新生儿嵌顿性腹股沟斜疝肠切除高危因素分析  

Analysis of high-risk factors of bowel resection for incarcerated inguinal hernia in neonates

作　　者：王敏[1] 朱海涛[1] 沈淳[1] 郑珊[1] 

机构地区：[1]复旦大学附属儿科医院外科,上海201102

出　　处：《中华小儿外科杂志》2016年第3期206-210,共5页Chinese Journal of Pediatric Surgery

基　　金：国家临床重点专科建设项目（国卫办医函[2013]544）;上海市“非重中之重”临床医学中心（2014-2016）;上海市申康发展中心（SHDC12014106）

摘　　要：目的探讨新生儿嵌顿性腹股沟斜疝致肠切除的高危因素。方法回顾性分析2009年1月至2014年1月收治的42例新生儿嵌顿性腹股沟斜疝的临床资料。其中26例为肠管嵌顿。将其分为行肠切除患儿（6例，肠切除组）和未行肠切除患）k（20例，未行肠切除组），比较其差异，探讨新生儿嵌顿疝肠切除的可能高危因素。结果肠切除组，男5例（83．33％），女1例（16．67%）；腹胀6例（100％），便血3例（50％）；右侧嵌顿5例（83．33％），左侧嵌顿1例（16．67％）；嵌顿时间（20．33±4．59）h;入院至急诊手术时间为（1．92±0．65）h。未行肠切除组，男9例（45％），女11例（55％）；腹胀7例（35％），便血1例（5％）；右侧嵌顿5例（25％），左侧嵌顿15例（75％）；嵌顿时间（10．05±6．17）h；入院至急诊手术时间为（4．30±0．53）h。两组在性别、腹胀、便血、发生部位、嵌顿时间、入院至急诊手术时间上的差异有统计学意义（P〈0．05）。两组平均随访时间（36．55±19．97）个月，肠切除组失访1例，未行肠切除组无失访。肠切除组术后出现睾丸萎缩1例（20％），未行肠切除组出现1例（5％），组间差异有统计学意义（P〈0．05）。结论男新生儿发病时间〉20h、右侧嵌顿是新生儿嵌顿疝肠切除可能的高危因素，新生儿嵌顿疝肠切除者术后更易发生睾丸萎缩。识别高危因素、提高观察警惕性，将有利于高危患儿的早期筛选与积极治疗。Objective To explore the high-risk factors of bowel resection for incarcerated inguinal hernia in neonates. Methods A total of 42 cases of neonatal incarcerated inguinal hernia were treated from January 2009 to January 2014. Among them, the sac contents of 26 cases were bowel. Based on whether bowel resection was performed or not, they were divided into 2 groups of intestinal resection （A, n = 6） and non-resection （B, n = 20）. Their clinical profiles, operative findings and follow-up data were compared. Results [n Group A, there were 5 males （83.33 % ） and I female （16. 67%） ; There were abdominal distention （n = 6, 100%） and hematochezia （n = 3, 50%） ; The involved sides were right （n = 5, 83.33 %） and left （n = 1, 16.67 %） ; in Group B, 9 males （45 %） and 11 females （55%） ; Abdominal distention （n = 7, 35%） and hematoehezia （n = 1, 5%） ; right （n = 5, 25%） and （n = 15, 75%）. For Groups A and B, the incarceration times were （20. 33 ± 4. 59） and （ 10. 05 ± 6. 17） hours and admission to emergency operation time （ 1.92 ± 0. 65） and （ 4. 30 ± 0.53 ） hours respectively. Statistically significant inter-group differences existed in gender, abdominal distention, hematoehezia, location of hernia, incarceration time and admission to emergency operation time （P〈0. 05）. The average follow-up time was （36. 55 ± 19. 97） months. One case in Group A became lost to follow-up. And the incidence of testicular atrophy was 20% （n = 1 ） and 5% （n = 1） in Groups A and B respectively. There was statistically significant inter-group difference （P〈0. 05）. Conclusions Male gender, incarceration 〉20 hours and right-sidedness are the possible high-risk factors of bowel resection for incarcerated inguinal hernia in neonates. And the incidence of testicular atrophy is higher after bowel resectiorL Thus identifying high--risk factors and enhancing vigilance shall facilitate early screening and effective interventions.

关 键 词：疝 腹股沟 危险因素 对比研究 

分 类 号：R722.1[医药卫生—儿科]