Ibrahim Musa, Ladan Mu'azu Adamu, Abdussalam Umar Sharif, Getso Kabiru Ibrahim, Mohammad Mohammad Aminu, Chukwuemeka Anyanwu Lofty-John, Owolabi Femi Luqman, Akhparov Nurlan Nurkenovich, Aipov Rassulbek Rakhmanberdievich
Department of Surgery, Children Surgical Unit, Murtala Muhammad Specialist Hospital, Kano, Nigeria.
Afr J Paediatr Surg. 2015 Apr-Jun;12(2):131-5. doi: 10.4103/0189-6725.160361.
Repair of congenital groin hernia/hydrocele is the most common surgical procedure performed by paediatric surgeons. There is dearth of literature comparing the outcomes of open herniotomy in children using various surgical approaches. This study was aimed at evaluating the efficacy of open herniotomy by comparing external ring incision, hernial sac twisting and whether or not double ligation has benefit over a single suture application.
A multi-centre prospective randomised clinical trial was conducted with a total of 428 patients having congenital inguinal hernia and/or hydrocele. Patients were randomly assigned into four groups: RO (had external ring opened, hernial sac twisted and doubly ligated), ST (had hernial sac twisted and doubly ligated without opening the ring), DL (had double ligation of hernial sac without ring opening nor twisted) while SL (had single ligation of hernial sac with neither ring opening nor sac twisting).
A total of 458 repairs were done. Patients' age ranged from 0.25 years (3 months) to 21 years in group RO with mean of 4.87 × 4.07 (median, 4), 0.069 years (24 days) to 17 years in group ST with mean of 4.23 × 4.03 (median, 3), 0.5 years (6 months) to 16 years in group DL with mean of 4.59 × 3.87 (median, 4) and 1 year to 19 years in group SL with mean of 5.00 × 4.19 (median, 4). Operation time per repair was 26.50 × 5.46 min, range 16-40 min (median, 27 min) in group RO, 22.18 × 5.34 min, range 12-39 min (median, 21 min) in group ST while 17.98 × 3.40 min with range of 12-39 min (median, 17 min) in group DL and 15.27 × 4.18 min, range 7-40 min (median, 15 min) in group SL P < 0.0001. The mean paracetamol dose/patient was 3.96 × 1.43, 2.94 × 0.81, 2.18 × 0.69, 1.87 × 0.78 in group RO, ST, DL and SL, respectively, P < 0.0001.
Congenital inguinal hernia repair with opening of the external ring, hernia sac twisting and double ligation of the processus vaginalis confers no advantage.
先天性腹股沟疝/鞘膜积液修补术是小儿外科医生最常开展的手术。目前缺乏关于采用不同手术方法进行小儿开放式疝囊高位结扎术疗效比较的文献。本研究旨在通过比较外环切口、疝囊扭转以及双重结扎与单一缝合应用相比是否具有优势，来评估开放式疝囊高位结扎术的疗效。
进行了一项多中心前瞻性随机临床试验，共有428例患有先天性腹股沟疝和/或鞘膜积液的患者。患者被随机分为四组：RO组（外环打开、疝囊扭转并双重结扎）、ST组（疝囊扭转并双重结扎但未打开外环）、DL组（疝囊双重结扎，未打开外环也未扭转疝囊）以及SL组（疝囊单一结扎，既未打开外环也未扭转疝囊）。
共进行了458例修补手术。RO组患者年龄范围为0.25岁（3个月）至21岁，平均年龄为4.87×4.07岁（中位数为4岁）；ST组患者年龄范围为0.069岁（24天）至17岁，平均年龄为4.23×4.03岁（中位数为3岁）；DL组患者年龄范围为0.5岁（6个月）至16岁，平均年龄为4.59×3.87岁（中位数为4岁）；SL组患者年龄范围为1岁至19岁，平均年龄为5.00×4.19岁（中位数为4岁）。每组每次修补手术时间分别为：RO组26.50×5.46分钟，范围为16 - 40分钟（中位数为27分钟）；ST组22.18×5.34分钟，范围为12 - 39分钟（中位数为21分钟）；DL组17.98×3.40分钟，范围为12 - 39分钟（中位数为17分钟）；SL组15.27×4.18分钟，范围为7 - 40分钟（中位数为15分钟），P < 0.0001。每组患者对乙酰氨基酚平均剂量分别为：RO组3.96×1.43、ST组2.94×0.81、DL组2.18×0.69、SL组1.87×0.78，P < 0.0001。
先天性腹股沟疝修补术中打开外环、扭转疝囊并双重结扎鞘突并无优势。
