经脐单一部位单通道与双通道腹腔镜手术治疗小儿腹股沟斜疝的对比研究

目的 探讨经脐单一部位单通道与双通道腹腔镜手术治疗小儿腹股沟斜疝的临床价值.方法 2010年1月-2012年12月,360例腹股沟斜疝患儿分为2组（单通道腹腔镜组178例,双通道腹腔镜组182例）.单通道腹腔镜组于脐部上缘纵行切开10-15 mm,直视下放置10 mm trocar,经trocar置入10 mm单孔带操作孔道的腹腔镜,自操作孔道置入专用加长5 mm腹腔镜持针器,经腹壁穿入腹腔-2-0带针丝线,荷包缝合未闭合内环口1周.双通道腹腔镜组于脐部纵行切开10-15 mm,蚊式钳游离切口上、下极皮下组织,于上极直视下置入5 mm trocar作为观察孔,下极钝性穿刺置入5 mm trocar作为操作孔,置入常规操作器械,荷包缝合内环口.结果 3岁以上的患儿双通道腹腔镜组术后脐部疼痛发生率高[46.3%（19/41） vs.23.7%（9/38）,χ^2=4.425,P=0.035],但2组手术时间[（25.9±5.7）min vs.（25.0±5.4） min,t=1.538,P=0 125],术后住院时间[（1.8±0.8）d vs.（1.9±0.7）d,t=-1.263,P=0.207],住院费用[（3473.6±165.4）元 vs.（3478.2±131.4）,t=-0.293,P=0 770]均无明显差异.单、双通道腹腔镜组分别随访172、168例,术后6个月无斜疝复发,无脐疝、睾丸萎缩及睾丸下降不全等并发症,脐部未见明显手术瘢痕.结论经脐单一部位单通道与双通道腹腔镜疝囊高位结扎术疗效相当,腹壁不留瘢痕,但双通道腹腔镜手术无须特殊器械,更值得临床推广.

Comparative Study between Transumbilical Single Site One-port and Double-port Laparoscopic High Ligation of Hernia Sac for the Treatment of Indirect Inguinal Hernia in Children

Objective To explore the clinical value of transumbilical single site one-port and double-port laparoscopic high ligation of hernia sac for the treatment of indirect inguinal hernia in children. Methods The clinical data of 360 children with indirect inguinal hernia undergoing laparoscopie high ligation of hernia sac from November 2010 to December 2012 were analyzed retrospectively, including 178 cases undergoing single site one-port laparoseopic surgery（ one-port group）, and 182 cases undergoing single site double-port laparoscopie surgery（ double-port group）. In the one-port group, a 10 -15 mm longitudinal incision above the umbilicus was made for the insertion of 10-mm trocar, and then through the trocar, a 10-mm laparoseope with an operating hole was inserted. An appropriative 5-mm needle-holder was inserted through the operating hole, and a round needle with 2-0 nonabsorbable suture was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The orifice of the hernia sac was closed extraperitoneally with a purse-string suture around the internal inguinal ring, and then intraperitoneal knot-tying was performed. In the double-port group, a 10 -15 mm longitudinal incision above the umbilicus was made and the subcutaneous tissue of the upper and lower poles of the incision were separated with mosquito clamp. A 5-mm trocar was inserted through the upper pole of the incision as an observation hole, while another 5-ram trocar was inserted on the lower pole of the incision as an operating hole. The orifice of the hernial sac was closed extraperitoneally with a purse-string suture using routine operation instruments inserted through the operating hole. Results The rate of postoperative umbilicus pain was higher in the double-port group than that of the one-port group [ （46. 3 % , 19/41 ） vs. （23.7% ,9/38 ）, X^2 = 4. 425,P = 0. 035 % ; no significant differences were found between the two groups in operative time[（25.9±5.7） min vs. （25.0±5.4） min, t=1.538,P=0.125], postoperative hospital stay [（1.8 ±0.8） d vs. （1.9±0.7）d , t= -1.263, P=0.207], and hospital costs [（3473.6 ±165.4） yuan vs. （ 3478.2 ±131.4） yuan, t = 0. 293, P =0. 7701. A total of 172 eases and 168 cases were followed up in the one-port and double-port groups respectively. No recurrence, umbilical hernia, orchiatrophy or incomplete orchiocatabasis was found 6 months after operation. No obvious scar was observed in the umbilicus. Conclusions The two procedures have the same curative effect without scar being observed in abdominal wall. Single site double-port laparoseopy is preferred as it does not require special instruments.