Rescorla F J, West K W, Engum S A, Scherer L R, Grosfeld J L
Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
Am Surg. 1997 Aug;63(8):690-3.
The role of contralateral inguinal exploration in neonates, infants, and children presenting with unilateral hernias is controversial. Factors considered by surgeons include the patient's age, sex, and side of the clinically apparent hernia. The purpose of this study was to evaluate the role of diagnostic laparoscopy performed through the clinically apparent hernia sac to identify a contralateral patent processus vaginalis (CPPV) in children and limit contralateral exploration to CPPV-positive patients. One hundred neonates, infants, and children underwent laparoscopic evaluation for a CPPV through the ipsilateral hernia sac. There were 79 boys and 21 girls. Forty-eight of 100 (48%) had a CPPV identified, which was confirmed operatively. Thirty-one of 68 patients (46%) with a right-sided and 18 of 32 (56%) with a left-sided hernias had a CPPV (P = 0.39). Thirty-six of 56 (64%) patients younger than 6 months of age had a CPPV compared to 13 of 44 (30%) older than six months (P = 0.001). Fourteen of 21 (67%) girls had a CPPV compared to 35 of 79 (44%) boys (P = 0.087). Laparoscopy through the hernia sac is a safe and effective means of identifying the presence of a CPPV and avoiding unnecessary contralateral inguinal exploration. Infants (< 6 months) are much more likely to have a CPPV.
对于出现单侧疝的新生儿、婴儿和儿童，对侧腹股沟探查的作用存在争议。外科医生考虑的因素包括患者的年龄、性别以及临床明显疝的侧别。本研究的目的是评估通过临床明显的疝囊进行诊断性腹腔镜检查，以识别儿童对侧未闭的鞘突（CPPV），并将对侧探查限制在CPPV阳性患者中的作用。100例新生儿、婴儿和儿童通过同侧疝囊接受了CPPV的腹腔镜评估。其中有79名男孩和21名女孩。100例中有48例（48%）被发现存在CPPV，手术证实了这一结果。右侧疝的68例患者中有31例（46%）以及左侧疝的32例患者中有18例（56%）存在CPPV（P = 0.39）。6个月以下的56例患者中有36例（64%）存在CPPV，而6个月以上的44例患者中有13例（30%）存在CPPV（P = 0.001）。21例女孩中有14例（67%）存在CPPV，而79例男孩中有35例（44%）存在CPPV（P = 0.087）。通过疝囊进行腹腔镜检查是识别CPPV存在并避免不必要的对侧腹股沟探查的一种安全有效的方法。婴儿（<6个月）更有可能存在CPPV。
