Cao Zhiqing, Chen Jiangyi, Li Zhixiong, Li Guoxin
Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou.
Department of Pediatric Surgery, Huangshi Maternity and Children's Health Hospital of Edong Healthcare Group, Huangshi, Hubei, P.R. China.
Medicine (Baltimore). 2018 Oct;97(42):e12790. doi: 10.1097/MD.0000000000012790.
Pediatric inguinal hernia is one of the most common diseases in children, and laparoscopy is the main surgical method. This study aims to evaluate the efficacy of a new modified 2-port laparoscopic herniorrhaphy with Kirschner wire (TLHK) for inguinal hernia in children.
A total of 5304 children with inguinal hernia hospitalized at the Jiangmen Center Hospital from June 2003 to May 2016 were enrolled in this retrospective study. Four thousand one hundred thirty-five children underwent TLHK that comprised the observation group, while 1169 received single incision laparoscopy (SIL) as the control group (CG). A propensity score matched cohort study was conducted between these groups. We included all patients who were diagnosed as inguinal hernia and matched comparators with a proportion of 1:1. The propensity score was calculated using logistic regression with forward stepwise selection in 4 variables. The patients' operative details, intra- and postoperative complications, and postoperative hospital stay were analyzed. The follow-up lasted from 1 month to 2 years.
Among 5304 potential patients, the propensity score identified 270 (135 TLHK cases and 135 comparators) patients. The age, sex, body mass index, and the hernia type and location did not differ between CG and TLHK. TLHK group had a shorter operative time (unilateral: 17.4 ± 3.35 minutes vs 20.7 ± 3.71 minutes; bilateral: 20.4 ± 5.17 minutes vs 25.2 ± 5.43 minutes), less complications (2.10% vs 2.65%), lower recurrence rate (0% vs 4.44%), and similar hospital stay (2.3 ± 1.1 vs 2.1 ± 1.3) as compared with CG. No iliac vessel injury, spermatic cord vessels injury, vas deferens injury, or iatrogenic cryptorchidism occurred in either of the groups.
TLHK is a safe and feasible treatment for inguinal hernia in children due to less invasion and less recurrence rate than SIL.
小儿腹股沟疝是儿童最常见的疾病之一，腹腔镜手术是主要的手术方法。本研究旨在评估一种新的改良双孔腹腔镜钢丝疝修补术（TLHK）治疗小儿腹股沟疝的疗效。
本回顾性研究纳入了2003年6月至2016年5月在江门市中心医院住院的5304例小儿腹股沟疝患者。4135例患儿接受了TLHK，组成观察组，1169例接受单切口腹腔镜手术（SIL）作为对照组（CG）。对这些组进行倾向评分匹配队列研究。我们纳入了所有诊断为腹股沟疝的患者，并按1:1的比例匹配对照。使用逻辑回归在4个变量中进行向前逐步选择来计算倾向评分。分析患者的手术细节、术中和术后并发症以及术后住院时间。随访持续1个月至2年。
在5304例潜在患者中，倾向评分确定了270例患者（135例TLHK病例和135例对照）。CG组和TLHK组在年龄、性别、体重指数以及疝的类型和位置方面没有差异。与CG组相比，TLHK组手术时间更短（单侧：17.4±3.35分钟对20.7±3.71分钟；双侧：20.4±5.17分钟对25.2±5.43分钟），并发症更少（2.10%对2.65%），复发率更低（0%对4.44%），住院时间相似（2.3±1.1对2.1±1.3）。两组均未发生髂血管损伤、精索血管损伤、输精管损伤或医源性隐睾。
由于TLHK比SIL侵袭性更小且复发率更低，因此它是治疗小儿腹股沟疝的一种安全可行的方法。
