经脐单部位双通道腹腔镜手术诊治小儿Amyand's疝  

Transumbilical single-site double-channel laparoscopic operation for diagnosing and treating Amyand's hernia in children

作　　者：周承校 唐然 未德成 卞剑 杨涌 段永鹏 方园 戚士芹 Zhou Chengxiao;Tang Ran;Wei Decheng;Bian Jian;Yang Yong;Duan Yongpeng;Fang Yuan;Qi Shiqin(Department of General Surgery,Anhui Provincial Children's Hospital,Hefei 230051,China)

机构地区：[1]安徽省儿童医院普外科,合肥230051

出　　处：《中华小儿外科杂志》2025年第1期52-55,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨经脐单部位双通道腹腔镜手术诊治小儿Amyand's疝(Amyand's hernia,AH)的可行性及临床疗效。方法回顾性分析2014年4月至2023年7月安徽省儿童医院收治16例AH患儿的临床资料;其中男12例,女4例;患儿平均入院年龄为46个月,范围在1岁至10岁1个月。根据AH的疝囊内阑尾病理类型为AH分型,其中Ⅰ型AH5例,Ⅱ、Ⅲ型AH11例。5例Ⅰ型AH患儿接受腹腔镜下阑尾还纳入腹腔+疝囊高位结扎术,11例Ⅱ、Ⅲ型AH患儿接受腹腔镜下松解还纳疝内容物+阑尾切除+疝囊高位结扎术。观察所有患儿的手术结果并随访。结果15例AH在经脐单部位双通道腹腔镜下顺利完成手术;1例Ⅲ型AH的疝内容物无法复位遂中转右下腹横纹小切口手术,手术顺利完成。术中发现8例患儿存在对侧隐匿性斜疝,遂同期手术。5例Ⅰ型AH患儿的平均手术时间为54 min,范围在45~67 min;术后平均3.5 d出院,范围在3~5 d。7例Ⅱ型AH患儿的平均手术时间为57 min,范围在30~78 min;术后平均5.5 d出院,范围在4~10 d。4例Ⅲ型AH患儿的平均手术时间为74 min,范围在50~120 min;术后平均6.0 d出院,范围在5~7 d。11例患儿术中切除阑尾,术后病理提示慢性阑尾炎7例,急性阑尾炎3例,急性化脓性阑尾炎1例。所有病例平均随访18.5个月,范围在1~60个月;其中5例Ⅰ型AH患儿无急性阑尾炎发作,所有患儿无疝复发、睾丸萎缩、医源性隐睾、阴囊感染等并发症。15例经腹腔镜完成手术的患儿手术部位几乎无可见瘢痕,美容效果显著。结论经脐单部位双通道腹腔镜手术诊疗小儿AH安全有效、美观可行,值得临床推广。Objective To explore the feasibility and clinical efficacy of transumbilical single-site double-channel laparoscopic operation for the diagnosis and treatment of pediatric Amyand's hernia(AH).MethodsA retrospective analysis was conducted on the clinical data of 16 children with AH who were treated at Anhui Provincial Children's Hospital from April 2014 to July 2023.There were 12 boys and 4 girls,with an average age of 46 months,and ranged from 1 year to 10 years and 1 month.According to the pathological classification of the appendix within the hernia sac,children were divided into typeⅠAH(n=5),and typeⅡ-ⅢAH(n=11).TypeⅠAH was treated with laparoscopic appendiceal reduction combined with high ligation of the hernia sac,and typeⅡ-ⅢAH was treated with laparoscopic hernia content reduction,appendectomy,and high ligation of the hernia sac.The surgical outcomes and follow-up data of all patients were observed.ResultsLaparoscopic surgery was successfully performed in 15 children with AH using the single-site dual-channel technique.One case of typeⅢAH was conversed to an open surgery with a small incision in the right lower abdominal transverse region for reduction of the hernia content,and the surgery was completed successfully.Eight children were found to have contralateral occult inguinal hernia during surgery,which was corrected simultaneously.The average operative time for 5 cases of typeⅠAH was 54 minutes(range:45-67 minutes),with an average postoperative length of stay of 3.5 days(range:3-5 days).The average operative time for 7 cases of typeⅡAH was 57 minutes(range:30-78 minutes),with an average postoperative length of stay of 5.5 days(range:4-10 days).The average operative time for 4 cases of typeⅢAH was 74 minutes(range:50-120 minutes),with an average postoperative length of stay of 6.0 days(range:5-7 days).Appendectomy was performed in 11 cases,with postoperative pathology showing chronic appendicitis in 7 cases,acute appendicitis in 3 cases,and acute suppurative appendicitis in 1 case.All

关 键 词：腹腔镜 诊断 治疗 腹股沟疝 

分 类 号：R726.5[医药卫生—儿科]