Eller Miranda Marcelo, Duarte Lanna José Carlos Brandão
Department of Pediatric Surgery, University Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
Pediatr Surg Int. 2002 Sep;18(5-6):463-9. doi: 10.1007/s00383-002-0792-5. Epub 2002 Jul 23.
Videolaparoscopy of the contralateral internal inguinal ring (CIIR) via the hernia sac was performed in 100 children with a unilateral inguinal hernia (UIH) between August 1996 and May 1999. During general anesthesia, after dissection and opening of the hernia sac with the patient in the Trendelenburg position, the external cannula of a 10-mm trocar was introduced into the peritoneal cavity via the hernia sac. The abdomen was insufflated with CO(2) to a maximum pressure of 9 mmHg. A 10-mm, 30 degrees angled laparoscope attached to a video camera was then inserted through the trocar to examine the CIIR. Routine contralateral inguinal exploration was performed in the first 10 cases and in all children whose videolaparoscopic exam showed an open CIIR. There were no false-positive findings. The positive predictive value of the method was 100% for an open CIIR; the average time needed to perform the examination was 8.06 min. The frequency of an open CIIR was 21% and that of a closed CIIR was 79%. There was no statistically significant relationship between the morphology of the CIIR and the sex or race of the child. The frequency of an open CIIR was significantly higher (34.1%) in children with a left IH, than in those with a right IH (11.8%, chi(2) = 5.95, P = 0.0146). The frequency of an open CIIR was significantly higher (31.1%) in children aged 4 years or older than in those less than 4 years (12.7%, chi(2) = 3.99; P = 0.0456), although the sample was too small to study the correlation between the morphology of the CIIR and age. There were no intra- or postoperative complications. This method for examining the CIIR is safe, efficient and rapid and provides the surgeon with more objective anatomic data for the appropriate selection of children with a UIH who will benefit from contralateral inguinal exploration for ligature of the contralateral patent Processus vaginalis, during the same anesthetic in order to prevent a possible subsequent contralateral indirect IH. Our initial experience is presented with a meta-analysis.
1996年8月至1999年5月期间，对100例单侧腹股沟疝（UIH）患儿经疝囊行对侧腹股沟内环（CIIR）的视频腹腔镜检查。在全身麻醉下，将患儿置于头低脚高位，切开并打开疝囊后，将10mm套管针的外鞘经疝囊置入腹腔。向腹腔内注入二氧化碳，最大压力为9mmHg。然后将连接有摄像机的10mm、30°角的腹腔镜经套管针插入，检查CIIR。前10例以及所有视频腹腔镜检查显示CIIR开放的患儿均进行了常规对侧腹股沟探查。未发现假阳性结果。该方法对CIIR开放的阳性预测值为100%；检查所需的平均时间为8.06分钟。CIIR开放的频率为21%，闭合的频率为79%。CIIR的形态与患儿的性别或种族之间无统计学显著关系。左侧腹股沟疝患儿CIIR开放的频率（34.1%）显著高于右侧腹股沟疝患儿（11.8%，χ² = 5.95，P = 0.0146）。4岁及以上患儿CIIR开放的频率（31.1%）显著高于4岁以下患儿（12.7%，χ² = 3.99；P = 0.0456），尽管样本量太小，无法研究CIIR形态与年龄之间的相关性。术中及术后均无并发症。这种检查CIIR的方法安全、高效、快速，为外科医生提供了更客观的解剖学数据，以便在同一麻醉期间，为适合进行对侧腹股沟探查以结扎对侧开放的鞘突，从而预防可能随后发生的对侧间接腹股沟疝的UIH患儿做出恰当选择。我们通过荟萃分析展示了初步经验。
