目的：探究腹腔镜下小儿斜疝疝囊高位结扎术后复发高危因素，为临床上小儿斜疝的术后预防提供思路。方法：本研究为回顾性病例对照研究，以自2017年1月至2021年1月收入我院小儿外科的457例小儿腹股沟斜疝患儿为研究对象，根据是否复发，将入组的457例小儿腹股沟斜疝患儿分成两组：复发组10例，非复发组447例。统计并记录患儿的一般基准资料，比如性别，年龄，身高，体重和相关实验室指标，包括血沉，CRP等。利用单因素分析和Logistic回归多因素分析方法进行分析相关指标。结果：457例小儿腹股沟斜疝患儿采用腹腔镜下行小儿斜疝疝囊高位结扎后，复发10例，复发率为2.19%。单因素分析结果显示，年龄，BMI，ESR，CRP，内环口直径大小和结扎线类型是与腹腔镜下行小儿斜疝疝囊高位结扎术后复发的高危因素(P < 0.05)。多因素分析结果显示，ESR，CRP，内环口直径大小和结扎线类型是与腹腔镜下行小儿斜疝疝囊高位结扎术后复发的高危因素(P < 0.05)。结论：ESR，CRP，内环口直径大小和结扎线类型是与腹腔镜下行小儿斜疝疝囊高位结扎术后复发的高危因素，临床上要给予高度重视。 Objective: To explore the high risk factors of recurrence after laparoscopic high ligation of hernia sac in children with indirect hernia, and to provide ideas for clinical prevention of indirect hernia in children. Methods: This study was a retrospective case-control study. 457 children with indirect inguinal hernia who were admitted to the pediatric surgery department of our hospital from January 2017 to January 2021 were taken as the research objects. According to whether they relapsed, the 457 children with indirect inguinal hernia were divided into two groups: 10 in the recurrence group and 447 in the non recurrence group. Make statistics and record the general baseline data of the children, such as gender, age, height, weight and relevant laboratory indicators, including ESR, CRP, etc. Single factor analysis and logistic regression were used to analyze the related indicators. Results: After laparoscopic high ligation of indirect inguinal hernia sac in 457 children with indirect inguinal hernia, 10 cases recurred, and the recurrence rate was 2.19%. Univariate analysis showed that age, BMI, ESR, CRP, diameter of internal loop and type of ligation line were the high risk factors for recurrence after laparoscopic high ligation of indirect hernia sac in children (P < 0.05). The results of multivariate analysis showed that ESR, CRP, diameter of internal loop and type of ligation line were the high risk factors for recurrence after laparoscopic high ligation of indirect hernia sac in children (P < 0.05). Conclusion: The ESR, CRP, the diameter of inner ring and the type of ligation line are the high risk factors of recurrence after laparoscopic high ligation of indirect hernia sac in children, which should be paid more attention in clinic.
目的：探究腹腔镜下小儿斜疝疝囊高位结扎术后复发高危因素，为临床上小儿斜疝的术后预防提供思路。方法：本研究为回顾性病例对照研究，以自2017年1月至2021年1月收入我院小儿外科的457例小儿腹股沟斜疝患儿为研究对象，根据是否复发，将入组的457例小儿腹股沟斜疝患儿分成两组：复发组10例，非复发组447例。统计并记录患儿的一般基准资料，比如性别，年龄，身高，体重和相关实验室指标，包括血沉，CRP等。利用单因素分析和Logistic回归多因素分析方法进行分析相关指标。结果：457例小儿腹股沟斜疝患儿采用腹腔镜下行小儿斜疝疝囊高位结扎后，复发10例，复发率为2.19%。单因素分析结果显示，年龄，BMI，ESR，CRP，内环口直径大小和结扎线类型是与腹腔镜下行小儿斜疝疝囊高位结扎术后复发的高危因素(P < 0.05)。多因素分析结果显示，ESR，CRP，内环口直径大小和结扎线类型是与腹腔镜下行小儿斜疝疝囊高位结扎术后复发的高危因素(P < 0.05)。结论：ESR，CRP，内环口直径大小和结扎线类型是与腹腔镜下行小儿斜疝疝囊高位结扎术后复发的高危因素，临床上要给予高度重视。
