Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan.
J Urol. 2011 Mar;185(3):1071-6. doi: 10.1016/j.juro.2010.10.044. Epub 2011 Jan 21.
We compared surgical outcomes of mini laparoscopic and open herniorrhaphy in infants.
We enrolled 55 infants undergoing herniorrhaphy, of whom 24 underwent mini laparoscopic herniorrhaphy (bilateral in 17, unilateral in 7) and 31 open herniorrhaphy (bilateral in 9, unilateral in 22). Mean±SD patient age was 7.17±4.21 months in the mini laparoscopic and 5.39±4.11 months in the open groups (p=0.37). During laparoscopy a contralateral patent processus vaginalis of 2 cm or greater was noted and repaired simultaneously in 13 of 20 infants (65%) initially diagnosed with unilateral hernia.
Mean±SD followup was 22.9±10.5 months in the mini laparoscopic group and 20.2±10.5 months in the open group (p=0.20). Contralateral metachronous inguinal hernia manifested in 4 of 22 patients (18%) initially presenting with unilateral hernia in the open group and in no patient in the mini laparoscopic group (p<0.05). Recurrence was noted in 1 of the 40 open herniorrhaphy sites and in none of the 41 mini laparoscopic herniorrhaphy sites (p=0.49). For unilateral repair mean±SD operative time was significantly longer in the mini laparoscopic group (80.00±18.97 minutes) compared to the open group (51.15±23.27 minutes, p<0.05). For bilateral repair mean±SD operative time was comparable between the 2 groups (82.52±14.74 minutes for mini laparoscopy and 95.62±20.62 minutes for open repair, p=0.35).
Mini laparoscopic herniorrhaphy in infants may prevent contralateral metachronous inguinal hernia, and is as safe and effective as open herniorrhaphy. The drawback of mini laparoscopic repair is the longer operative time for unilateral herniorrhaphy, which may be overcome by increased experience.
我们比较了小儿微创腹腔镜疝修补术和开放疝修补术的手术效果。
我们纳入了 55 例行疝修补术的婴儿，其中 24 例行微创腹腔镜疝修补术（双侧 17 例，单侧 7 例），31 例行开放疝修补术（双侧 9 例，单侧 22 例）。微创腹腔镜组患者的平均年龄为 7.17±4.21 个月，开放组为 5.39±4.11 个月（p=0.37）。腹腔镜检查时，我们发现 20 例单侧疝患儿中有 13 例（65%）对侧鞘状突直径为 2cm 或更大，并同时进行了修补。
微创腹腔镜组的平均随访时间为 22.9±10.5 个月，开放组为 20.2±10.5 个月（p=0.20）。在开放组中，22 例最初表现为单侧疝的患儿中有 4 例（18%）出现对侧迟发性腹股沟疝，而在微创腹腔镜组中则无患儿出现该情况（p<0.05）。在开放疝修补术的 40 个部位中有 1 个复发，而在微创腹腔镜疝修补术的 41 个部位中则无复发（p=0.49）。对于单侧修补，微创腹腔镜组的平均手术时间（80.00±18.97 分钟）明显长于开放组（51.15±23.27 分钟，p<0.05）。对于双侧修补，两组的平均手术时间相当（微创腹腔镜组为 82.52±14.74 分钟，开放组为 95.62±20.62 分钟，p=0.35）。
微创腹腔镜疝修补术可预防对侧迟发性腹股沟疝，且与开放疝修补术一样安全有效。微创腹腔镜修补术的缺点是单侧疝修补术的手术时间较长，但随着经验的增加，这一问题可能会得到克服。
