Effects of single-port laparoscopic extraperitoneal ligation on surgical indexes, intestinal mucosal barrier function and recurrence rate in children with pediatric inguinal hernia
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摘要:目的
探讨单孔腹腔镜腹膜外结扎对小儿腹股沟疝患儿手术指标、肠黏膜屏障功能及复发率的影响。
方法将2019年2月—2021年6月本院收治的86例小儿腹股沟疝患儿随机分为对照组(n=43)和研究组(n=43), 对照组采用传统开放式手术，研究组采用单孔腹腔镜腹膜外结扎术。采用高效液相色谱法检测尿乳果糖与甘露醇比值(L/M); 采用酶联免疫吸附法检测血清二胺氧化酶(DAO)水平; 采用酶学分光光度法检测血清D-乳酸水平; 采用视觉模拟评分法(VAS)评估患者疼痛; 比较2组手术指标、并发症以及术后复发率。
结果与对照组相比，研究组手术时间、术中出血量、肛门排气时间和术后住院时间均减少或缩短，差异有统计学意义(P < 0.05); 2组VAS评分、L/M、DAO以及血D-乳酸水平在术后均降低，且研究组术后VAS评分、L/M、DAO以及血D-乳酸水平均低于对照组，差异有统计学意义(P < 0.05); 研究组并发症发生率为4.65%(2/43), 低于对照组的20.93%(9/43), 差异有统计学意义(P=0.024)。
结论单孔腹腔镜腹膜外结扎更有利于小儿腹股沟疝患儿的治疗，具有出血少、痛感轻、并发症少、肠黏膜屏障功能恢复快、复发率低等优势。
Abstract:ObjectiveTo investigate the effects of single-port laparoscopic extraperitoneal ligation on surgical indexes, intestinal mucosal barrier function and recurrence rate in children with pediatric inguinal hernia.
MethodsA total of 86 children with pediatric inguinal hernia in the hospital from February 2019 to June 2021 were randomly divided into control group (n=43) and study group (n=43). The study group performed single-port laparoscopic extraperitoneal ligation, while the control group received traditional open surgery. The ratio of urinary lactulose to mannitol (L/M) was measured by high-performance liquid chromatography; serum diamine oxidase (DAO) level was detected by enzyme-linked immunosorbent assay; serum D-lactic acid level was detected by enzymatic spectrophotometry; pain was assessed by the Visual Analogue Scale (VAS); surgical indicators, complications and postoperative recurrence rate were compared between the two groups.
ResultsCompared with the control group, the study group had significant reduction in operation time, intraoperative blood loss, time to first flatus, and postoperative hospital stay (P < 0.05); in both groups, the VAS score, L/M, DAO level and serum D-lactic acid level decreased significantly after operation, and these indexes after operation in the study group were significantly lower than those in the control group (P < 0.05); the incidence of complications in the study group was 4.65%(2/43), which was significantly lower than 20.93%(9/43) in the control group (P=0.024).
ConclusionSingle-port laparoscopic extraperitoneal ligation is benefit for the treatment of children with pediatric inguinal hernia, which has advantages of fewer bleeding, less pain, fewer complications, faster recovery of intestinal mucosal barrier function, and lower recurrence rate.
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表 1 2组患儿手术指标比较(x±s)
组别 n 手术时间/min 术中出血量/mL 肛门排气时间/d 术后住院时间/d 对照组 43 26.22±4.35 8.42±2.21 1.39±0.37 3.86±0.98 研究组 43 21.34±4.11* 3.73±0.97* 1.05±0.26* 3.01±0.86* 与对照组比较, * P＜0.05。 
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表 2 2组患儿手术前后VAS评分比较(x±s)
分 组别 n 术前 术后 对照组 43 8.14±1.35 5.28±0.94* 研究组 43 8.32±1.37 2.38±0.62*# VAS: 视觉模拟评分法。与术前比较, * P＜0.05; 与对照组比较, #P＜0.05。
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表 3 2组患儿手术前后肠黏膜屏障功能指标比较(x±s)
组别 n L/M DAO/(U/L) 血D-乳酸/(mg/L) 术前 术后 术前 术后 术前 术后 对照组 43 0.073±0.014 0.043±0.011* 33.42±10.35 20.31±6.52* 21.84±6.32 13.26±4.06* 研究组 43 0.073±0.014 0.033±0.010*# 32.87±10.14 13.26±4.14*# 20.73±6.15 9.17±2.83*# L/M: 尿乳果糖与甘露醇比值; DAO: 二胺氧化酶。与术前比较, * P＜0.05; 与对照组比较, #P＜0.05。
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表 4 2组患儿手术后疼痛、并发症和复发率比较[n(%)]
指标 分类 对照组(n=43) 研究组(n=43) 并发症 阴囊水肿 4(9.30) 1(2.33) 发热 4(9.30) 1(2.33) 术后出血 1(2.33) 0 合计 9(20.93) 2(4.65)* 复发情况 6个月 2(4.65) 0 12个月 0 0 合计 2(4.65) 0 与对照组比较, * P＜0.05。
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