腹股沟疝患儿腹腔镜经皮腹膜外闭合术后疝复发及对侧腹股沟疝发生的危险因素分析

Risk factors for recurrence and contralateral inguinal hernia after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia

目的探讨腹股沟疝患儿腹腔镜经皮腹膜外闭合术后疝复发及对侧腹股沟疝发生的危险因素。方法选取2011年7月—2017年12月湖南省人民医院胃肠小儿外科诊治的腹股沟斜疝患儿225例,入选206例。其中,男性120例,女性86例;平均随访(48.12±1.23)个月;手术时平均年龄(3.88±1.01)岁。手术期间常规观察无症状的对侧内环,腹膜鞘状突未闭合(PPV)时,行预防性手术。观察患儿疝复发和对侧异时性腹股沟疝(CMIH)发生率。采用多因素Cox比例风险回归分析疝复发和CMIH的危险因素。结果腹腔镜经皮腹膜外闭合术后疝复发率为2.24%(5/223侧),复发均为男性患儿。多因素Cox比例风险回归分析显示年龄<1岁是男性患儿复发的危险因素[RR=4.542(95%CI:1.072,19.215),P=0.041]。腹腔镜经皮腹膜外闭合术后CMIH发生率为1.72%(3/174),均为男性患儿。189例单侧患儿中84例(44.44%)确诊为无症状对侧PPV,并接受预防性腹腔镜经皮腹膜外闭合(LPEC)术。女性、<1岁及外科医生经LPEC术治疗前30例患者是无症状对侧PPV发生的危险因素。结论为防止腹股沟疝复发,外科医生对年龄较小男性患儿行手术时需要谨慎。尽管本研究未发现CMIH的危险因素,但确定了无症状对侧PPV的危险因素。需要进一步探讨CMIH与PPV的这些因素之间的相关性。

Objecctive To analyze the risk factors for recurrence and CMIH after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia. Methods From July 2011 to December 2017, 225 cases of children with indirect inguinal hernia were selected and 206 cases were selected, with 120 male and 86 female. The average follow-up time was(48.12 1 ± 1.23) months;the average age at the time of operation was 3.88 ± 1.01 years.The asymptomatic contralateral internal ring was routinely observed during the operation. When a patent processus vaginalis(PPV) was confirmed, prophylactic surgery was performed. The incidence of recurrent hernia and contralateral metachronous inguinal hernia(CMIH) were observed. Multivariate Cox proportional hazards regression was used to analyze the risk factors of hernia recurrence and CMIH. Results The recurrence rate was 2.24%(5/223 sides), all of whom were male. According to multivariate analysis, age less than 1 year was the only risk factor for recurrence in male patients [■= 4.542(95% CI: 1.072, 19.215), P = 0.041]. CMIH occupied 1.72% of the patients(3/174), only for male patients. As a result of intraoperative observation, 44.44% of patients were confirmed to have an asymptomatic contralateral PPV and underwent prophylactic LPEC. Female, age less than 1 year, and the surgeon’s experience were identified as risk factors associated with asymptomatic contralateral PPV. Conclusions To prevent recurrence, surgeons need to be careful when operating on young male patients. Whereas no specific factor could be identified as a risk factor for CMIH, some risk factors associated with asymptomatic PPV were identified.Further study and discussion will be needed to identify correlations between CMIH and these factors for PPV.