小儿单侧鞘膜积液对侧鞘状突的腹腔镜探查与治疗

Laparoscopic exploration and repair on contralateral patent processus vaginalis in children with unilateral hydrocele

目的总结724例小儿鞘膜积液对侧鞘状突的腹腔镜探查及治疗情况，以为临床决策手术方案提供参考。方法自2011年6月至2013年5月，我们收治单侧鞘膜积液患儿724例，其中左侧291例，右侧433例。2岁以内97例，2岁以上627例。均于腹腔镜下缝扎未闭的患侧鞘状突，同时探查对侧鞘状突，若对侧鞘状突未闭，予同时缝扎。统计单侧鞘膜积液对侧鞘状突未闭的发生率，并分析其与左右侧及患儿年龄的关系。结果724例中，409例（56．5％）合并对侧鞘状突未闭，其中左侧187例（64.26％）合并对侧鞘状突未闭，右侧222例（51．27％）合并对侧鞘状突未闭，经卡方检验，P=0．001，差异有统计学意义。2岁以内患儿61例（62．9％）合并对侧鞘状突未闭，2岁以上患儿348例（55．5％）合并对侧鞘状突未闭，经卡方检验，P=0。172，差异无统计学意义。术后无一例出现与对侧鞘状突手术相关的并发症。随访未发现对侧腹股沟斜疝或鞘膜积液。结论腹腔镜技术可以清楚显示对侧鞘状突是否闭合，且可以同时治疗，创伤小，疗效满意。左侧鞘膜积液合并对侧鞘状突未闭的机率较右侧高，建议对左侧鞘膜积液行腹腔镜手术时，更加注重探查对侧鞘状突情况。小儿鞘膜积液对侧鞘状突未闭的发生率与年龄无相关性。多大的鞘状突未闭需要手术，尚待进一步研究。

objective The management of the contralateral processus vaginalis in children presenting with unilateral hydrocele is still controversial. We summarize the laparoscopic exploration and repair of contralateral patent processus vaginalis （CPPV）, to investigate its clinical implication. Methods From June 2011 to May 2013, 724 children with unilateral hydrocele were admitted in our department, including 291 patients with left hydrocele, and 433 patients with right hydrocele. Ninety-seven patients were under 2 years of age and 627 were over 2 year. Laparoseopic exploration and repair were carried out in the symptomatic side, and we explored the CPPV, and repaired if it was present. Results There were 409（56.5% ）patients with CPPV in all the patents. CPPV was present in 187 （64.26%） patients of left hydrocele and in 222（51.27% ） patients of right hydrocele （ P = 0. 001 ）. CPPV was present in 61 children（ 62.9% ） under 2 years old and in 348 children （55.5 % ） over 2 years （P = 0. 172）. There was no occurrence of contralateral hydrocde or hernia after operation. Conduslons Laparoscopic exploration in CPPV is an accurate, minimally invasive technique, which is admitted by most doctors. Left hydrocele is associated with higher prevalence of CPPV. It is advised that we should pay more attention to CPPV in left hydrocele. The prevalence of CPPV is not correlated with age. Fur- ther studies on the nature of CPPV is necessary to determine the indications for repair of CPPV.