经皮腹膜外疝囊高位结扎术治疗小儿单侧腹股沟疝的疗效及对侧鞘状突未闭探查的意义

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目的:探讨经皮腹膜外疝囊高位结扎术(LPEC)治疗小儿单侧腹股沟疝的疗效,及术中腹腔镜探查有无对侧鞘状突未闭(CPPV)对预防对侧异时性疝(MCH)的作用。方法:回顾性分析2013年1月—2014年12月161例行LPEC的单侧腹股沟疝患儿临床资料(观察组),并以2010年1月—2012年12月252例行开放疝囊修补术的单侧腹股沟疝患儿为历史对照(对照组),观察组同时行对侧腹股沟区探查,如诊断CPPV,均行结扎术,对照组不行对侧腹股沟内环口区探查。分析两组术后并发症、复发疝及MCH情况,并分析MCH的影响因素。结果:两组术后并发症与复发疝发生率的差异均无统计学意义(均P>0.05),全组共发生MCH 13例,其中观察组1例,对照组12例,差异有统计学意义(0.6%vs.4.8%,P<0.05),且对照组9例(3.6%)发生在术后24个月内。观察组术中共发现CPPV 62例(38.5%),且在0.5~<2岁组发生率达59.0%(23/39),随年龄增长发生率逐渐下降。对照组中早产儿MCH发生率高于足月儿(3.6%vs.1.2%,P<0.05)。总体分析显示,MCH主要发生于4岁以内的行开放手术的男性右侧腹股沟疝患儿。结论:LPEC治疗小儿单侧腹股沟疝的疗效确切,且腹腔镜下探查CPPV可明显降低MCH的发生率,尤其对于有早产和年龄<4岁的患儿尤为重要。 Objective: To investigate the efficacy of percutaneous extraperitoneal hernia sac ligation (LPEC) in the treatment of unilateral inguinal hernia in children and whether laparoscopic surgery with or without contralateral sheath herniation (CPPV) on the prevention of contralateral hernia (MCH) role. Methods: The clinical data of 161 children with unilateral inguinal hernia who underwent routine LPEC from January 2013 to December 2014 were retrospectively analyzed (observation group). Hernia sac repair was performed in 252 cases from January 2010 to December 2012 The patients with unilateral inguinal hernia were treated as the historical control group (control group). The observation group also performed the contralateral inguinal area exploration. For example, if CPPV was diagnosed, the ligation was performed in the control group, but not in the control group. Two groups of postoperative complications, recurrent hernia and MCH were analyzed, and the influencing factors of MCH were analyzed. Results: There was no significant difference in the incidence of postoperative complications and recurrent hernia between the two groups (all P> 0.05). There were 13 MCH cases in the whole group, including 1 case in observation group and 12 cases in control group, with statistical difference (0.6% vs.4.8%, P <0.05), and 9 cases (3.6%) in the control group occurred within 24 months after operation. In the observation group, 62 cases (38.5%) of CPPV were found in operation group, and the incidence rate was 59.0% (23/39) in 0.5 ~ <2 years old group. The incidence of CPPV gradually decreased with age. The incidence of MCH in preterm infants in the control group was higher than that in term infants (3.6% vs 1.2%, P <0.05). Overall analysis showed that MCH mainly occurred in children under 4 years old with open inguinal hernia on the right side of the groin. Conclusion: LPEC is effective in treating unilateral inguinal hernia in children and laparoscopic exploration of CPPV can significantly reduce the incidence of MCH, especially for children with preterm and age <4 years old.
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