摘要目的 腹腔镜对小儿Amyand,s疝的诊断和治疗在临床上报道极少,本文报道腹腔镜治疗小儿Amyand,s疝6例,探讨该方法初步经验和临床应用价值.方法 回顾分析本研究组2010年10月至2012年2月用腹腔镜治疗小儿Amyand's疝6例,男5例,女1例,年龄40 d至13个月(平均234 d),左侧1例,右侧5例,因腹股沟斜疝嵌顿行急诊手术4例.在腹腔镜监测下明确诊断后,手法按压的同时配合抓钳的分离与牵拉促使阑尾回纳入腹腔,将阑尾从脐孔提出致腹腔外行直视下阑尾切除术及腹腔镜疝修补术.结果 6例中4例为急诊腹腔镜手术,中转手术1例,术中发现合并对侧鞘状突未闭4例.3例腹腔镜下完成急诊疝修补及阑尾切除术,手术时间为50～75min(平均65 min),术后5～9 d出院(平均6.5 d);2例阑尾正常回纳入腹腔,仅做疝修补术,手术时间为15～25min(平均20 min),术后3d出院.获得随访1～17个月,平均6.5个月,无疝复发,无睾丸萎缩,无医源性隐睾,无切口感染、切口疝等并发症.结论 小儿Amyand's疝术前难以明确诊断,腹腔镜治疗Amyand's疝是一个有效而且可靠的技术,值得推广.

abstractsObjective Laparoscope-assisted diagnosis and treatment for Amyand's hernia in children is rarely reported in literature.We report our preliminary experience to emphasize the advantages and feasibility of this procedure in 6 cases.Methods A retrospective review of laparoscopic-assisted method for Amyand 's hernias in 6 children from October 2010-December 2012 was performed.The mean age of patients was 234 days (ranged from 40 days-13 months),1 case was on the left,5 on the right.4 cases were operated with laparoscopic-assisted method urgently due to incarceration and inflamed appendix.Upon entry into the peritoneal cavity with the laparoscopy,we applied gentle traction on the appendix near the internal ring and applied pressure externally using the surgeon's finger to manipulate the appendix back into the peritoneum. The appendix was exteriorized through the umbilical port site,and appendectomy performed in open fasion while laparoscope-assisted herniorrhaphy was then performed.Results The overall incidence of a patent processus vaginalis on contralateral examination was 4 in the 6 cases. In the 4 urgent cases,appendectomy and laparoscopic -assisted herniorrhsphy were accomplished in 3 cases.The operation time was 50-75 min.(mean 65 min).Patients were discharged from hospital between postoperative day 5 and 9 (mean 6.5 d),and 1 case transferred.In the 2 cases with normal appendix,only herniorrhaphy was performed after reduction.the operation time was 15-25 min (mean 20 min),discharge from hospital was on postoperative day 3.Average follow-up was 6.4 months(1-17 months),and no complications of testicular atrophy,cryptorchidism,wound infection,incisional hernia was seen.Conclusions Diagnosis for Amyand's hernia before operation is difficult,and laparoscopic method is safe and effective in these cases with good outcomes,and worth introduced.