Pavlovich C P, Gmyrek G A, Gardner T A, Poppas D P, Mininberg D T
James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell University Medical Center, New York 10021, USA.
Tech Urol. 1998 Sep;4(3):141-4.
The incidence of contralateral patent processus vaginalis (CPPV) is >50% in infants with clinical unilateral inguinal hernia (CUIH) and decreases only slowly with advancing age. Laparoscopy through the hernia sac (transinguinal laparoscopy) to detect suspected CPPV is a safe and efficient way to minimize routine contralateral inguinal exploration, but can be technically difficult. We used flexible urologic instruments and/or angled cystoscopic lenses to make transinguinal laparoscopy easier. Over a 3-year period, 37 patients (34 boys and 3 girls) ranging in age from 4 months to 12 years (mean age 59 months) with CUIH underwent ipsilateral groin exploration and diagnostic transinguinal laparoscopy. Laparoscopy was performed with flexible 17F cystoscopes (26 cases), flexible 9F ureteroscopes (2 cases), and rigid 70 degrees cystoscope lenses (9 cases). We detected eight CPPV (22%) in our series of 20 right and 17 left inguinal hernias, in a mean transinguinal laparoscopy time of 4.5 minutes. At 26-month mean follow-up, no patient whose contralateral inguinal ring was deemed closed had developed a hernia. Flexible fiberoptic urologic scopes and/or angled cystoscope lenses make transinguinal laparoscopy easy and efficacious in the pediatric population. Our series represents the longest longitudinal study of transinguinal laparoscopy for the diagnosis of CPPV.
临床单侧腹股沟疝（CUIH）患儿对侧鞘状突未闭（CPPV）的发生率>50%，且仅随年龄增长缓慢下降。通过疝囊进行腹腔镜检查（经腹股沟腹腔镜检查）以检测疑似CPPV是一种安全有效的方法，可最大程度减少常规对侧腹股沟探查，但技术上可能存在困难。我们使用了柔性泌尿外科器械和/或带角度的膀胱镜镜头，以使经腹股沟腹腔镜检查更容易。在3年期间，37例年龄从4个月至12岁（平均年龄59个月）的CUIH患儿接受了同侧腹股沟探查和诊断性经腹股沟腹腔镜检查。腹腔镜检查使用了柔性17F膀胱镜（26例）、柔性9F输尿管镜（2例）和硬性70度膀胱镜镜头（9例）。在我们这组20例右侧和17例左侧腹股沟疝中，我们检测到8例CPPV（22%），平均经腹股沟腹腔镜检查时间为4.5分钟。在平均26个月的随访中，对侧腹股沟环被认为已闭合的患者均未发生疝。柔性纤维光学泌尿外科镜和/或带角度的膀胱镜镜头使经腹股沟腹腔镜检查在儿科人群中既简便又有效。我们这组研究是经腹股沟腹腔镜检查诊断CPPV最长的纵向研究。
