小儿腹腔镜下单侧斜疝对侧无症状鞘状突未闭发生情况及非手术指征探讨  

Discussion of status and non-surgical indications of asymptomatic contralateral patent processus vaginalis in laparoscopic pediatric unilateral inguinal hernia

作　　者：耿伟民 刘宁 苏鹏超 李婷 刘昆强 刘丹丹 胡晓威 张海东 Geng Weimin;Liu Ning;Su Pengchao;Li Ting;Liu Kunqiang;Liu Dandan;Hu Xiaowei;Zhang Haidong(Department of Pediatric Surgery,Tongzhou District Maternal and Child Health Care Hospital,Beijing 101101,China)

机构地区：[1]北京市通州区妇幼保健院儿外科,101101

出　　处：《中华疝和腹壁外科杂志（电子版）》2021年第2期195-198,共4页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：北京市通州区科技计划项目(KJ2020CX011)。

摘　　要：目的在小儿单侧斜疝腹腔镜手术中行对侧无症状鞘状突未闭(ACPPV)探查并了解其发生情况,探讨ACPPV的非手术指征,为患儿得到个体化治疗,避免过度治疗提供临床依据。方法选取北京市通州区妇幼保健院2019年1至12月收治的124例单侧斜疝患儿,术中均行对侧内环口情况探查,对于有ACPPV患儿,术前超声提示鞘状突内环口≥4.5 mm或内环口<4.5 mm但术中探查鞘状突的深度和宽度均>1 cm,则行疝囊高位结扎术,如术前超声下内环口<4.5 mm,术中牵拉内环口深度和宽度<1cm,患儿无阳性家族史,则不予手术。对比手术时间、并发症及术后1年内对侧异时性疝(MCH)发生情况。结果(1)探查发现ACPPV的发生率为56.5%,左右侧ACPPV发生率无统计学差异(P>0.05)。(2)双侧行高位结扎术组平均手术时间为(39.2±6.5)min,对侧无处理组为(27.2±4.6)min,差异有统计学意义(P<0.05);双侧手术组术中出血量(2.9±1.28)ml,无处理组(2.1±0.43)ml,差异有统计学意义(P<0.05);双侧手术患儿有16例出现术后腹股沟和阴囊区水肿,对侧无处理组术后无明显水肿,差异有统计学意义(P<0.05)。(3)术后追踪1年,无ACPPV患儿中有1例MCH发生,ACPPV患儿中均无复发和MCH发生。结论单侧斜疝对侧ACPPV发生率较高。超声内环口<4.5mm,术中探查内环口深度和宽度均<1cm,患儿无阳性家族史,可作为无症状鞘状突未闭的非手术治疗的指征。Objective To explore the occurrence rate of asymptomatic contralateral patent processus vaginalis(ACPPV)in laparoscopic surgery for unilateral inguinal hernia in children,and to discuss the non-surgical indications of ACPPV to provide clinical basis for individualized treatment and avoiding overtreatment.Methods 124 children with unilateral inguinal hernia were selected in Tongzhou district maternal and child health care hospital between January 2019 and December 2019.The contralateral situation was explored during the laparoscopic surgery.For children with ACPPV,if the inner ring≥4.5 mm under preoperative ultrasonic examination,or the inner ring<4.5 mm while the depth and width of the inner ring>1 cm during the exploration,the percutaneous extraperitoneal closure was performed.If the inner ring<4.5 mm under preoperative ultrasonic examination,the depth and width of the inner ring<1 cm during the exploration,and the patients had no positive family history,no treatment was required.Operation time,complications and occurrence of MCH within 1 year after operation were compared.Results(1)The incidence of ACPPV was 56.5%and there was no statistical difference of ACPPV occurring in left and right side(P>0.05).(2)The average operation time of bilateral closure group was(39.2±6.5)minutes,and that of single closure group was(27.2±4.6)minutes,the difference was statistically significant(P<0.05).The intraoperative blood loss in the bilateral operation group was 2.9±1.28 mL,and that in the single closure group was(2.1±0.43)ml,with statistical difference(P<0.05).There were 16 cases of postoperative inguinal and scrotal edema in children with bilateral surgery,and there was no obvious edema in the contralateral non-treatment group after surgery,with significant statistical difference(P<0.05).(3)After 1 year follow-up,MCH occurred in 1 case without ACPPV,and no recurrence and MCH occurred in ACPPV children.Conclusion The occurrence rate of ACPPV was high in unilateral inguinal hernia of children.When the inner ring<4.5 mm

关 键 词：斜疝 无症状鞘状突未闭 非手术指征 腹腔镜 小儿 

分 类 号：R726.5[医药卫生—儿科]