经脐单通道与两孔腹腔镜治疗小儿鞘膜积液的比较

doi:10.3877/cma.j.issn.1674-3253.2020.05.008

目的

比较经脐单通道与两孔腹腔镜下腹膜外结扎鞘状突治疗小儿鞘膜积液的疗效。

方法

回顾性分析2018年8月至2020年3月，连云港市第一人民医院收治的400例临床表现为单侧的鞘膜积液病例。根据手术方法分为两组，A组（200例）：采用经脐单通道腹腔镜下硬膜外穿刺针引导prolene线完全腹膜外结扎鞘状突治疗小儿鞘膜积液。B组（200例）：采用两孔腹腔镜法。

结果

两组共400例患儿均顺利完成腹腔镜手术，无中转开放手术，术中探查发现内环口开放情况：A组：单侧37例，双侧163例，B组：单侧21例，双侧179例。A组在平均手术时间[单侧（14.62±3.20）vs（19.29±2.12）min，双侧（23.82±5.24）vs（29.93±5.22）min]，术后平均住院天数[（2.98±0.38）vs（3.26±0.54）d]方面均短于B组，差异有统计学意义。术后B组发生切口疝2例，两组均无阴囊水肿、血肿及切口感染发生。术后随访3个月至1年，两组在术后近、远期并发症方面差异均无统计学意义。

结论

经脐单通道腹腔镜下采用硬膜外穿刺针完全腹膜外结扎鞘状突治疗小儿鞘膜积液的方法简便，安全有效，创伤小，是治疗小儿鞘膜积液的理想术式之一。

关键词: 单孔, 腹腔镜, 小儿鞘膜积液, 腹膜外

Objective

To compare the effect of single-port and two-port laparoscopic extraperitoneal ligation of patent processus vaginalis (PPV) in the treatment of pediatric hydrocele.

Methods

From August 2018 to March 2020, single-port laparoscopy was performed with an epidural needle and two prolene lines for extraperitoneal ligation of the PPV for the treatment of pediatric hydrocele. Group A: 200 patients received single-port laparoscopic ligation, Group B: 200 patients received two-port laparoscopic ligation as control.

Results

All the 400 patients were successfully performed laparoscopic PPV ligation without transposition, no spermatic cord injury, no subcutaneous hematoma, and no scrotal edema was found. Two cases of port-site hernia were found in group B. The operation time [unilateral (14.62±3.20) vs (19.29±2.12) min, bilateral (23.82±5.24) vs (29.93±5.22) min], postoperative hospital stay [(2.98±0.38) vs (3.26±0.54 )d] of group A were significantly shorter than group B. After 3-12 months of follow-up, there was no tissue reaction, no incision infection and recurrence. There was no statistical difference in postoperative complications between group A and group B.

Conclusion

Single-port laparoscopy with epidural needle and prolene line for extraperitoneal ligation of the PPV in the treatment of pediatric hydrocele has the advantages of being minimally invasive, safe, effective. This procedure could be recommended for treatment of pediatric hydrocele.

Key words: Single port, Laparoscopy, Pediatric hydrocele, Extraperitoneal

表1 经脐单通道（A组）与两孔（B组）小儿鞘膜积液患者一般资料的比较

	例数	左侧(例)	右侧(例)	年龄(月，±s)
A组	200	70	130	38±15
B组	200	85	115	37±12
统计值		χ²=2.370^‡		t=1.146^*
P值		0.124		0.252

表1 经脐单通道（A组）与两孔（B组）小儿鞘膜积液患者一般资料的比较

	例数	左侧(例)	右侧(例)	年龄(月，±s)
A组	200	70	130	38±15
B组	200	85	115	37±12
统计值		χ²=2.370^‡		t=1.146^*
P值		0.124		0.252

图9 经脐单通道结扎鞘状突示意图

表2 经脐单通道（A组）和两孔（B组）鞘状突结扎术的比较

		A组	B组	统计值	P值
术中诊断为双侧(例)		163	179	χ²=5.162	0.023
手术时间(min，±s)
	单侧	14.62±3.20	19.29±2.12	t=5.963	<0.001
	双侧	23.82±5.24	29.93±5.22	t=10.795	<0.001
术后住院天数(d，±s)		2.98±0.38	3.26±0.54	t=5.919	<0.001
手术短期并发症(例)				-	0.156
	阴囊血肿	0	0
	阴囊水肿	0	0
	切口感染	0	0
	切口疝	0	2
	精索损伤	0	0
术后随访3～12个月(例)				-	0.571
	睾丸萎缩	0	0
	复发	2	1
	肠粘连肠梗阻	0	0
	缝线反应	0	0

表2 经脐单通道（A组）和两孔（B组）鞘状突结扎术的比较

		A组	B组	统计值	P值
术中诊断为双侧(例)		163	179	χ²=5.162	0.023
手术时间(min，±s)
	单侧	14.62±3.20	19.29±2.12	t=5.963	<0.001
	双侧	23.82±5.24	29.93±5.22	t=10.795	<0.001
术后住院天数(d，±s)		2.98±0.38	3.26±0.54	t=5.919	<0.001
手术短期并发症(例)				-	0.156
	阴囊血肿	0	0
	阴囊水肿	0	0
	切口感染	0	0
	切口疝	0	2
	精索损伤	0	0
术后随访3～12个月(例)				-	0.571
	睾丸萎缩	0	0
	复发	2	1
	肠粘连肠梗阻	0	0
	缝线反应	0	0

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Comparision of single-port and two-port laparoscopic extraperitoneal patent processus vaginalis ligation in the treatment of pediatric hydrocele

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Comparision of single-port and two-port laparoscopic extraperitoneal patent processus vaginalis ligation in the treatment of pediatric hydrocele