Vogels Helen D E, Bruijnen Christine J P, Beasley Spencer W
Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
Pediatr Surg Int. 2009 Mar;25(3):235-8. doi: 10.1007/s00383-008-2309-3. Epub 2009 Jan 16.
Recurrence is the most important complication of inguinal hernia repair in childhood, but little is known about its contributing factors. The aim of our study was to identify factors evident at the time of primary surgery that may be predictive of subsequent recurrence.
All hernias in boys operated on by the Christchurch-based Paediatric Surgical Service of the South Island of New Zealand between September 1996 and December 2007 were reviewed. Characteristics of initial hernias that recurred were compared with hernias that did not recur.
There were 2,471 primary herniotomies in boys, of which 17 recurred, giving an overall recurrence rate of 0.69%. Factors predicting an increased likelihood of later recurrence were inadvertent opening of the hernial sac during its dissection off the vas and vessels (OR = 5.1, P = 0.0039) and larger size of the hernia (P = 0.0037). Ten recurrences (62.5%) occurred in infants less than 37 weeks gestation. Hernias considered 'massive' at the time of surgery tended to recur earlier (P = 0.006), as did those where the sac was opened (P = 0.011). The side of the hernia and initial strangulation did not differ significantly between the two groups.
Larger hernial sacs and sacs inadvertently opened during surgery are predictors of later recurrence. Low gestation and specific comorbidities were also associated with a higher likelihood of recurrence.
复发是儿童腹股沟疝修补术最重要的并发症，但对其相关因素了解甚少。我们研究的目的是确定初次手术时明显存在的、可能预测随后复发的因素。
回顾了1996年9月至2007年12月间由新西兰南岛克赖斯特彻奇市小儿外科服务中心为男孩施行手术的所有疝气病例。将复发的初始疝气特征与未复发的疝气进行比较。
男孩共进行了2471例初次疝囊高位结扎术，其中17例复发，总体复发率为0.69%。预测后期复发可能性增加的因素包括在疝囊从输精管和血管分离过程中意外打开疝囊（比值比=5.1，P=0.0039）和疝气较大（P=0.0037）。10例复发（62.5%）发生在孕周小于37周的婴儿中。手术时被认为“巨大”的疝气往往复发较早（P=0.006），疝囊被打开的疝气也是如此（P=0.011）。两组之间疝气的侧别和初始绞窄情况无显著差异。
较大的疝囊以及手术中意外打开的疝囊是后期复发的预测因素。低孕周和特定的合并症也与较高的复发可能性相关。
