腹腔镜术中男性患儿对侧隐匿性鞘状突未闭初步研究  

Preliminary study of contralateral occult inguinal indirect hernia in male children by laparoscopy

作　　者：何文飞[1] 赵丹[1] 张红梅[2] 敬鹏[1] 张灿[1] 廖君左[1] 梁云[1] 王亮[1] 刘雪岚[1] 王城[1] 

机构地区：[1]川北医学院附属医院儿外科国家卫生部内镜诊疗技术培训基地川北医学院肝胆胰肠疾病研究所,南充637000 [2]川北医学院附属医院儿外科国家卫生部内镜诊疗技术培训基地川北医学院肿瘤科,南充637000

出　　处：《中华小儿外科杂志》2014年第6期429-431,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨腹腔镜术中男性患儿对侧隐匿性鞘状突未闭（occult patent processus vaginalis，OPPV）的患病率、发病率及其临床意义。方法回顾性分析2008年1月至2013年6月行经脐二孔法腹腔镜下疝囊高位结扎术2596患儿的临床资料。结果本组44．65％（1159／2596）患儿对侧腹股沟区探查为阳性，右侧OPPV患病率为48．89%（420／859），左侧OPPV患病率为42．54％（739／1737），左右侧患病率差异有统计学意义（X^2=9．38，P〈0．01），右侧相对于左侧相对危险度为1．15。OPPV总发病率为4．31％（50／1159）。其中，1岁以内患儿OPPV患病率为40．65％（163／401），发病率为6．75％（11／163）；1～2岁内患儿OPPV患病率最高达59．53％（534／897），发病率为1．87％（10／534）；2～6岁患儿OPPV患病率为40．41％（379／938），发病率为5．28％（20／379）；6至16岁患儿OPPV患病率最低为23．06％（83／360），发病率为最高10．84％（9／83）。80．00％（40／50）患儿有呼吸道感染、腹泻等诱发因素，20．00％（10／50）为不明诱因。本组复发率为0．08%（2／2596）。结论不同年龄段OPPV患病率及发病率不同，提示所有患儿腹腔镜下常规行对侧OPPV探查有一定临床价值，尤其是2岁后OPPV可能更需要积极的手术干预。Objective To evaluate the prevalence and incidence of contralateral occult inguinal indirect hernia （OPPV） in male children by laparoscopy. Methods A 5-year retrospective review was conducted for 2596 male patients undergoing unilateral inguinal laparoscopic herniorraphy （LH） from January 2008 to June 2013. Results Among them, 44. 65% （1 159/2 596） had OPPV in contralateral inguinal groin while 4. 31% （50/1 159） developed contralareal indirect hernia. Laparoscopic evaluation was positive for right-sided OPPV in 48. 89% （420/859） and left-sided lesion in 42. 54% （739/1 737） （X^2 = 9. 38, P〈0. 01）. Left-sided indirect hernia （RR= 1.15） was associated with an elevated risk of contralateral OPPV. OPPV was diagnosed in 40. 65 % （163/401） of patients aged under 1 year and the future contralateral occurrence rate was 6.75% （11/163）. The highest prevalence of 59.53% （534/897） and the lowest incidence of 1. 87% （10/534） of OPPV were found in those patients aged under 2 years respectively. Laparoscopic evaluation was positive for OPPV in 40. 41% of patients aged 2-6 years. And 5.28% patients developed contralateral indirect hernia. The lowest prevalence of 23. 06% （83/360） and the highest incidence of 10. 84%（9/83） of OPPV were found in those aged 6 - 16 years respectively. And 80. 00% （40/50） patients with contralateral indirect hernia resulting from OPPV had the causes of respiratory infections and diarrheal diseases while 20. 00% （10/50） did not. The future recurrence rate was 0. 08% （2/2 596）. Conclusions Laparoscopic exploration should be routinely performed for pediatric patients of all ages because of a high prevalence and incidence of contralateral OPPV. Especially, LH should be actively performed in patients aged over 2 year because of a high incidence of contralateral OPPV.

关 键 词：腹股沟 腹腔镜检查 患病率 发病率 

分 类 号：R726.5[医药卫生—儿科]