Harrison C B, Kaplan G W, Scherz H C, Packer M G
Children's Hospital and Health Center, San Diego, California.
J Urol. 1990 Aug;144(2 Pt 2):510-1; discussion 512-3. doi: 10.1016/s0022-5347(17)39506-x.
The detection and management of occult contralateral hernia in children who present with a clinically evident unilateral hernia have evoked controversy. Routine use of herniography, intraoperative probing of the contralateral inguinal area and routine or selective exploration of the contralateral groin all have their advocates and detractors. During the last 5 years we have used intraoperative pneumoperitoneum and we report our experience in 64 patients 3 months to 9 years old. A retrospective analysis of the data revealed that pneumoperitoneum was negative in demonstrating a contralateral inguinal hernia in 59 of 64 patients (92%). Contralateral exploration was not performed in patients in whom pneumoperitoneum was negative. All 5 patients who tested positive had an indirect inguinal hernia upon contralateral exploration and all 5 were less than 3 years old. Patients who had a negative pneumoperitoneum were followed for up to 5 years and only 1 (1.8%) false negative examination was discovered. Pneumoperitoneum is a safe, effective means to evaluate the contralateral groin for occult hernia at the time of unilateral hernia repair in children.
对于出现临床明显单侧疝的儿童，隐匿性对侧疝的检测和处理引发了争议。疝造影术的常规应用、术中对侧腹股沟区探查以及对侧腹股沟的常规或选择性探查都有其支持者和反对者。在过去5年中，我们采用了术中气腹术，并报告了我们对64例年龄在3个月至9岁患者的经验。对数据的回顾性分析显示，64例患者中有59例（92%）气腹术在显示对侧腹股沟疝方面为阴性。气腹术阴性的患者未进行对侧探查。所有5例检测呈阳性的患者在对侧探查时均为间接腹股沟疝，且所有5例均小于3岁。气腹术阴性的患者随访长达5年，仅发现1例（1.8%）假阴性检查。气腹术是在儿童单侧疝修补时评估对侧腹股沟隐匿性疝的一种安全、有效的方法。
