两组患儿CHEOPS评分比较差异无统计学意义(P>0.05);术后6h、1d,两组患儿CHEOPS评分均较术后1h时有显著降低,差异有统计学意义(P<0.05),但组间同一时间比较差异均无统计学意义(P>0.05)。两组患儿手术时间、术中出血量、肛门排气时间、下床活动时间及住院时间比较差异均无统计学意义(P>0.05)。术后6个月,TEP组患儿VSS评分均明显低于TAPP组(P<0.05),但两组患儿切口感染、尿潴留、肠梗阻、血清肿并发症发生率及腹股沟疝复发率比较差异均无统计学意义(P>0.05)。结论:不同微创术式治疗小儿腹股沟疝均可取得理想疗效,但TEP相较于TAPP能减轻瘢痕严重程度,有利于维持其局部皮肤美观。

Comparison of Wound Recovery and Appearance of Children with Inguinal Hernia Treated by Different Minimally Invasive Surgeries

Objective To explore the clinical effects of laparoscopic totally extraperitoneal(TEP) inguinal hernia repair and laparoscopic transabdominal preperitoneal(TAPP) inguinal hernia repair in the treatment of children with inguinal hernia. Methods A total of 56 children with inguinal hernia were selected for the study. According to the random number table method, the patients were divided into TEP group and TAPP group, with 28 cases in each group. They were treated with TEP and TAPP respectively. The pain degree(Children’s hospital of eastern ontario-pain scale, CHEOPS) was compared at 1 h, 6 h and 1 d after surgery, and the perioperative basic indicators, severity of scars(Vancouver scar scale, VSS) and occurrence of complications at 6 months after surgery were analyzed in the two groups. Results At 1 h after surgery, there was no significant difference in CHEOPS score between the two groups(P>0.05). At 6 h and 1 d after surgery, the CHEOPS scores in the two groups were significantly lower than those at 1 h after surgery(P<0.05). However, there was no statistically significant difference between the groups at the same time(P>0.05). There were no significant differences in the operative time, intraoperative blood loss, anal exhaust time, ambulation time and hospital stay between the two groups(P>0.05). At 6 months after operation, the VSS scores in TEP group were significantly lower than those in TAPP group(P<0.05), but there were no significant differences in the incidence rates of complications of incision infection, urinary retention, intestinal obstruction and seroma and recurrence rate of inguinal hernia between the two groups(P>0.05). Conclusion Different minimally invasive surgeries can achieve ideal efficacy in the treatment of children with inguinal hernia. However, TEP can reduce the severity of scar compared with TAPP, and it is beneficial to maintain the local skin beauty.