腹腔镜术中男性患儿对侧隐匿性鞘状突未闭初步研究

Preliminary study of contralateral occult inguinal indirect hernia in male children by laparoscopy

目的探讨腹腔镜术中男性患儿对侧隐匿性鞘状突未闭（occult patent processus vaginalis，OPPV）的患病率、发病率及其临床意义。方法回顾性分析2008年1月至2013年6月行经脐二孔法腹腔镜下疝囊高位结扎术2596患儿的临床资料。结果本组44．65％（1159／2596）患儿对侧腹股沟区探查为阳性，右侧OPPV患病率为48．89%（420／859），左侧OPPV患病率为42．54％（739／1737），左右侧患病率差异有统计学意义（X^2=9．38，P〈0．01），右侧相对于左侧相对危险度为1．15。OPPV总发病率为4．31％（50／1159）。其中，1岁以内患儿OPPV患病率为40．65％（163／401），发病率为6．75％（11／163）；1～2岁内患儿OPPV患病率最高达59．53％（534／897），发病率为1．87％（10／534）；2～6岁患儿OPPV患病率为40．41％（379／938），发病率为5．28％（20／379）；6至16岁患儿OPPV患病率最低为23．06％（83／360），发病率为最高10．84％（9／83）。80．00％（40／50）患儿有呼吸道感染、腹泻等诱发因素，20．00％（10／50）为不明诱因。本组复发率为0．08%（2／2596）。结论不同年龄段OPPV患病率及发病率不同，提示所有患儿腹腔镜下常规行对侧OPPV探查有一定临床价值，尤其是2岁后OPPV可能更需要积极的手术干预。

Objective To evaluate the prevalence and incidence of contralateral occult inguinal indirect hernia （OPPV） in male children by laparoscopy. Methods A 5-year retrospective review was conducted for 2596 male patients undergoing unilateral inguinal laparoscopic herniorraphy （LH） from January 2008 to June 2013. Results Among them, 44. 65% （1 159/2 596） had OPPV in contralateral inguinal groin while 4. 31% （50/1 159） developed contralareal indirect hernia. Laparoscopic evaluation was positive for right-sided OPPV in 48. 89% （420/859） and left-sided lesion in 42. 54% （739/1 737） （X^2 = 9. 38, P〈0. 01）. Left-sided indirect hernia （RR= 1.15） was associated with an elevated risk of contralateral OPPV. OPPV was diagnosed in 40. 65 % （163/401） of patients aged under 1 year and the future contralateral occurrence rate was 6.75% （11/163）. The highest prevalence of 59.53% （534/897） and the lowest incidence of 1. 87% （10/534） of OPPV were found in those patients aged under 2 years respectively. Laparoscopic evaluation was positive for OPPV in 40. 41% of patients aged 2-6 years. And 5.28% patients developed contralateral indirect hernia. The lowest prevalence of 23. 06% （83/360） and the highest incidence of 10. 84%（9/83） of OPPV were found in those aged 6 - 16 years respectively. And 80. 00% （40/50） patients with contralateral indirect hernia resulting from OPPV had the causes of respiratory infections and diarrheal diseases while 20. 00% （10/50） did not. The future recurrence rate was 0. 08% （2/2 596）. Conclusions Laparoscopic exploration should be routinely performed for pediatric patients of all ages because of a high prevalence and incidence of contralateral OPPV. Especially, LH should be actively performed in patients aged over 2 year because of a high incidence of contralateral OPPV.