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

Efficacy of laparoscopic percutaneous extraperitoneal closure for unilateral inguinal hernia in children and significance of exploration for contralateral patent processus vaginalis

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MCH13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CPPV62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 laparoscopic percutaneous extraperitoneal closure （LEPC） for unilateral inguinal hernia in children, and effect of intraoperative laparoscopic exploration for finding contralateral patent processus vaginalis （CPPV） on prevention of the metachronous contralateral hernia （MCH）. Methods： The clinical data of 161 children with unilateral inguinal hernia undergoing LPEC from January 2013 to December 2014 were retrospectively analyzed （observational group）, and another 252 children with unilateralinguinal hernia undergoing open hernia repair from January 2010 to December 2012 were used as a historical control （control group）. Patients in observational group received synchronous exploration of the inguinal region and had a ligation if CPPV was diagnosed, while exploration of the inguinal region was not performed in those in control group. The postoperative complications, hernia recurrence and MCH of the two groups as well as the influential factors for MCH were analyzed. Results＂ ＂Ihere was no statistical difference in incidence of postoperative complications and hernia recurrence between the two groups （both P〉0.05）, and MCH occurred in 13 cases in the whole group, of whom, one case occurred in observational group and 12 cases occurred in control group, and the difference had statistical significance （0.6% vs. 4.8%, P〈0.05）, further, 9 cases in control group occurred within postoperative 24 months. CPPV was found in 62 cases （38.5%） in observational group, which in age group of 0.5-〈2 years reached 59.0% （23/39）, and decreased with age increase. In control group, the incidence of MCH in of CPPV in cases with premature birth was significantly higher than in those with full-term birth （3.6% vs. 1.2%, P〈0.05）. Overall analysis demonstrated that MCH mainly occurred in male children undergoing open surgery with age less than 4 years and right inguinal hernia. Conclusion： LEPC has proven efficacy in treatment of unilateral inguinal hernia in children, and synchronous laparoscopic exploration for CPPV can reduce the incidence of MCH, which is particularly important for those with premature birth and age less than 4 years.