Nghiên cứu tiến cứu so sánh kết quả phẫu thuật nội soi khâu lỗ bẹn sâu ngoài phúc mạc so với kỹ thuật mổ mở điều trị thoát vị bẹn ở trẻ em

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Tác giả: Phi Duy Hồ, Hiền Nguyễn, Thanh Trúc Nguyễn, Ngọc Thạch Phạm, Nguyễn Ngọc Tú Phan, Quốc Việt Trần, Thanh Trí Trần

Ngôn ngữ: vie

Ký hiệu phân loại: 611.981 Human anatomy, cytology, histology

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2022

Mô tả vật lý: 283-289

Bộ sưu tập: Metadata

ID: 500533

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Considerable controversy exists regarding the role of laparoscopic hernia repair and its benefits over open herniotomy repair. This study aimed to compare the outcomes of the laparoscopic inguinal hernia repair with the open one. Methods: A prospective comparative study was conducted at Children's Hospital 2 in Ho Chi Minh City, Vietnam, from January 2019 to December 2021. Patients presented with inguinal hernia were submitted into two groups of operation: laparoscopic completely extraperitoneal repair versus open herniotomy repair. The outcomes of the two groups were reported and compared in terms of clinical and operative characteristics and postoperative complications. Results: Six hundred and forty-eight patients were enrolled in this study. The mean age at surgery was 47.9 ± 31.7 months. Three hundred twenty-four patients underwent laparoscopic surgery, and 324 others with open surgery. Postoperative diagnosis reported that 10.8% (35/324 cases) of patients with contralateral hernia patency were revealed during the laparoscopic repair. Mean surgical time was 22.1 ± 10.1 minutes for laparoscopic surgery, significantly higher than 16.9 ± 6.5 minutes for open surgery (P <
0.05). The conversion rate to open surgery is 1.9% (6/324 patients). The rate of redo surgery in the laparoscopic group is 0.9% (3/324 patients: one of recurrence and two of hydrocele) compared with 0.3% (1/324 patients) in the open group. The outcomes of all the cases in the two groups at the follow-up after six months of surgery were good. Conclusions: The laparoscopic technique in this study has revealed the patency of the contralateral inguinal hernia. However, the limitation of surgery time and the rate of redo-surgery are still controversial in cases operated on with the laparoscopic technique.Thoát vị bẹn (TVB) ở trẻ em là bệnh lý ngoại nhi phổ biến. Còn nhiều tranh cãi liên quan đến vai trò của phẫu thuật nội soi (PTNS) điều trị TVB và lợi ích của nó so với phương pháp PT mở. Do đó, nghiên cứu này nhằm so sánh kết quả của PTNS so với PT mở trong điều trị TVB ở trẻ em. Phương pháp nghiên cứu: Nghiên cứu tiền cứu so sánh được thực hiện tại Bệnh viện Nhi đồng 2 từ tháng 1/2019 đến tháng 12/2021. Bệnh nhi nam bị TVB được tư vấn PT và phân vào 2 nhóm PTNS khâu lỗ bẹn sâu ngoài phúc mạc và PT mở. Các kết quả được ghi nhận và so sánh giữa 2 nhóm về đặc điểm lâm sàng, PT, biến chứng PT và kết quả theo dõi sau PT. Kết quả: Có tổng cộng 648 bệnh nhân đã được tham gia vào nghiên cứu này. Tuổi trung bình lúc PT là 47,9 ± 31,7 tháng. 324 bệnh nhân được PTNS và 324 người khác được PT mở. Chẩn đoán sau PT: 10,8% (35/324 trường hợp) bệnh nhân thoát vị hai bên được phát hiện trong quá trình sửa chữa nội soi. Thời gian PT trung bình là 22,1 ± 10,1 phút đối với PTNS, cao hơn đáng kể so với 16,9 ± 6,5 phút đối với PT mở (P <
0,05). Tỷ lệ chuyển sang mổ hở là 1,9% (6/324 trường hợp). Tỷ lệ PT lại ở nhóm mổ nội soi là 0,9% (3/324 trường hợp: 01 trường hợp tái phát và 02 trường hợp thủy tinh mạc) so với 0,3% (1/324 trường hợp) ở nhóm mổ hở. Kết quả tại thời điểm theo dõi 6 tháng sau PT ở các nhóm bệnh nhân được PTNS và mổ mở đều tốt. Kết luận: Việc ứng dụng kỹ thuật nội soi ổ bụng khâu lỗ bẹn sâu ngoài phúc mạc đầu cho kết quả rất khả quan với những ưu điểm về việc phát hiện TVB đối bên cũng như tính thẫm mỹ cao. Tuy nhiên, những hạn chế về thời gian PT, tỷ lệ PT lại cũng còn là vấn đề đáng quan tâm.

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