大连医科大学附属第二医院 疝与结直肠外科，辽宁 大连 116023
Department of Hernia and Colorectal Cancer, the Second Hospital of Dalian Medical University, Dalian, Liaoning 116023, China
背景与目的 Amyand疝是一种特殊类型的腹股沟疝，目前并无统一的处理规范。本研究旨在通过系统评价其临床特征及相关手术决策，为降低该病的并发症和改善患者预后提供依据。方法 计算机检索多个国内外数据库，收集自2000年1月1日至今公开发表的成人Amyand疝的相关文献。根据纳入与排除标准，由2名研究员独立筛选文献、提取相关资料、评估偏倚并交叉核对后行系统评价。结果 最终纳入141篇文献，共计184例成人Amyand疝患者。中国为发文量最多的国家，而刊文量最多的期刊为Hernia。在临床特征方面，男性占91.8%，其中位发病年龄为60岁，而女性中位发病年龄为69岁；89.1%的Amyand疝发生于右侧，8.9%的患者是复发疝；75例患者未报告相关信息，余109例患者中有104例斜疝，4例直疝，1例马鞍疝；25.7%（45/175）的患者于术前诊断，其中超声准确率为23.1%（6/26），CT准确率为75.0%（33/44），超声联合CT的准确率为62.5%（5/8），1例通过灌肠诊断。治疗方面，42例患者行择期手术，122例行急诊手术，20例未获得相关信息；45.6%的患者行无张力疝修补术，50%的患者行传统疝修补术，4.4%的患者未做修补或择期手术修补；80.9%的患者切除阑尾，其余患者均保留阑尾；140例术中表现为Losanoff和Basson 1、2型，35例为3、4型，其中12例合并阑尾肿瘤。结局方面，术后中位住院时间为4 d，125例患者获随访，中位随访时间为6个月，17例出现并发症（肺部感染或栓塞性疾病6例，手术部位感染5例，血清肿3例，复发3例，尿潴留1例），均为急诊手术患者。结论 成人Amyand疝是一种特殊类型的腹股沟疝，与嵌顿性或绞窄性疝难以鉴别，常需急诊手术，术中应根据具体情况个体化治疗，以不引起植入的补片感染为基本原则。应鼓励更多Amyand疝的基础和临床研究，以提高Amyand疝的诊疗水平及改善患者预后。
Background and Aims Amyand's hernia is a special type of inguinal hernia, and there is currently no uniform treatment standard. This study was conducted to provide a basis for reducing complications of this condition and improving prognosis of the patients by systematically evaluating its clinical characteristics and related surgical strategies.Methods The studies concerning Amyand's hernia in adults published since January 1, 2000 to date were collected by comprehensively searching several domestic and foreign online databases. After literature screening, relevant data extraction, bias assessment and crosschecking by two independent reviewers according to the inclusion and exclusion criteria, a systematic review was performed.Results A total of 141 studies were included involving 184 adult patients with Amyand's hernia, and the most majority of papers was contributed by the authors from China and the highest number of papers was published by the journal of Hernia, respectively. In terms of clinical features, male patients accounted for 91.8%, with a median onset age of 60 years, and the median onset age in women was 69 years; 89.1% of them had a right hernia and 8.9% had a recurrent hernia; a total of 75 patients failed to access the relevant information; the remaining 109 patients consisted of 104 indirect hernias, 4 direct hernias, and 1 saddle hernia; 25.7% of the patients were diagnosed before surgery, and the diagnostic accuracy of ultrasound, CT and their combination were 23.1% (6/26), 75.0% (33/44), and 62.5% (5/8), and one case was diagnosed by enema. With regard to the treatment, 42 patients underwent elective procedures, 122 cases received emergency operation, and 20 cases had no treatment information; 45.6% of cases underwent mesh repair, 50% of cases underwent endogenous repair, and 4.4% of cases did not undergo repair or delayed repair; 80.9% of cases underwent appendectomy and the appendix was preserved in remaining of them; there were Losanoff and Basson type 1 or 2 lesion in 140 cases and type 3 or 4 lesion in 35 cases verified by intraoperative findings, and 12 cases had combined appendix tumors. As for the outcomes, the median length of postoperative hospital stay was 4 d, a total of 125 patients were followed up with a median time of 6 months, and 17 cases had complications (6 cases of pulmonary infection or embolic disease, 5 cases of surgical site infection, 3 cases of seroma, 3 cases of recurrence, 1 case of urinary retention), all of them were emergency surgery patients.Conclusion The adult Amyand's hernia is a rare type of inguinal hernia, which is difficult to distinguish from the incarcerated or strangulated hernia. It usually requires an emergency surgery. The treatment of Amyand's hernia should be individualized based on intraoperative conditions, with the fundamental principle of avoiding the infection of the implanted mesh. Further basic and clinical research on Amyand's hernia should be encouraged for improving the treatment efficacy and the prognosis of the patients.