小儿斜疝，腹腔镜，复发，高危因素
Dongqian Bai
Department of Pediatric Surgery, Shan County Central Hospital, Heze Shandong
Received: Jun. 9th, 2022; accepted: Jul. 18th, 2022; published: Jul. 25th, 2022
Objective: To explore the high risk factors of recurrence after laparoscopic high ligation of hernia sac in children with indirect hernia, and to provide ideas for clinical prevention of indirect hernia in children. Methods: This study was a retrospective case-control study. 457 children with indirect inguinal hernia who were admitted to the pediatric surgery department of our hospital from January 2017 to January 2021 were taken as the research objects. According to whether they relapsed, the 457 children with indirect inguinal hernia were divided into two groups: 10 in the recurrence group and 447 in the non recurrence group. Make statistics and record the general baseline data of the children, such as gender, age, height, weight and relevant laboratory indicators, including ESR, CRP, etc. Single factor analysis and logistic regression were used to analyze the related indicators. Results: After laparoscopic high ligation of indirect inguinal hernia sac in 457 children with indirect inguinal hernia, 10 cases recurred, and the recurrence rate was 2.19%. Univariate analysis showed that age, BMI, ESR, CRP, diameter of internal loop and type of ligation line were the high risk factors for recurrence after laparoscopic high ligation of indirect hernia sac in children (P < 0.05). The results of multivariate analysis showed that ESR, CRP, diameter of internal loop and type of ligation line were the high risk factors for recurrence after laparoscopic high ligation of indirect hernia sac in children (P < 0.05). Conclusion: The ESR, CRP, the diameter of inner ring and the type of ligation line are the high risk factors of recurrence after laparoscopic high ligation of indirect hernia sac in children, which should be paid more attention in clinic.
Keywords:Pediatric Indirect Hernia, Laparoscope, Recurrence, High Risk Factors
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小儿斜疝是临床上的多发病、常见病。尤其见于男孩。既往文献报道，小儿斜疝的发病率为2%以上，而男孩的发病率是女孩的1倍以上 [
本研究为回顾性病例对照研究，以自2017年1月至2021年1月收入我院小儿外科的457例小儿腹股沟斜疝患儿为研究对象，研究方案获得本院伦理委员会批准。统计并记录患儿的一般基准资料，比如性别，年龄，身高，体重和相关实验室指标，包括血沉，CRP等。
