儿童嵌顿性腹股沟斜疝致睾丸缺血损伤的影响因素

Predictors of testicular injury secondary to incarcerated inguinal Hernia in children

目的本研究旨在总结儿童嵌顿性腹股沟斜疝对睾丸缺血损伤的影响因素,以便术前更准确地评估睾丸缺血损伤,从而及时进行睾丸探查或防止不必要的探查。方法回顾性分析重庆医科大学附属儿童医院2013年7月到2019年6月行疝囊及同侧睾丸探查术的单侧嵌顿性腹股沟斜疝患儿临床资料,收集数据包括年龄、嵌顿时间、肠管损伤程度(术中发现)、睾丸损伤程度(探查发现)、既往手法复位次数和术前超声检查等。通过SAS 9.4(Copyright © 2016 SAS Institute Inc.Cary,NC,USA)进行单因素分析和逐步倒退多因素Logistics回归分析。结果 460例接受了术前超声检查,其中57例(12.39%)(中位年龄:1.4个月,四分位区间:0.8~10.7个月)有严重的睾丸缺血损伤,平均嵌顿时间为(23.9±9.3)h,术前超声检查预测严重睾丸缺血损伤的敏感度为68.42%,特异度为95.30%。单因素Logistic回归分析显示:年龄(OR=0.257,95%CI=0.146~0.451)、手法复位次数增多(OR=4.543,95%CI=3.285~6.283)与睾丸损伤程度呈负相关,术前超声评分(OR=3.994,95%CI=2.845~5.609)、嵌顿时间(OR=0.457,95%CI=0.224~0.934)、肠管损伤程度(OR=2.317,95%CI=1.633~3.287)与睾丸损伤严重程度呈正相关(P<0.05)。通过多元分析与后向逐步逻辑回归分析建立了一个严重的睾丸局部缺血损伤可能性计算模型:,当P<0.15时,则认为该患者患有严重的睾丸局部缺血损伤。通过十字交叉试验初步验证了模型的预测准确性。结论本研究提供了一个相对可靠的预测模型,可使用易获得的临床数据来预测因嵌顿性腹股沟斜疝导致的严重睾丸缺血损伤的风险,与单独的术前超声相比,该模型可提高严重睾丸损伤的预测准确性。

Objective To find out predictors of the testicular ischemia caused by incarcerated inguinal hernia and evaluate the ischemic injury of the testis more accurately,which can indicate testicle exploration in time or prevent unnecessary testicle exploration.Methods Pediatric patients(median:9 months)undergoing operation of unilateral incarcerated inguinal hernia and ipsilateral testicular exploration from 1 Jul.2013 to 30 Jun.2019 were retrospectively investigated.Age at surgery,incarcerate duration,degree of intestinal and testicular injury,times of manual reduction and preoperative ultrasound data were collected.Statistical analysis was performed by SAS 9.4(Copyright©2016 SAS Institute Inc.Cary,NC,USA).Results 460 patients(median:9 months),of which 57(12.39%)(median:1.4 months,interquartile range 0.8-10.7 months)had severe testicular injury,and their average incarceration time was(23.9±9.3)h.Univariate logistic regression revealed that increased times of manual reduction,ultrasound scores,incarcerate duration and degree of intestinal injury were positively correlated with the degree of testicular ischemia,while age at surgery was negatively correlated with the degree of testicular ischemia(Pv0.05).A model for calculating the probability of severe testicular ischemia injury was established:P=1+e^(4.966+1.168Age-1.194 Score-0.845 Time/1)through multivariate analysis with backward stepwise logistic regression and 10-fold cross-validation was used for preliminary verification of the model.Conclusion This study provides a relative reliable model to predict the risk of irreversible testicular ischemia due to incarcerated inguinal hernia using readily available clinical characteristics in young pediatrics with testicular ischemia.