Yerkes E B, Brock J W, Holcomb G W, Morgan W M
Division of Pediatric Urology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA.
Urology. 1998 Mar;51(3):480-3. doi: 10.1016/s0090-4295(97)00719-x.
Between May 1, 1992 and August 1, 1996, 759 consecutive children younger than 10 years of age were evaluated and treated for known inguinal hernia. These children were participating in a prospective investigation of the potential role of diagnostic laparoscopy in the evaluation of the contralateral inguinal anatomy. The initial two series of data (parts I and II of this three-part series) were previously presented at the 1993 and 1995 American Academy of Pediatrics meetings.
Of 759 patients, 100 children were diagnosed with bilateral inguinal hernias and therefore did not undergo laparoscopy. Thirty-two patients did not undergo laparoscopic evaluation due to technical difficulties or complicated clinical situations. The patient's contralateral inguinal region was carefully examined under anesthesia, and predictions were made regarding the likelihood of contralateral patent processus vaginalis (CPPV). Six hundred twenty-seven children underwent diagnostic laparoscopy to confirm the presence or absence of CPPV. Laparoscopy was initially exclusively performed through the umbilicus prior to repair of the known hernia, but over the last 26 months, 250 children successfully underwent laparoscopy through the ipsilateral hernia sac.
Of patients younger than 1 year of age, 114 were diagnosed with both a known unilateral hernia and CPPV, whereas 132 had a unilateral hernia only (46% versus 54%). Among children older than 1 year of age, 148 (39%) were diagnosed with unilateral hernia and CPPV, and 233 (61%) were diagnosed with a unilateral hernia alone. After examination under anesthesia, 233 of the 627 patients were suspected of having a CPPV, and 107 were confirmed at laparoscopy (46%). The remaining 394 patients were not believed to have a CPPV. Normal inguinal anatomy was confirmed in 234 patients (59%), but 160 patients were found at laparoscopy to have a CPPV (41%).
A contralateral patent processus vaginalis may be present in a surprising number of young patients being evaluated for a known inguinal hernia. Laparoscopy can be performed without a separate incision when the ipsilateral hernia sac is of sufficient width to allow passage of the scope. Laparoscopy is the best method for evaluating the contralateral inguinal region, particularly in younger children, as it prevents unnecessary inguinal exploration and it decreases the risk that the child will later present with a clinical contralateral hernia.
在1992年5月1日至1996年8月1日期间，对759名连续的10岁以下已知腹股沟疝患儿进行了评估和治疗。这些患儿参与了一项关于诊断性腹腔镜检查在评估对侧腹股沟解剖结构中潜在作用的前瞻性研究。最初的两组数据（这个三部分系列的第一部分和第二部分）之前已在1993年和1995年美国儿科学会会议上发表。
759例患者中，100名儿童被诊断为双侧腹股沟疝，因此未接受腹腔镜检查。32例患者由于技术困难或复杂的临床情况未接受腹腔镜评估。在麻醉下仔细检查患者的对侧腹股沟区域，并对侧方腹膜鞘突未闭（CPPV）的可能性进行预测。627名儿童接受了诊断性腹腔镜检查以确认是否存在CPPV。在修复已知疝之前，腹腔镜检查最初仅通过脐部进行，但在最后26个月中，250名儿童通过同侧疝囊成功接受了腹腔镜检查。
在1岁以下的患者中，114例被诊断为既有已知的单侧疝又有CPPV，而132例仅有单侧疝（46%对54%）。在1岁以上的儿童中，148例（39%）被诊断为单侧疝和CPPV，233例（61%）仅被诊断为单侧疝。在麻醉下检查后，627例患者中有233例被怀疑有CPPV，107例在腹腔镜检查中得到证实（46%）。其余394例患者被认为没有CPPV。234例患者（59%）的腹股沟解剖结构正常，但在腹腔镜检查中发现160例患者有CPPV（41%）。
在因已知腹股沟疝接受评估的众多年轻患者中，可能存在数量惊人的对侧腹膜鞘突未闭。当同侧疝囊宽度足够允许腹腔镜通过时，可不作单独切口进行腹腔镜检查。腹腔镜检查是评估对侧腹股沟区域的最佳方法，特别是对年幼儿童，因为它可避免不必要的腹股沟探查，并降低患儿日后出现临床对侧疝的风险。
