小儿脐疝修补术 53 年经验

Fifty-three-year experience with pediatric umbilical hernia repairs.

机构信息

Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.

出版信息

J Pediatr Surg. 2011 Nov;46(11):2151-6. doi: 10.1016/j.jpedsurg.2011.06.014.

DOI:10.1016/j.jpedsurg.2011.06.014

PMID:22075348

Abstract

PURPOSE

The aim of this study was to evaluate the long-term surgical and patient-reported outcomes of pediatric umbilical hernia (UH) repairs.

METHODS

A retrospective review of all children (<18 years old) who underwent UH repair at Mayo Clinic-Rochester in the last half century was done. Follow-up was obtained by mailed survey.

RESULTS

From 1956 to 2009, 489 children (boys, 251; girls, 238) underwent a primary UH repair. The mean age was 3.9 years (range, 0.01-17.8 years). Complicated UHs that required emergent repair (n = 34, or 7%) included recurrent incarceration (22), enteric fistula (7), strangulation (4), and evisceration (1). Mean UH size was 1.3 cm (range, 0.2-7.0 cm), varying by operative indication (1.0 cm emergent vs 1.5 cm elective repairs, P = .008) and decade of repair (2.2 cm, 1950s-60s vs 1.3 cm, 1990s-2000s; P = .001). Postoperative morbidity (2%) consisted of superficial wound infection (7), hematoma (3), and seroma (1). With a 66% survey response rate and mean follow-up of 13.0 years (range, 0-53.8 years), 8 (2%) patients experienced a recurrence. Most patients reported satisfaction (90%) with the cosmetic appearance of their umbilicus and are pain free (96%).

CONCLUSION

Pediatric UH repairs have low morbidity and recurrence rates. Most patients are satisfied and pain free. Importantly, complicated UHs were more likely to be associated with smaller defects; therefore, parental counseling for signs of incarceration is recommended even in small defects.

摘要

目的

本研究旨在评估小儿脐疝（UH）修复的长期手术和患者报告结果。

方法

对过去半个世纪在梅奥诊所-罗切斯特接受 UH 修复的所有儿童（<18 岁）进行了回顾性分析。通过邮件调查获得随访。

结果

1956 年至 2009 年，489 名儿童（男 251 名，女 238 名）接受了原发性 UH 修复。平均年龄为 3.9 岁（范围，0.01-17.8 岁）。需要紧急修复的复杂 UH 包括复发性嵌顿（22 例）、肠瘘（7 例）、绞窄（4 例）和肠脱出（1 例）。平均 UH 大小为 1.3cm（范围，0.2-7.0cm），根据手术指征（1.0cm 紧急修复与 1.5cm 择期修复，P=0.008）和修复的十年有所不同（2.2cm，1950 年代-60 年代与 1.3cm，1990 年代-2000 年代；P=0.001）。术后并发症（2%）包括浅表伤口感染（7 例）、血肿（3 例）和血清肿（1 例）。通过 66%的调查回复率和 13.0 年的平均随访（范围，0-53.8 年），8 例（2%）患者复发。大多数患者对脐部的美容外观表示满意（90%），并且没有疼痛（96%）。