目的：探究腹腔镜下腹股沟高位结扎术与小切口技术在小儿斜疝中的治疗效果对比。方法：研究为回顾性研究，选取自2019年1月至2022年1月收治我院小儿外科的148例小儿斜疝患儿为研究对象，根据手术方案的不同分成2组：腹腔镜组56例，选择腹腔镜下腹股沟高位结扎术，其中男孩49例，女孩7例。小切口组92例，选择小切口微创技术，其中男孩81例，女孩11例。收集患儿的一般资料，手术相关资料和术后并发症的发生率。结果：2组患儿的一般资料比较无统计学差异(P > 0.05)，可以进行组间比较。腹腔镜组患儿的手术时间，麻醉时间要明显短于小切口组(P < 0.05)，手术切口明显短于小切口组(P < 0.05)，术后恢复时间和术后住院时间明显短于小切口组(P < 0.05)。腹腔镜组患儿的复发率，腹胀，阴囊肿胀和继发鞘膜积液发生率明显低于小切口组(P < 0.05)。结论：腹腔镜下腹股沟高位结扎术治疗小儿斜疝效果肯定，值得进一步推广和应用。 Objective: To compare the effect of laparoscopic high ligation of groin and small incision technique in the treatment of indirect hernia in children. Methods: The study was a retrospective study. 148 children with indirect hernia who were admitted to the pediatric surgery department of our hospital from January 2019 to January 2022 were selected as the research objects. According to the different operation schemes, they were divided into two groups: 56 cases in the laparoscopic group were treated with laparoscopic high ligation of the groin, including 49 boys and 7 girls. In the small incision group, 92 cases were treated with small incision minimally invasive technique, including 81 boys and 11 girls. The general data, operation related data and the incidence of postoperative complications were collected. Results: There was no significant difference in the general data be-tween the two groups (P > 0.05). The operation time and anesthesia time of children in the laparoscopic group were significantly shorter than those in the small incision group (P < 0.05), the operation incision was significantly shorter than those in the small incision group (P < 0.05), and the postoperative recovery time and postoperative hospital stay were significantly shorter than those in the small incision group (P < 0.05). The recurrence rate, abdominal distension, scrotal swelling and secondary hydrocele in the laparoscopic group were significantly lower than those in the small incision group (P < 0.05). Conclusion: The laparoscopic high ligation of groin in the treatment of indirect hernia in children is effective and worthy of further promotion and application.
目的：探究腹腔镜下腹股沟高位结扎术与小切口技术在小儿斜疝中的治疗效果对比。方法：研究为回顾性研究，选取自2019年1月至2022年1月收治我院小儿外科的148例小儿斜疝患儿为研究对象，根据手术方案的不同分成2组：腹腔镜组56例，选择腹腔镜下腹股沟高位结扎术，其中男孩49例，女孩7例。小切口组92例，选择小切口微创技术，其中男孩81例，女孩11例。收集患儿的一般资料，手术相关资料和术后并发症的发生率。结果：2组患儿的一般资料比较无统计学差异(P > 0.05)，可以进行组间比较。腹腔镜组患儿的手术时间，麻醉时间要明显短于小切口组(P < 0.05)，手术切口明显短于小切口组(P < 0.05)，术后恢复时间和术后住院时间明显短于小切口组(P < 0.05)。腹腔镜组患儿的复发率，腹胀，阴囊肿胀和继发鞘膜积液发生率明显低于小切口组(P < 0.05)。结论：腹腔镜下腹股沟高位结扎术治疗小儿斜疝效果肯定，值得进一步推广和应用。
小儿斜疝，腹腔镜，高位结扎术，小切口
Dongqian Bai
Department of Pediatric Surgery, Shan County Central Hospital, Heze Shandong
Received: Jun. 1st, 2022; accepted: Jul. 11th, 2022; published: Jul. 18th, 2022
Objective: To compare the effect of laparoscopic high ligation of groin and small incision technique in the treatment of indirect hernia in children. Methods: The study was a retrospective study. 148 children with indirect hernia who were admitted to the pediatric surgery department of our hospital from January 2019 to January 2022 were selected as the research objects. According to the different operation schemes, they were divided into two groups: 56 cases in the laparoscopic group were treated with laparoscopic high ligation of the groin, including 49 boys and 7 girls. In the small incision group, 92 cases were treated with small incision minimally invasive technique, including 81 boys and 11 girls. The general data, operation related data and the incidence of postoperative complications were collected. Results: There was no significant difference in the general data between the two groups (P > 0.05). The operation time and anesthesia time of children in the laparoscopic group were significantly shorter than those in the small incision group (P < 0.05), the operation incision was significantly shorter than those in the small incision group (P < 0.05), and the postoperative recovery time and postoperative hospital stay were significantly shorter than those in the small incision group (P < 0.05). The recurrence rate, abdominal distension, scrotal swelling and secondary hydrocele in the laparoscopic group were significantly lower than those in the small incision group (P < 0.05). Conclusion: The laparoscopic high ligation of groin in the treatment of indirect hernia in children is effective and worthy of further promotion and application.
