小儿腹股沟嵌顿疝形成阑尾炎的危险因素分析  

Analysis of risk factors for appendicitis caused by incarcerated inguinal hernia in infants

作　　者：桂琳玲 鲁巍 邢福中[1] 肖必栋 熊晓峰[1] 余雷[1] 方琼 Gui Linling;Lu Wei;Xing Fuzhong;Xiao Bidong;Xiong Xiaofeng;Yu Lei;Fang Qiong(Department of Neonatal Surgery,Wuhan Children′s Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院新生儿外科,430016

出　　处：《中华消化外科杂志》2019年第11期1048-1053,共6页Chinese Journal of Digestive Surgery

基　　金：武汉市卫生和计划生育委员会科研项目(WX17C15)。

摘　　要：目的探讨影响小儿腹股沟嵌顿疝形成阑尾炎的危险因素。方法采用回顾性病例对照研究方法。收集华中科技大学同济医学院附属武汉儿童医院2010年1月至2018年12月收治的371例嵌顿疝患儿的临床病理资料;男256例,女115例;平均年龄为47 d,年龄范围为0~90 d。观察指标:(1)嵌顿疝情况。(2)手术及术后恢复情况。(3)术后病理学检查情况。(4)影响小儿腹股沟嵌顿疝形成阑尾炎的危险因素分析。偏态分布的计量资料以M(范围)表示,计数资料以绝对数表示。单因素分析采用χ^2检验,多因素分析采用Logistic回归模型。结果(1)嵌顿疝情况:371例患儿中,肠管嵌顿264例,卵巢嵌顿102例,双侧卵巢和小肠同时嵌顿2例,双侧卵巢及子宫同时嵌顿于一侧1例,梅克尔憩室嵌顿2例。264例肠管嵌顿中,Amyand′s疝29例(回盲部嵌顿18例,其中3例形成阑尾炎;单纯阑尾嵌顿11例,其中10例形成阑尾炎)。(2)手术及术后恢复情况:29例Amyand′s疝患儿中,10例行腹腔镜疝囊高位结扎术,19例行嵌顿侧腹股沟区探查疝环松解后疝囊高位结扎术。行腹腔镜疝囊高位结扎术患儿中1例为单纯阑尾嵌顿,术中可见阑尾盲端索带与疝囊底部相连,阑尾未见明显炎症,松解索带,还纳阑尾于腹腔;1例腹腔镜下还纳回盲部后见阑尾炎形成,腹腔镜下予以切除。行嵌顿侧腹股沟区探查疝环松解后疝囊高位结扎术患儿中12例形成阑尾炎(回盲部嵌顿2例、单纯阑尾嵌顿10例),于阑尾根部行阑尾切除疝囊高扎术。1例回盲部嵌顿患儿术后出现肠梗阻,再次腹腔探查,发现回盲部于右髂区形成粘连狭窄,切除回盲部,行回肠 升结肠吻合术。所有患儿术后均恢复顺利。(3)术后病理学检查情况:29例Amyand′s疝患儿中,13例阑尾炎病理学检查证实阑尾化脓4例,化脓并穿孔2例,坏疽2例。(4)影响小儿腹股沟嵌顿疝形成阑尾炎的危险因素分析:单因素分析结果显示Objective To investigate the risk factors for appendicitis caused by incarcerated inguinal hernia in infants.Methods The retrospective case control study was conducted.The clinicopathological data of 371 infants with incarcerated inguinal hernia who were admitted to Wuhan Children′s Hospital of Tongji Medical College of Huazhong University of Science and Technology between January 2010 and December 2018 were collected.There were 256 males and 115 females,aged from 0 to 90 days,with an average age of 47 days.Observation indicators:(1)situations of incarcerated hernia;(2)surgical and postoperative recovery;(3)postoperative pathological examination;(4)analysis of risk factors for appendicitis caused by incarcerated inguinal hernia in infants.Measurement data with skewed distribution were described as M(range).Count data were expressed as absolute numbers.Univariate analysis was performed using the chi square test.Multivariate analysis was performed using the Logistic regression model.Results(1)Situations of incarcerated hernia:of the 371 infants,264 had bowel incarceration,102 had ovarian incarceration,2 had both bilateral ovarian and bowel incarceration,1 had bilateral ovarian and womb incarcerated into one side,and 2 had Meckel′s diverticulums incarceration.Among the 264 infants with bowel incarceration,29 had Amyand′s hernia,including 18 of ileocecal incarceration(3 with appendicitis)and 11 of pure appendix incarceration(10 with appendicitis).(2)Surgical and postoperative recovery:of the 29 infants with Amyand′s hernia,10 underwent laparoscopic hernia sac high ligation and 19 underwent inguinal explorations,relaxation of hernia ring and then hernia sac high ligation.One infant undergoing laparoscopic hernia sac high ligation had pure appendix incarceration.It showed that chorda at the blind end of appendix was connected with the bottom of hernia sac intraoperatively.There was no obvious inflammation in the appendix.Chorda was released,and the appendix was reset into the abdominal cavity.One infant was res

关 键 词：疝 腹股沟嵌顿疝 Amyand′s疝 阑尾炎 小儿 危险因素 

分 类 号：R65[医药卫生—外科学]