斜疝患儿行腹腔镜下疝囊高位结扎术后的复发及危险因素分析  

Recurrence of oblique inguinal hernias in children after laparoscopic high hernia sac ligation and its risk factors

作　　者：宣晓琪[1] 于忠勤[1] 徐建国[1] 张亦鹏[1] 浦晓[1] 王达丰[1] 

机构地区：[1]江苏省无锡市儿童医院小儿外科,江苏无锡214000

出　　处：《中国普通外科杂志》2017年第10期1253-1257,共5页China Journal of General Surgery

摘　　要：目的:探讨与行腹腔镜下疝囊高位结扎术斜疝患儿术后复发的因素。方法:收集2013年1月—2016年1月期间行腹腔镜下疝囊高位结扎术的306斜疝患儿临床资料,对影响患儿术后复发的相关危险因素进行统计学分析。结果:306例患儿(401侧)中,13例复发,复发率为3.24%。单变量分析显示,斜疝患儿的年龄、内环口直径和结扎线的选择与腹腔镜下疝囊高位结扎术术后复发有关(χ~2=6.275、9.145、11.371,P=0.043、0.010、0.001);多变量Logistic回归分析显示,年龄与内环口直径较大以及用可吸收线结扎是腹腔镜下疝囊高位结扎术术后复发的独立危险因素(OR=3.466,95%CI=1.432~8.389;OR=1.988,95%CI=1.237~3.194;OR=1.089,95%CI=1.015~1.168,均P<0.05)。结论:年龄与内环口直径较大以及可吸收线的使用是导致斜疝患儿行腹腔镜下疝囊高位结扎术术后复发的主要危险因素,对存在危险因素的患儿应考虑改良的腹腔镜手术方法、加强术后监护,并避免使用可吸收线,减少复发的发生。Objective： To investigate the risk factors for recurrence of oblique inguinal hernias in children a^er laparoscopic high ligation of the hernia sac. Methods： The clinical data of 306 children with oblique inguinal hernias undergoing laparoscopic high ligation of the hernia sac from January 2013 to January 2016 were collected. The risk factors affecting the postoperative recurrence of the pediatric patients were analyzed. Results： In these 306 patients （401 sides）, recurrence occurred in 13 cases, and the recurrence rate was 3.24%, Univariate analysis showed that age, diameter of the deep inguinal associated with recurrence after laparoscopic high ligation of the ring and ligation thread were significantly hernia sac （X2=6.275, 9.145, and 11.371,P=0.043, 0.010, and 0.001）; multivariate Logistic regression analysis revealed that older age, large diameter of the deep inguinal ring and use of absorbable sutures were independent risk factors for recurrence after laparoscopic high ligation of the hernia sac （OR=3.466, 95% CI=1.432-8.389; OR=1.988, 95% CI=1.237-3.194; OR=1.089, 95% CI= 1.015-1.168, all P〈0.05）. Conclusion： Older age, large diameter of the deep inguinal ring and use of absorbable sutures are the main risk factors for recurrence of oblique inguinal hernias in children after laparoscopic high ligation of the hernia sac. In children with risk factors, the modified laparoscopic procedure should be considered, postoperative monitoring should be enhanced, and use of absorbable suture should be avoided to reduce the recurrence rate.

关 键 词：疝 腹股沟 腹腔镜 复发 儿童 

分 类 号：R656.2[医药卫生—外科学]