Keywords:Pediatric Indirect Hernia, Laparoscope, High Ligation, Small Incision
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小儿斜疝是临床上的多发病、常见病。尤其见于男孩。既往文献报道，小儿斜疝的发病率为2%以上，而男孩的发病率是女孩的1倍以上 [
本研究为回顾性研究，选取自2019年1月至2022年1月收治我院小儿外科的148例小儿斜疝患儿为研究对象，根据手术方案的不同分成2组：腹腔镜组56例，选择腹腔镜下腹股沟高位结扎术，其中男孩49例，女孩7例。小切口组92例，选择小切口微创技术，其中男孩81例，女孩11例。本研究方案获得本院伦理委员批准。
1) 纳入标准：① 所有入组者均为斜疝；② 年龄 < 18岁；③ 签署知情同意书。
2) 排除标准：① 年龄 ≥ 18岁；② 直疝的患者；③ 不同意手术方案的入组者。
1) 腹腔镜下腹股沟高位结扎术：麻醉方案选择静脉联合吸入麻醉方案，取平卧位，常规消毒铺巾后，脐部穿刺制备气腹，气腹压力为8~12 mmHg，脐周置入穿刺套管，置入腹腔镜，疝的对侧腹壁置孔，放置抓钳，内口置孔，作为操作孔。在内环口顶部持微型抓钳提起内环口的外侧半腹膜，然后操针缝1~2针后再在内环口底部腹膜缝一针，该处不要伤到精索血管，将线的另一端穿入针孔于内环口体表戳孔再次穿入腹腔缝内环口的内侧半1~2针，将线另一端也送入腹腔缝线的中段留在体外并用弯钳夹持然后缝合内口。将内环口体表缝线拉紧结扎线头陷入皮下，内环口即被关闭。
2) 小切口技术：麻醉方案选择静脉联合吸入麻醉方案，取平卧位，下肢分开，微屈固定。在患侧耻骨结节外侧、外环口体表投影处取一长约0.8~1.0 cm的横切口切开皮肤，显露腹外斜肌腿膜向内下侧牵拉皮下组织显露腹股沟管外环。以手术刀顺着纤维走行向外环口方向切开腹外斜肌腱膜显露精索，小儿疝环一般较狭窄，可于内环处高位贯穿缝合结扎。彻底止血后逐层缝合皮下和皮肤。
进行镇痛补液处理，指导功能锻炼。
1) 一般资料：包括年龄，性别，体重等；
2) 手术相关指标：包括手术时间，切口长度，麻醉时间，术中失血量和住院时间等；
3) 术后并发症：包括复发率，腹胀，阴囊肿胀和继发鞘膜积液等。
采用IBM SPSS21.0软件进行数据处理。计量资料首先使用Shapiro-Wilk检验判断数据是否为正态分布，数值以x ± s表示，组内计量资料采用配对样本t检验，组间计量资料采用独立样本t检验。计数资料比较采用χ2检验，P ≤ 0.05被认为差异有统计学意义。
结果显示，2组患儿的一般资料比较无统计学差异(P > 0.05)，可以进行组间比较。见表1。
| 分组 | 腹腔镜组(n = 56) | 小切口组(n = 92) | 统计值 | P值 |
|---|---|---|---|---|
| 性别 | X2= 0.124 | >0.05 | ||
| 男孩 | 49 | 81 | ||
| 女孩 | 7 | 11 | ||
| 年龄(岁) | 4.15 ± 0.45 | 4.34 ± 0.47 | t = 0.448 | >0.05 |
| BMI (Kg/cm2) | 19.33 ± 1.02 | 19.51 ± 1.24 | t = 0.501 | >0.05 |
表1. 一般资料比较结果
