目的:探讨单孔腹腔镜下行双改良疝穿刺针腹膜外闭合术(SLPEC组)和两孔腹腔镜下经皮腹膜外闭合术(TLPEC组)治疗小儿巨大腹股沟斜疝的疗效。我们对2019年1月至2021年12月在福建省儿童医院行腹腔镜疝囊高位结扎术的所有巨大腹股沟斜疝(内环口直径≥1.5cm)患儿进行了回顾性分析。我们从所有儿童的病历中收集数据,并分析了他们的临床特征以及与手术相关的和随访信息。总的来说,这项研究纳入了219例孤立性巨大腹股沟疝患者的队列,这些患者有完整的临床资料,并在我们中心接受了腹腔镜疝囊高位结扎术.在我们中心,对106例接受SLPEC的患者和113例接受TLPEC的患者成功进行了所有手术。患者年龄差异无统计学意义,性别,体重,SLPEC组与TLPEC组之间的随访时间或腹股沟疝侧(分别为P=0.123、0.613、0.121、0.076和0.081)。然而,出血量有显著差异,视觉模拟量表(VAS)评分,术后活动时间两组比较(P≤0.001)。TLPEC组手术时间明显长于SLPEC组(P=0.048),但两组间住院时间和住院费用无显著差异(P=0.244和0.073).SLPEC组2例,TLPEC组9例,切口瘢痕,两组间差异有统计学意义(P=0.04)。然而,同侧疝复发的发生率,手术部位感染,两组间缝合结反应和慢性腹股沟痛无显著差异(分别为P=0.332,0.301,0.332和0.599).SLPEC组仅有1名男童发生术后鞘膜积液,TLPEC组无男童发生术后鞘膜积液,两组间差异无统计学意义(P=0.310)。在这项研究中,没有睾丸萎缩或医源性睾丸上升的病例。与TLPEC组比拟,SLPEC组具有隐匿切口的优势,轻度疤痕,最小的侵入性,减少操作时间,出血最少,轻度疼痛和快速恢复。总之,SLPEC使用双改良疝针进行水切开和疝囊高位结扎术是一种安全的,有效和微创手术。美容效果令人印象深刻,后续成果很有希望。
The objective was to explore the efficacy of single-port laparoscopic percutaneous extraperitoneal closure using double-modified hernia needles with
hydrodissection (SLPEC group) and two-port laparoscopic percutaneous extraperitoneal closure (TLPEC group) for the treatment of giant indirect inguinal hernias in children. We performed a retrospective review of all children with giant indirect inguinal hernias (inner ring orifice diameter ≥ 1.5 cm) who underwent laparoscopic high ligation of the hernia sac at FuJian Children\'s Hospital from January 2019 to December 2021. We collected data from the medical records of all the children and analysed their clinical characteristics and operation-related and follow-up information. Overall, this study included a cohort of 219 patients with isolated giant inguinal hernias who had complete clinical data and who had undergone laparoscopic high ligation of the hernia sac at our centre. All procedures were successfully performed for the 106 patients who underwent SLPEC and for the 113 patients who underwent TLPEC at our centre. There were no statistically significant differences in patient age, sex, body weight, follow-up time or the side of inguinal hernia between the SLPEC group and the TLPEC group (P = 0.123, 0.613, 0.121, 0.076 and 0.081, respectively). However, there were significant differences in the bleeding volume, visual analogue scale (VAS) score, and postoperative activity time between the two groups (P ≤ 0.001). The operation times in the TLPEC group were significantly longer than those in the SLPEC group (P = 0.048), but there were no significant differences in hospital length of stay or hospitalization costs between the two groups (P = 0.244 and 0.073, respectively). Incision scars were found in 2 patients in the SLPEC group and 9 patients in the TLPEC group, and there was a significant difference between the two groups (P = 0.04). However, the incidence of ipsilateral hernia recurrence, surgical site infection, suture-knot reactions and chronic inguinodynia did not significantly differ between the two groups (P = 0.332, 0.301, 0.332 and 0.599, respectively). Postoperative hydrocele occurred in only 1 male child in the SLPEC group and in no male children in the TLPEC group, and there was no difference between the two groups (P = 0.310). In this study, there were no cases of testicular atrophy or iatrogenic ascent of the testis. Compared with the TLPEC group, the SLPEC group had the advantages of a concealed incision, light scarring, minimal invasiveness, a reduced operation time, minimal bleeding, mild pain and rapid recovery. In conclusion, SLPEC using double-modified hernia needles with
hydrodissection and high ligation of the hernia sac is a safe, effective and minimally invasive surgery. The cosmetic results are impressive, and the follow-up results are promising.