女性婴幼儿腹股沟嵌顿疝致卵巢绞窄坏死的相关因素分析  

Analysis of risk factors of ovarian strangulation and necrosis due to incarcerated inguinal hernia in female infants

作　　者：王子涵 罗玉[1] 刘冬[1] 廖亚娟 张曦耘 王斌[1] Wang Zihan;Luo Yu;Liu Dong;Liao Yajuan;Zhang Xiyun;Wang Bin(Department II of General Surgery,Affiliated Shenzhen Children's Hospital,China Medical University,Shenzhen 518000,China)

机构地区：[1]中国医科大学附属深圳市儿童医院普外二科,深圳518000

出　　处：《临床小儿外科杂志》2022年第8期764-768,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金项目(81770512);深圳市医疗卫生三名工程项目(SZSM201812055)。

摘　　要：目的探讨女性婴幼儿腹股沟嵌顿疝致卵巢坏死的相关因素。方法回顾性分析中国医科大学附属深圳市儿童医院普外二科2014年2月至2020年12月诊断为腹股沟嵌顿疝并行急诊手术治疗的79例女性婴幼儿临床资料,嵌顿内容物为卵巢(或包含卵巢)。按照嵌顿卵巢预后分为卵巢绞窄坏死组(19例)及卵巢未坏死组(60例),比较两组患儿的基本信息、临床体征、术前检查、术中探查结果及预后情况,对卵巢坏死相关因素进行单因素分析及多因素Logistic回归分析。结果79例患儿中有19例发生卵巢绞窄坏死(24.1%,19/79)。单因素分析结果显示:腹股沟红肿、白细胞计数、卵巢血流信号、卵巢体积、卵巢扭转是卵巢坏死的相关因素(P<0.05);多因素Logistic回归分析结果显示,卵巢体积增大、未见明显血流信号及卵巢扭转是卵巢坏死的相关因素(P<0.05)。卵巢体积≥2.02 cm 3预测卵巢绞窄坏死的曲线下面积为0.874(95%CI:0.774~0.977,P<0.001),敏感性为89.5%,特异性为71.7%。结论腹股沟嵌顿疝作为女性婴幼儿常见外科急症之一,当内容物包含卵巢时临床表现多不典型。超声检查为首选的影像学诊断方法。卵巢体积增大、无明显血流信号及卵巢扭转是卵巢发生坏死的相关因素,卵巢体积≥2.02 cm 3时应警惕卵巢嵌顿坏死。Objective To explore the risk factors of ovarian strangulation and necrosis due to incarcerated inguinal hernia in female infants.Methods From February 2014 to December 2020,retrospective analysis was performed for 79 female infants of incarcerated inguinal hernia with strangulated ovary.All cases underwent emergency surgery.Based upon the prognosis of incarcerated ovaries,they were divided into two groups of ovarian necrosis(n=19)and non-necrosis(n=60).Patient demographics,clinical signs,preoperative examinations and intraoperative findings were compared between two groups and the risk factors of ovarian necrosis examined by univariate and multivariate Logistic regression analyses.Results Ovarian necrosis occurred in 19/79 patients with an incidence rate of 24.1%.Single variate analysis revealed that inguinal mass with localized erythema,leucocyte count,ovarian vascularity,ovarian volume and ovary torsion were correlated factors of strangulated ovarian necrosis(P<0.05);Multivariate analysis showed that greater ovarian volume,an absence of ovarian vascularity and ovarian torsion were the independent risk factors of strangulated ovarian.The area under the curve(AUC)of ovarian strangulation necrosis predicted by ovarian volume≥2.02 cm 3 was 0.874(95%CI=0.774-0.9774;P=0.000)with a sensitivity of 89.5%and a specificity of 71.7%.Conclusion The clinical manifestations of incarcerated inguinal hernia with ovarian are non-typical.Gynecological ultrasonography remains a primary diagnostic tool.An absence of ovarian vascularity,greater ovarian volume and ovarian torsion are the risk factors of strangulated ovarian necrosis.Ovarian volume≥2.02 cm 3 should raise a high alert for ovarian necrosis.

关 键 词：疝 腹股沟/外科学 卵巢/病理生理学 女性 婴儿 儿童 

分 类 号：R725[医药卫生—儿科]