结果显示，腹腔镜组患儿的手术时间，麻醉时间要明显短于小切口组(P < 0.05)，手术切口明显短于小切口组(P < 0.05)，术后恢复时间和术后住院时间明显短于小切口组(P < 0.05)，见表2。
| 分组 | 腹腔镜组(n = 56) | 小切口组(n = 92) | t值 | P值 |
|---|---|---|---|---|
| 手术时间(min) | 36.23 ± 4.16 | 50.89 ± 3.97 | 2.124 | <0.05 |
| 麻醉时间(min) | 39.46 ± 2.89 | 56.77 ± 2.46 | 2.301 | <0.05 |
| 手术切口(cm) | 2.02 ± 0.41 | 4.26 ± 1.22 | 2.468 | <0.05 |
| 术后恢复时间(d) | 1.02 ± 0.05 | 1.77 ± 0.87 | 3.447 | <0.05 |
| 术后住院时间(d) | 2.14 ± 0.33 | 3.76 ± 1.02 | 3.871 | <0.05 |
表2. 手术相关资料比较结果
结果显示，腹腔镜组患儿的复发率，腹胀，阴囊肿胀和继发鞘膜积液发生率明显低于小切口组(P < 0.05)，见表3。
| 分组 | 腹腔镜组(n = 56) | 小切口组(n = 92) | χ2值 | P值 |
|---|---|---|---|---|
| 复发率 | 1 (1.79%) | 3 (3.26%) | 3.249 | <0.05 |
| 腹胀 | 5 (8.93%) | 15 (16.31%) | 2.809 | <0.05 |
| 阴囊肿胀 | 2 (3.57%) | 8 (8.70%) | 2.522 | <0.05 |
| 继发鞘膜积液发生率 | 4 (7.14%) | 14 (15.22%) | 3.074 | <0.05 |
表3. 术后并发症比较结果
临床上的小儿腹股沟疝以单侧为主，发病率较高，对于患儿而言，及时及早的就诊，可以减轻患儿的痛苦。腹股沟斜疝的发病原因较多，临床较为常见的原因为腹腔的压力升高，比如剧烈咳嗽，长期便秘和排尿困难等 [
小切口技术是从传统手术发展而来，因为传统的手术方案切口较大，对疝囊的暴露较为充分，但是，大切口对患儿的损伤较大，术后并发症发生率较高，患者的满意度较差。小切口技术是通过改变切口的位置，从而缩短手术切口而达到相对微创的目的。有研究证明，小切口技术对患儿术后疗效较为肯定，可以取得较好的术后效果 [
术后并发症也是影响患儿腹股沟斜疝效果的关键因素，比如患儿的腹股沟疝气复发率，腹胀，阴囊肿胀和继发鞘膜积液发生率等，有研究认为，患儿术后并发症的发生率与术中的操作和术后的炎症反应密切相关，在本研究中，结果表明，腹腔镜组患儿的复发率，腹胀，阴囊肿胀和继发鞘膜积液发生率明显低于小切口组(P < 0.05)，分析原因，可能是腹腔镜技术对周围组织损伤较小的原因。
但是，本研究也存在一定的局限性，比如本研究属于回顾性研究，缺乏前瞻性研究，参考意义尚待进一步完善。
白东乾. 腹腔镜下腹股沟高位结扎术与小切口技术在小儿斜疝中的治疗效果对比研究Comparative Study of Laparoscopic High Ligation of Groin and Small Incision Technique in the Treatment of Indirect Hernia in Children[J]. 外科, 2022, 11(03): 71-75. https://doi.org/10.12677/HJS.2022.113012