van Wessem K J P, Simons M P, Plaisier P W, Lange J F
Department of General Surgery, Medical Center Rijnmond-Zuid, Location Clara, Olympiaweg 350, 3078 HT, Rotterdam, The Netherlands.
Hernia. 2003 Jun;7(2):76-9. doi: 10.1007/s10029-002-0108-7. Epub 2003 Mar 18.
The development of indirect inguinal hernias in infants is caused by a patent processus vaginalis (PPV). Consequently, this type of hernia is cured by simple herniotomy. In adults, however, herniotomy alone is accompanied by a high recurrence rate. This indicates that additional factors play a part in the development of indirect inguinal hernias in adults. The aim of this study was to determine the etiology of the development of an indirect hernia in adult life. Also, the prevalence of a PPV without clinical evidence of a hernia was determined and related to age. From November 1998 until February 2002, 599 patients from four different teaching hospitals, who underwent abdominal laparoscopy for various pathologies, were included. During laparoscopy, the deep inguinal ring was bilaterally inspected. Patients undergoing laparoscopy for inguinal hernia repair were excluded. Mean age was 45 years (range 8-89 years). Thirty-two percent (189/599) were male. Twelve percent (71/599) had PPV, all without clinical symptoms. Fifty-five percent (39/71) with PPV were male (P<0.0001). Fifty-nine percent (42/71) with PPV were right-sided, 29% (21/71) with PPV were left sided, and 12% (8/71) were bilateral (P=0.01). The prevalence of PPV in patients under 20 years was 22%. Of those between 20 and 30 years of age, 6% had PPV. Of those between 30 and 50 years, 24 patients (11%) had PPV. Of patients over 50 years, 33 (14%) had PPV. No significant differences between ages were observed. It is concluded that asymptomatic patent processus vaginalis frequently exists in adult life. The prevalence of PPV does not increase significantly with age. Assuming that indirect hernias start with asymptomatic peritoneal protrusion that can be observed laparoscopically, the incidence of PPV, like the incidence of adult indirect hernias, should increase in case of acquired etiology. Such an increase of incidence with age was not confirmed by our results. It is concluded that the etiology of indirect inguinal hernia in adults, as in infants, is congenital.
婴儿腹股沟斜疝的发生是由鞘状突未闭（PPV）引起的。因此，这种类型的疝气通过单纯疝囊高位结扎术即可治愈。然而，在成年人中，仅进行疝囊高位结扎术的复发率很高。这表明还有其他因素参与了成人腹股沟斜疝的发生。本研究的目的是确定成人腹股沟斜疝发生的病因。此外，还确定了无疝气临床证据的鞘状突未闭的患病率及其与年龄的关系。从1998年11月至2002年2月，纳入了来自四家不同教学医院的599例因各种病症接受腹部腹腔镜检查的患者。在腹腔镜检查期间，对双侧腹股沟深环进行了检查。因腹股沟疝修补而接受腹腔镜检查的患者被排除在外。平均年龄为45岁（范围8 - 89岁）。32%（189/599）为男性。12%（71/599）有鞘状突未闭，均无临床症状。鞘状突未闭的患者中55%（39/71）为男性（P<0.0001）。鞘状突未闭的患者中59%（42/71）为右侧，29%（21/71）为左侧，12%（8/71）为双侧（P = 0.01）。20岁以下患者鞘状突未闭的患病率为22%。20至30岁的患者中，6%有鞘状突未闭。30至50岁的患者中，24例（11%）有鞘状突未闭。50岁以上的患者中，33例（14%）有鞘状突未闭。各年龄组之间未观察到显著差异。结论是，无症状的鞘状突未闭在成年人中经常存在。鞘状突未闭的患病率不会随年龄显著增加。假设腹股沟斜疝始于可通过腹腔镜观察到的无症状腹膜突出，那么如果病因是后天性的，鞘状突未闭的发生率，就像成人腹股沟斜疝的发生率一样，应该会增加。但我们的结果并未证实这种随年龄增长而增加的发生率。结论是，成人腹股沟斜疝的病因与婴儿一样，是先天性的。
