摘要
目的探讨影响腹腔镜小儿斜疝疝囊高位结扎术术后疝复发的因素。方法回顾性分析2008年1月至2014年12月南充市中心医院收治的行腹腔镜下疝囊高位结扎术的儿童患儿临床资料264例。用Logistic回归模型对腹腔镜下小儿疝囊高位结扎术术后复发的相关因素进行单因素和多因素分析。共有年龄、性别、BMI、疝部位、术前病程、术前是否嵌顿、疝环口大小、结扎线种类等8个因素纳入分析。应用ROC曲线评估术后疝复发的风险，并做风险等级划分。结果264例患儿共完成346侧手术，患儿最小年龄3个月，最大年龄13岁，平均年龄为（3．3±2．9）岁。其中男229例，女35例。共有39例术前曾发生疝嵌顿，发生于右侧腹股沟者有114例，发生于左侧者有68例，发生于双侧者有82例。其中有11例疝于术后1个月至2年出现复发，复发率为3．2％。术后复发的11例患儿中，年龄最小者为4岁，小于4岁的患儿无一例术后出现复发。单因素分析和多因素分析均显示年龄、内环口大小、结扎线是影响患儿术后是否出现疝复发的独立危险因素。不同风险等级的患儿术后复发的发生率差异有统计学意义（x^2=31．434，P〈0．05）．结论腹腔镜下疝囊高位结扎尽量避免使用可吸收线，对于复发高风险患儿可选择一些改良的腹腔镜手术。
Objective To explore the recurrent factors after laparoscopic high ligation of hernia sac for pediatric indirect inguinal hernia （IIH）. Methods The clinical data were retrospectively analyzed for 264 IIH children undergoing single ligating inguinal ring from January 2008 to December 2014. The relevant factors were age, gender, body mass index （BMI）, location of sac, course of disease, incarceration or not, size of internal inguinal ring and suturing type. Multi and uni-variate analyses of recurrent factors were performed with a Logistic regression model. Risk factors of recurrence and risk stratification were analyzed by receiver operator characteristic （ROC） curve. Results A total of 346 operations were performed. There were 229 boys and 35 girls with an average age of （3.3 ± 2. 9） （0. 25-13） years. The involved sides were right （n = 114, 43. 2%）, left （n = 68, 25. 7%） and bilateral （n = 82, 31.1%）. And 11/346 （3.2%） hernias recurred between 1 and 24 months post-operation. Among 11 patients, the youngest age was 4 years. No recurrence was reported for patients aged under 4 years. Uni and multi-variate analyses revealed that age, size of internal inguinal ring and suturing type were associated with recurrent rate. Significant difference existed in the incidence of recurrence among patients with different risk stratifications （x^2 = 31. 434, P 〈0. 05 ）. Conclusions Use of non-absorbable suture is recommended for taparoscopic ligation of pediatric inguinal hernia. And modified laparoscopic high ligation of hernia sac is ideal for children with a high risk of recurrence.
出处
《中华小儿外科杂志》
CSCD
2016年第10期758-761,共4页
Chinese Journal of Pediatric Surgery
关键词
斜疝
腹腔镜检查
复发
Indirect hernia
Laparoscopy
Relapse
