对侧鞘状突未闭的单侧腹股沟斜疝患儿发生异时疝的危险因素分析  

Risk factors of metachronous unilateral inguinal hernia in children with contralateral patent processus vaginalis

作　　者：陈星兆 朱琳琳 吕志宝 徐伟珏 刘江斌 黄雄 孙俊 吴一波 Chen Xingzhao;Zhu Linlin;Lyu Zhibao;Xu Weijue;Liu Jiangbin;Huang Xiong;Sun Jun;Wu Yibo(Department of General Surgery,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院上海交通大学医学院附属儿童医院普外科,上海200062

出　　处：《中华小儿外科杂志》2022年第9期816-821,共6页Chinese Journal of Pediatric Surgery

基　　金：上海市卫生和计划生育委员会青年项目(20184Y0260)。

摘　　要：目的探讨对侧鞘状突未闭(contralateral patent processus vaginalis,CPPV)的单侧腹股沟斜疝患儿术后异时性腹股沟斜疝(metachronous indirect inguinal hernia,MCIH)发生的危险因素及处理单侧腹股沟斜疝患儿CPPV的指征。方法收集并筛选上海交通大学医学院附属儿童医院普外科2018年10月1日至2020年10月31日期间收治的术前诊断为单侧腹股沟斜疝的患儿临床资料81例,其中男67例,女14例;初发斜疝侧别为左侧32例,右侧49例。所有患儿均行腹腔镜下患侧鞘状突高位结扎术+对侧鞘状突探查术。收集患儿术前一般资料包括年龄、性别和体重等,收集患儿术后资料如对侧鞘状突类型、直径和随访时间等。根据术后有无对侧新发斜疝分为有MCIH发生组和无MCIH发生组。应用SPSS 23.0进行数据统计分析,通过Logistic回归多因素分析CPPV的单侧腹股沟斜疝患儿术后MCIH发生的相关危险因素。结果81例患儿中,对侧鞘状突类型为孔型15例,膜型64例,半膜型2例。所有患儿术后平均随访时间为19.41个月,MCIH发生率为7.41%(6/81)。有MCIH发生组中患儿年龄和CPPV直径分别为(19.00±9.61)个月、(6.83±1.47)mm,无MCIH发生组中,患儿年龄和CPPV直径分别为(43.39±30.89)个月、(3.57±1.84)mm,两组间比较差异均具有统计学意义(P<0.05)。两组患儿在性别、初发斜疝的侧别、身高、体重及CPPV类型方面差异无统计学意义。CPPV的直径是MCIH发生的独立危险因素。结论CPPV的直径是MCIH发生的独立危险因素,CPPV的直径越大,MCIH发生的风险越高。当腹腔镜下发现CPPV的直径>5 mm时,同时予以结扎可以有效预防MCIH的发生。Objective To explore the risk factors of postoperative metachronous inguinal hernia(MCIH)in children with unilateral indirect inguinal hernia with contralateral patent processus vaginalis(CPPV)and to examine the indications for managing CPPV.Methods From October 1,2018 to October 31,2020,clinical data were reviewed for 67 boys and 14 girls with a preoperative diagnosis of unilateral indirect inguinal hernia.The involved side was left(n=32)and right(n=49).Laparoscopic high ligation of processus vaginalis at affected side was performed along with an exploration of processus vaginalis at contralateral side.Preoperative profiles of age,gender and body weight were recorded along with postoperative data of contralateral processus vaginalis type,diameter and follow-up time.They were divided into groups of with MCIH and without MCIH according to the postoperative presence or absence of contralateral new indirect hernia.SPSS 23.0 was utilized for data processing and Logistic regression multivariate analysis for examining the risk factors associated with the occurrence of postoperative MCIH in CPPV children with unilateral indirect inguinal hernia.Results The type of contralateral processus vaginalis was fenestrated(n=15),membranous(n=64)and semimembranous(n=2).The mean postoperative follow-up period was 19.41 months and the incidence of MCIH 7.41%(6/81).In MCIH group,age and CPPV diameter were(19.00±9.61)months and(6.83±1.47)mm respectively;in non-MCIH group,age and CPPV diameter were(43.39±30.89)months and(3.57±1.84)mm respectively and there were significant inter-group differences(P<0.05).No significant inter-group differences existed in gender,side of initial indirect hernia,height,weight or CPPV type.And diameter of CPPV was an independent risk factor for the occurrence of MCIH.Conclusions Diameter of CPPV is an independent risk factor for the occurrence of MCIH.The larger diameter of CPPV,the higher occurring risk of MCIH.When diameter of CPPV is>5 mm laparoscopically,simultaneous ligation may effectively prevent

关 键 词：腹股沟疝 斜疝 单侧性 异时性 危险因素 

分 类 号：R726.5[医药卫生—儿科]