① 诊断明确的小儿斜疝者；② 选择方案为腹腔镜下斜疝疝囊高位结扎术；③ 入组者无明显的心肺功能疾病，比如肺功能不全，心功能不全，肾功能不全等疾病，无法耐受手术治疗；④ 入组者患者无血液类疾病，比如再生障碍性贫血，白血病，凝血功能障碍等疾病，术后出血发生率极高。
① 腹股沟直疝、股疝患儿；② 联合小切口患儿；③ 选择保守治疗的患儿。
根据是否复发，将入组的457例小儿腹股沟斜疝患儿分成两组：复发组10例，非复发组447例。
1) 一般资料：比如性别，年龄，身高，体重和BMI；
2) 实验室指标：包括血沉，CRP，红细胞含量和白蛋白含量；
3) 斜疝相关指标：疝囊位置，内环口大小和结扎线类型。
采用IBM SPSS21.0软件进行数据处理。计数资料采用平均值 ± 标准差(x ± s)进行统计，复发组和非复发组的组间比较采用t检验。计量资料采用例和比率的统计形式，组间比较采用c2检验。对于不符合正态分布的资料：无论计数资料还是计量资料均以中位数进行表示，组间比较采用秩和检验。认为P < 0.05为具有统计学差异。
结果显示，457例小儿腹股沟斜疝患儿采用腹腔镜下行小儿斜疝疝囊高位结扎后，复发10例，复发率为2.19%。
单因素分析结果显示，年龄，BMI，ESR，CRP，内环口直径大小和结扎线类型是与腹腔镜下行小儿斜疝疝囊高位结扎术后复发的高危因素(P < 0.05)，见表1。
| 项目 | 复发组(n = 10) | 非复发组(n = 447) | 统计值 | P值 |
|---|---|---|---|---|
| 性别 | c2= 0.146 | >0.05 | ||
| 男 | 8 | 357 | ||
| 女 | 2 | 90 | ||
| 年龄(岁) | 6.49 ± 1.77 | 4.25 ± 0.97 | t = 2.176 | <0.05 |
| BMI (Kg/cm2) | 22.45 ± 1.45 | 19.33 ± 1.04 | t = 2.577 | <0.05 |
| 血沉(ESR) | c2= 3.157 | <0.05 | ||
| 正常 | 3 | 440 | ||
| 异常 | 7 | 7 | ||
| CRP | c2= 3.011 | <0.05 | ||
| 正常 | 2 | 441 | ||
| 异常 | 8 | 6 | ||
| 疝囊部位 | c2= 0.842 | >0.05 | ||
| 左侧 | 4 | 276 | ||
| 右侧 | 4 | 128 | ||
| 双侧 | 1 | 43 | ||
| 内环口直径 | c2= 3.875 | <0.05 | ||
| ≥2 cm | 9 | 35 | ||
| <2 cm | 1 | 412 | ||
| 结扎线类型 | c2= 4.907 | <0.05 | ||
| 可吸收线 | 10 | 39 | ||
| 不可吸收线 | 0 | 416 |
表1. 腹腔镜下行小儿斜疝疝囊高位结扎术后复发的单因素分析
多因素分析结果显示，ESR，CRP，内环口直径大小和结扎线类型是与腹腔镜下行小儿斜疝疝囊高位结扎术后复发的高危因素(P < 0.05)，见表2。
| 自变量 | 回归系数 | 标准误差 | 标准回归系数 | 95%CI | P值 |
|---|---|---|---|---|---|
| 常数项 | 46.001 | 2.475 | - | 1.023~3.012 | <0.001 |
| 年龄 | −3.298 | 0.534 | −0.483 | 0.222~2.012 | 3.298 |
| 血沉(ESR) | 3.298 | 0.534 | 0.483 | 1.457~3.775 | <0.001 |
| CRP | 3.541 | 0.664 | 0.526 | 0.478~5.465 | <0.001 |
| BMI | −4.471 | 1.254 | −0.483 | 1.547~3.748 | 0.115 |
| 内环口直径大小 | 3.073 | 0.312 | 0.421 | 0.035~4.457 | <0.001 |
| 结扎线类型 | 3.426 | 0.326 | 0.429 | 0.078~2.288 | <0.001 |
表2. 腹腔镜下行小儿斜疝疝囊高位结扎术后复发的多因素分析
注：F = 20.412，P < 0.001，R2= 0.512，调整后R2= 0.603。
对于小儿斜疝疝囊高位结扎术而言，尤其是今年来随着腹腔镜技术的推广和应用，如何克服术后并发症，即术后复发的发生率是保证术后效果的重中之中，既往研究中认为，对于开放性手术而言，尤其是传统的小儿斜疝疝囊高位结扎术，手术创伤较大，术后斜疝复发率较高，他们认为与组织创伤相关，因此，腹腔镜作为一种微创技术，可以减轻对周围组织的损失，从理论上讲可以降低术后复发率 [
对于腹腔镜技术而言，如何降低术后的斜疝复发率是临床上的热点问题。有学者探究了单孔腹腔镜下行小儿斜疝疝囊高位结扎术后复发高危因素分析，他们的结果证明，年龄是其高危因素 [
此外，本研究还证明内环口直径大小和结扎线类型是与腹腔镜下行小儿斜疝疝囊高位结扎术后复发的高危因素，分析原因，可能是内环口的直径越大，其表面的肌肉组织和腹横筋膜也就越薄，从而使得固定失败。而结扎线类型中，不可吸收缝线具有更好的把持力，并且不容易被周围自身组织吸收，所以，这可能是影响小儿斜疝疝囊高位结扎术后复发的原因。也有学者 [
但是，本研究也存在一定的局限性，比如本研究属于回顾性研究，缺乏前瞻性研究，参考意义尚待进一步完善。
白东乾. 腹腔镜下小儿斜疝疝囊高位结扎术后复发高危因素分析High Risk Factors of Recurrence after Laparoscopic High Ligation of Hernia Sac in Children with Indirect Hernia[J]. 外科, 2022, 11(03): 83-87. https://doi.org/10.12677/HJS.2022.113014