儿童腹腔镜对侧阴道未闭(CPPV)修复术由于CPPV率高而存在争议,但异时对侧腹股沟疝(MCIH)发生率低。我们进行了这项研究,以寻找MCIH的危险因素。
我们进行了一项前瞻性研究,对上海儿童医院招募的患者进行观察性试验。符合条件的参与者是16岁以下的单侧腹股沟疝患者,其父母未选择同时进行CPPV修复。受试者随访24至34.1个月。对发生MCIH的患者进行分析,以确定CPPV与MCIH之间的关系。
在2018年10月17日至2019年7月31日之间,我们纳入了184例患者和182例完成了随访。MCIH发生在10例患者中,其中7例(7.53%)有CPPV,3例(3.37%)无CPPV。单因素分析显示年龄(p=0.025,OR=0.938)和CPPV直径(p=0.003,OR=1.783)与MCIH的发生发展有关。在多变量分析中,只有CPPV直径(p=0.008,OR=1.411)与MCIH相关。受试者工作特性(ROC)曲线用于测试,发现当CPPV的直径大于4毫米时,尤登指数最高,特异性为62.8%,灵敏度为100%。
与没有CPPV的患者相比,有CPPV的患者MCIH的发生率没有统计学上的升高,因此没有常规CPPV维修的迹象。MCIH发展的风险随CPPV直径而增加。4mm是最佳截止点。可以治疗大的CPPV(>4mm)以预防未来的疝。
中国临床试验注册中心(www.chictr.org.cn),编号ChiCTR2000041307。
Laparoscopic contralateral patent processus vaginalis (CPPV) repair in children is debatable due to the high CPPV rate, but low metachronous contralateral inguinal hernia (MCIH) rate. We conducted this study to find risk factors for MCIH.
We conducted a prospective, observational trial with patients recruited from Shanghai Children\'s Hospital. Eligible participants were patients under 16 years old with unilateral inguinal hernia whose parents did not opt for simultaneous CPPV repair. The subjects were followed for 24 to 34.1 months. Patients who developed MCIH were analyzed to identify the relationship between CPPV and MCIH.
Between October 17, 2018, and July 31, 2019, we included 184 patients and 182 completed follow-up. MCIH occurred in ten patients, of which 7 (7.53%) had CPPV and three (3.37%) had no CPPV. Univariate analysis showed that age (p = 0.025, OR = 0.938) and CPPV diameter (p = 0.003, OR = 1.783) were related to the development of MCIH. In multivariate analysis, only diameter of CPPV (p = 0.008, OR = 1.411) was associated with MCIH. The receiver operating characteristic (ROC) curve was used to test, and it was found that when the diameter of CPPV was greater than 4 mm, the Youden index was the highest, with a specificity of 62.8% and a sensitivity of 100%.
The incidence of MCIH was not statistically higher in patients with CPPV compared with those without CPPV, so there is no indication for routine CPPV repair. The risk of MCIH development increases with CPPV diameter. 4 mm is the optimal cutoff point. Large CPPVs (> 4 mm) could be treated to prevent future hernias.
The Chinese Clinical Trial Registry ( www.chictr.org.cn ), number ChiCTR2000041307.