自主研发穿刺带线针在小儿腹股沟疝腹腔镜治疗中的应用

The Application of a Self-Developed Puncture Suture Needle in the Laparoscopic Treatment of Pediatric Inguinal Hernia

摘要: 目的：探讨自主研发穿刺带线针在单孔腹腔镜疝囊高位结扎术治疗小儿腹股沟疝中的临床应用价值，包括手术效率、术后恢复及安全性。方法：本研究回顾性分析了2022年1月至2023年5月期间，在内蒙古科技大学包头医学院第一附属医院接受治疗的232例小儿腹股沟疝患者的临床数据。根据手术所用器械不同，将患者分为开放手术组、腔镜手术组及腔镜自研组(采用自研穿刺带线针)。收集并分析手术时间、术后疼痛评分、手术并发症、复发率等关键指标。结果：三组患者基线特征相似，无显著差异。腹腔镜探查中发现了28例对侧鞘状突未闭(contralateral patent processus vaginalis, CPPV)，发生率为19%。在手术效率方面，开放手术组与两腔镜组(包括腔镜手术组和腔镜自研组)进行对比，单侧手术时间存在差异(31.32 ± 3.35 min vs. 8.20 ± 1.13 min vs. 8.47 ± 1.12 min, P < 0.01, F = 2180.7)，双侧手术时间存在差异(48.13 ± 2.24 min vs. 15.47 ± 1.00 min vs. 14.91 ± 1.43, P < 0.01, F = 1430.1)，术中出血量存在差异[4.60 (3.90~5.30) ml vs. 0.68 (0.56~0.86) ml vs. 0.58 (0.52~0.75) ml, P < 0.01, H = 159.7]，住院时间存在差异[4.9 (3.8~6.0) day vs. 1.9 (1.5~2.3) day vs. 1.2 (1.0~1.4) day, P < 0.01, H = 157.9]，住院费用存在差异[6398.3 (5666.7~6987.3) yuan vs. 7654.9 (6587.9~8606.7) yuan vs. 6503.0 (5439.5~7484.6) yuan, P < 0.01, H = 26.9]，疤痕长度存在差异[1.52 (1.24~1.65) ml vs. 0.50 (0.36~0.62) ml vs. 0.52 (0.35~0.57) ml, P < 0.01, H = 156.7]。并且三组术后疼痛程度存在显著差异。三组在手术并发症的评估方面，开放手术组术后发现4例异时疝，其余2组未发现异时疝，三组存在显著差异(P < 0.05, χ² = 7.039)，开放手术组术后早期发现0例阴囊肿胀，腔镜手术组为5例，腔镜自研组为4例，存在差异(P < 0.05, χ² = 8.561)。其他并发症发生率无统计学意义。结论：自研穿刺带线针在费用及住院时间方面更具优势，为小儿腹股沟疝的微创治疗提供了新的、更为经济高效的选择，具有广阔的临床应用前景和推广价值。

Abstract: Objective: To investigate the clinical value of a self-developed puncture suture needle in single-port laparoscopic high ligation of the hernia sac for pediatric inguinal hernia, focusing on surgical efficiency, postoperative recovery, and safety. Methods: This study retrospectively analyzed clinical data from 232 pediatric inguinal hernia patients treated at The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, between January 2022 and May 2023. Patients were divided into three groups based on surgical instruments: open surgery group, conventional laparoscopic group, and the laparoscopic self-developed group (using the self-developed puncture suture needle). Key metrics, including operative time, postoperative pain scores, surgical complications, and recurrence rates, were collected and analyzed. Results: Baseline characteristics were similar across groups with no significant differences. Laparoscopy identified 28 cases of contralateral patent processus vaginalis (CPPV), an incidence of 19%. Regarding surgical efficiency, significant differences existed between the open surgery group and the two laparoscopic groups (conventional and self-developed): unilateral operative time (31.32 ± 3.35 min vs. 8.20 ± 1.13 min vs. 8.47 ± 1.12 min, P < 0.01, F = 2180.7), bilateral operative time (48.13 ± 2.24 min vs. 15.47 ± 1.00 min vs. 14.91 ± 1.43 min, P < 0.01, F = 1430.1), intraoperative blood loss [median (IQR): 4.60 (3.90~5.30) ml vs. 0.68 (0.56~0.86) ml vs. 0.58 (0.52~0.75) ml, P < 0.01, H = 159.7], hospital stay [median (IQR): 4.9 (3.8~6.0) days vs. 1.9 (1.5~2.3) days vs. 1.2 (1.0~1.4) days, P < 0.01, H = 157.9], hospitalization cost [median (IQR): 6398.3 (5666.7~6987.3) yuan vs. 7654.9 (6587.9~8606.7) yuan vs. 6503.0 (5439.5~7484.6) yuan, P < 0.01, H = 26.9], and scar length [median (IQR): 1.52 (1.24~1.65) cm vs. 0.50 (0.36~0.62) cm vs. 0.52 (0.35~0.57) cm, P < 0.01, H = 156.7]. Postoperative pain levels also differed significantly among the three groups. Complication assessment revealed significant differences: the open group had 4 cases of metachronous hernia while none in the other two groups (P < 0.05, χ² = 7.039), and early postoperative scrotal swelling occurred in 0 cases in the open surgery group, 5 cases in the conventional laparoscopic group, and 4 cases in the laparoscopic self-developed group, showing significant differences (P < 0.05, χ² = 8.561). Other complication rates showed no statistical significance. Conclusion: The self-developed puncture suture needle has advantages in terms of cost and hospital stay. It provides a new, more economical and efficient option for minimally invasive treatment of pediatric inguinal hernia, and has broad clinical application prospects and promotion value.