儿童对侧腹股沟疝的发生率与对侧未闭鞘状突的关系。
Incidence of pediatric metachronous contralateral inguinal hernia and the relationship with contralateral patent processus vaginalis.
机构信息
Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, #37 Guo-Xue-Xiang, Chengdu, 610041, China.
出版信息
Surg Endosc. 2019 Apr;33(4):1087-1090. doi: 10.1007/s00464-018-6359-x. Epub 2018 Sep 25.
BACKGROUND
The management of contralateral patent processus vaginalis (CPPV) in children with unilateral inguinal hernia is still controversial. The objective of this study was to verify the relationship between metachronous contralateral inguinal hernia (MCIH) and CPPV, and the risk factors of MCIH.
METHODS
Children with unilateral inguinal hernia from three medical centers underwent either open or laparoscopic repairs. Clinical information, including demographics, morphological characteristics of CPPV, follow-up outcomes were collected.
RESULTS
Among 2942 patients (92.2%) who received open repair with successful follow-up, 185 (6.29%) developed MCIHs [125 (10.9%) on the right side and 60 (3.3%)] on the left including 156 (7.07%) younger than 3 years old and 29 (3.94%) older than 3 years old. Patients younger than 3 years old with primary left inguinal hernias more easily develop MCIHs and the difference is statistically significant. Among 5370 patients (96.0%) who received laparoscopic repair with successful follow-up, the morphology of ipsilateral patent processus vaginalis were cavernous type in 5318 (99%) and 52 (1%) were fissure type. CPPVs were identified in 2233 (41.5%) cases [1256 (35.01%) on the left side and 977 (54.80%) on the right side, P < 0.001]; 1503 cases were cavernous type (1276 cases younger than 3 years old and 227 cases older than 3 years old) and 730 cases were fissure type (422 cases younger than 3 years old and 308 cases older than 3 years old). The probability of occurence of cavernous type and CPPV in children younger than 3 years old was higher than that in children older than 3 years old.
CONCLUSIONS
Not all CPPVS progress into an MIH, and approximate one of 15 CPPVs would progress into MIH. If patient with initial left-sided inguinal hernia is younger than 3 years old, when the morphology of CPPV is cavernous type identified by laparoscopic exploration, the contralateral repair would be recommended.
背景
对于患有单侧腹股沟疝的儿童，对侧未闭鞘状突（CPPV）的处理仍存在争议。本研究旨在验证同期对侧腹股沟疝（MCIH）与 CPPV 的关系，以及 MCIH 的危险因素。
方法
来自三个医疗中心的单侧腹股沟疝患儿接受开放或腹腔镜修补术。收集临床资料，包括人口统计学资料、CPPV 的形态特征、随访结果等。
结果
在 2942 例接受成功随访的开放性修补术患儿中，185 例（6.29%）发生了 MCIHs[125 例（10.9%）在右侧，60 例（3.3%）在左侧]，其中 156 例（7.07%）年龄小于 3 岁，29 例（3.94%）年龄大于 3 岁。小于 3 岁的初发左侧腹股沟疝患儿更易发生 MCIHs，差异有统计学意义。在 5370 例接受成功随访的腹腔镜修补术患儿中，同侧未闭鞘状突的形态为海绵状 5318 例（99%），裂隙状 52 例（1%）。CPPV 被发现于 2233 例（41.5%）患儿中[1256 例（35.01%）在左侧，977 例（54.80%）在右侧，P<0.001]；1503 例为海绵状（1276 例年龄小于 3 岁，227 例年龄大于 3 岁），730 例为裂隙状（422 例年龄小于 3 岁，308 例年龄大于 3 岁）。3 岁以下患儿发生海绵状和 CPPV 的概率高于 3 岁以上患儿。
结论
并非所有 CPPVS 都会进展为 MIH，约每 15 例 CPPV 中就有 1 例会进展为 MIH。如果初发左侧腹股沟疝患儿年龄小于 3 岁，且腹腔镜探查发现 CPPV 的形态为海绵状，建议行对侧修补。
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