腹腔镜下单孔套扎和三孔缝扎治疗儿童精索鞘膜积液对肠道黏膜屏障功能的影响

目的比较单孔腹腔镜钩针鞘突管高位套扎术与三孔法腹腔镜鞘突管内口缝扎术治疗儿童精索鞘膜积液对肠道黏膜屏障功能的影响。方法选择2018年1月至2018年7月哈尔滨市儿童医院完成的73例行腹腔镜治疗的小儿精索鞘膜积液临床资料,分为缝扎组(行三孔法腹腔镜鞘突管内口缝扎手术)35例和套扎组(行单孔腹腔镜钩针鞘突管高位套扎手术)38例,对比分析两组一般资料、手术时间、麻醉时间、手术前后尿乳果糖/甘露醇(ratio of lactulose to mannitol,L/M)、血清D-乳酸和尿肠型脂肪酸结合蛋白(intestinal fatty acid binding protein,IFABP)。结果所有患儿均顺利完成手术。两组患儿月龄、性别、侧别比较差异无统计学意义(P>0.05),具有可比性。两组患儿手术时间、麻醉时间比较差异有统计学意义(P<0.05)。两组尿L/M、血清D-乳酸和尿IFABP术前比较差异无统计学意义(P>0.05)。套扎组尿L/M术前与术后1、2 d比较差异无统计学意义(P>0.05),缝扎组尿L/M术后1、2 d高于术前(P=0.000)。套扎组血清D-乳酸术前、术后2 h比较差异无统计学意义(P>0.05),缝扎组术后2 h血清D-乳酸高于术前(P=0.000)。套扎组尿IFABP术前、术后1 d比较差异无统计学意义(P>0.05),缝扎组术后1 d尿IFABP高于术前(P=0.000)。结论单孔腹腔镜钩针鞘突管高位套扎术和三孔法腹腔镜鞘突管内口缝扎术均是治疗小儿精索鞘膜积液安全可行的术式。与缝扎术相比,套扎术对肠道黏膜屏障功能影响更小。

Single-port knotting versus three-port stitching under laparoscopy for treatment of funicular hydrocele in children: comparative study of intestinal mucosal barrier function

Objective To compare the intestinal mucosal barrier function between single-port extracorporeal knotting and three-ports intracorporeal purse-string stitching for treatment of funicular hydrocele in children. Methods From January 2018 to July 2018, the clinical data of 73 children with funicular hydrocele in Harbin Children Hospital were selected and divided into two groups randomly, including 35 cases undertaking three-port intracorporeal purse-string stitching( stitching group) and 38 cases undertaking single-port extracorporeal knotting(knotting group). The clinical data, operation time, anesthesia time, urine ratio of lactulose to mannitol(L/M), serum D-lactic acid and urine intestinal fatty acid binding protein(IFABP) were summarized and compared between the two groups. Results All of the operations were successful conducted. There was no significant difference in age, sex or sides between the two groups(P>0.05). The operation time and anesthesia time had statistical significance between the two groups(P<0.05). And there was no significant difference in urine L/M, serum D-lactic acid or urine IFABP between the two groups before operation(P>0.05). There was no significant difference in urine L/M before operation and 1, 2 d after operation in knotting group(P>0.05), but the urine L/M 1, 2 d after operation were respectively significantly higher than before operation in stitching group(P=0.000). There was no significant difference in serum Dlactic acid before operation and 2 h after operation in knotting group(P>0.05), but the serum D-lactic acid 2 h after operation was significantly higher than before operation in stitching group(P=0.000). There was no significant difference in urine IFABP before operation and 1 d after operation in knotting group(P>0.05), but the urine IFABP 1 d after operation was significantly higher than before operation in stitching group(P=0.000). Conclusions Three-port intracorporeal purse-string stitching and single-port extracorporeal knotting are both safe and feasible for funicular hydrocele in children. Compared with three-port intracorporeal purse-string stitching, the single-port extracorporeal knotting has less influence on intestinal mucosal barrier function.