摘要目的 探讨腹腔镜术中男性患儿对侧隐匿性鞘状突未闭(occult patent processus vaginalis,OPPV)的患病率、发病率及其临床意义.方法 回顾性分析2008年1月至2013年6月行经脐二孔法腹腔镜下疝囊高位结扎术2 596患儿的临床资料.结果 本组44.65％(1 159/2 596)患儿对侧腹股沟区探查为阳性,右侧OPPV患病率为48.89％(420/859),左侧OPPV患病率为42.54％(739/1 737),左右侧患病率差异有统计学意义(x2=9.38,P＜0.01),右侧相对于左侧相对危险度为1.15.OPPV总发病率为4.31％ (50/1 159).其中,1岁以内患儿OPPV患病率为40.65％(163/401),发病率为6.75％(11/163);1～2岁内患儿OPPV患病率最高达59.53％(534/897),发病率为1.87％(10/534);2～6岁患儿OPPV患病率为40.41％(379/938),发病率为5.28％ (20/379);6至16岁患儿OPPV患病率最低为23.06％ (83/360),发病率为最高10.84％(9/83).80.00％ (40/50)患儿有呼吸道感染、腹泻等诱发因素,20.00％ (10/50)为不明诱因.本组复发率为0.08％％ (2/2 596).结论 不同年龄段OPPV患病率及发病率不同,提示所有患儿腹腔镜下常规行对侧OPPV探查有一定临床价值,尤其是2岁后OPPV可能更需要积极的手术干预.

abstractsObjective To evaluate the prevalence and incidence of contralateral occult inguinal indirect hernia (OPPV) in male children by laparoscopy.Methods A 5-year retrospective review was conducted for 2596 male patients undergoing unilateral inguinal laparoscopic herniorraphy (LH) from January 2008 to June 2013.Results Among them,44.65％ (1 159/2 596) had OPPV in contralateral inguinal groin while 4.31％ (50/1 159) developed contralareal indirect hernia.Laparoscopic evaluation was positive for right-sided OPPV in 48.89％ (420/859) and left-sided lesion in 42.54％ (739/1 737)(x2 =9.38,P＜0.01).Left-sided indirect hernia (RR =1.15) was associated with an elevated risk of contralateral OPPV.OPPV was diagnosed in 40.65％ (163/401) of patients aged under 1 year and the future contralateral occurrence rate was 6.75％ (11/163).The highest prevalence of 59.53％ (534/897) and the lowest incidence of 1.87％ (10/534) of OPPV were found in those patients aged under 2 years respectively.Laparoscopic evaluation was positive for OPPV in 40.41％ of patients aged 2-6 years.And 5.28％ patients developed contralateral indirect hernia.The lowest prevalence of 23.06％ (83/360) and the highest incidence of 10.84％ (9/83) of OPPV were found in those aged 6-16 years respectively.And 80.00％ (40/50) patients with contralateral indirect hernia resulting from OPPV had the causes of respiratory infections and diarrheal diseases while 20.00％ (10/50) did not.The future recurrence rate was 0.08 ％ (2/2 596).Conclusions Laparoscopic exploration should be routinely performed for pediatric patients of all ages because of a high prevalence and incidence of contralateral OPPV.Especially,LH should be actively performed in patients aged over 2 year because of a high incidence of contralateral OPPV.