目的 分析经腹腔镜手术治疗婴幼儿鞘膜积液的利弊。方法 回顾分析本院2012年1月至2016年1月经腹腔镜手术治疗的1 473例鞘膜积液病例资料(腹腔镜手术组),并与2005年1月至2010年1月经传统开放手术治疗的1 352例鞘膜积液(开放手术组)进行比较。结果 单侧鞘膜积液患儿行腹腔镜手术和开放手术的时间分别为(12.3±3.1)min和(17.1±4.2)min,差异有统计学意义(t=-33.435,P<0.001); 双侧鞘膜积液患儿行腹腔镜手术和开放手术的时间分别为(16.1±2.2)min和(35.5±4.5)min,差异有统计学意义(t=-31.838,P<0.001)。腹腔镜组术中发现对侧隐性鞘状突未闭合453例,占术前单侧鞘膜积液的 32.5%(453/1 392),术后复发6例(0.4%),阴囊血肿3例(0.2%),脐上缘切口裂开大网膜膨出 2 例(0.1%),线结反应 2 例(0.1%); 开放手术组术后复发8例(0.6%),阴囊血肿2例(0.1%),线结反应 8 例(0.6%)。两组术后复发率和其他并发症的发生率均无统计学差异(P>0.05)。两组均无肠粘连、腹腔内脏器损伤、切口感染、医源性隐睾及睾丸萎缩等并发症发生。结论 腹腔镜手术可作为婴幼儿鞘膜积液的首选治疗方式,但尚不能完全替代开放手术。
Objective To explore the advantages and disadvantages of laparoscopy of hydrocele in infants and children. Methods The authors retrospectively analyzed 1 473 laparoscopic cases of hydrocele from January 2012 to January 2016 and compared them with 1 352 cases of open surgery from January 2005 to January 2010. Results The operative duration of laparoscopic group versus open surgery group were as follows:unilateral 12.3±3.1 min vs 17.1±4.2 min(P<0.01)and bilateral 16.1±2.2 min vs 35.5±4.5 min(P<0.01); postoperative recurrence rate 0.4% and 0.6%(P>0.05); Other complications rate 0.4% and 0.7%(P>0.05)respectively.Both comparisons had significant statistical significances.In laparoscopic group,contralateral patent processus vaginalis accounted for 32.5%(453/1 392)of preoperative unilateral hydrocele.There were postoperative onsets of recurrence(n=6,0.4%),scrotum hematoma(n=3,0.2%),supra-umbilical incision dehiscence & omental bulging(n=2,0.1%)and suture knot reaction(n=2,0.1%); In open surgery group,recurrence(n=8,0.6%),scrotum hematoma(n=2,0.1%)and suture knot reaction(n=8,0.6%).No statistical significance existed in postoperative recurrence rate or other complications.No intestinal adhesion,viscera injury,infection of incision,iatrogenic cryptorchidism and testicular atrophy.There was no occurrence of intestinal adhesion,viscera injury,infection of incision,iatrogenic cryptorchidism or testicular atrophy. Conclusion Laparoscopy is the preferred treatment for hydrocele in infants and children.However,it can not entirely replace open surgery.
