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目的总结和分析腹腔镜在诊治未触及睾丸的隐睾中的应用。方法2000年1月-2006年12月应用腹腔镜对127例未触及睾丸的隐睾患儿进行诊治。手术时平均年龄55个月。全麻或加单次硬膜外麻醉下建立气腹,腹腔镜探察。术中发现腹腔内睾丸,行分期Fowler-Stephen手术或睾丸固定术;如精索在腹内为盲端或虽出内环但发育极差,诊断为睾丸缺如,无需进一步探查;如精索发育较好出内环,行腹股沟探查,发现睾丸存在则行睾丸固定术。对分期行Fowler-Stephen手术患儿术后随访睾丸大小和位置。结果隐睾患儿127例中,62例(48.8%)直接诊断为睾丸缺如;24例(18.9%)经腹股沟探查后,11例睾丸缺如,13例直接行睾丸固定术;41例(32.3%)诊为腹腔内睾丸,26例行分期Fowler-Stephen手术,包括11例双侧,8例右侧,7例左侧,余15例患儿行睾丸固定术。127例中单侧病例104例(81.9%),其中左侧75例,右侧29例。左侧睾丸缺如57例,占左侧总例数的76%。右侧睾丸缺如12例,约占右侧的41%。双侧病例共23例(18.1%),左右均行分期Fowler-Stephen手术共11例,22只睾丸。双侧睾丸均缺如3例。127例患儿中9只睾丸发育极差,病理均未见曲细精管结构。行分期Fowler-Stephen手术患儿18例得到随访,睾丸大小较术前无缩小,1例术后睾丸上缩。结论应用腹腔镜可准确诊断未触及睾丸的隐睾,对于腹内靠近内环口的睾丸可行腹腔镜或传统睾丸固定术,对于高位腹内睾丸可行分期Fowler-Stephen手术。
Objective To summarize and analyze the application of laparoscopy in the diagnosis and treatment of cryptorchidism without touching the testes. Methods From January 2000 to December 2006, 127 cases of cryptorchidism who did not touch the testis were diagnosed and treated by laparoscopy. The average age of surgery 55 months. Anesthesia or plus a single epidural anesthesia to establish pneumoperitoneum, laparoscopic exploration. Intraoperative intra-abdominal testis, Fowler-Stephen surgery or testicular fixation; such as spermatic cord in the abdomen for the blind end or although the development of poor but poor, diagnosed as lack of testicular, without further exploration; such as spermatic cord Better development of the inner loop, groin exploration, found that testicular testicular fixation. The size and location of testis were followed up in children undergoing Fowler-Stephen surgery. Results In 127 cases of cryptorchidism, 62 cases (48.8%) were directly diagnosed as testicular absent. In 24 cases (18.9%), 11 cases had testicular absent after direct inguinal exploration and 13 cases had direct testicular fixation. 32.3%) were diagnosed as intraperitoneal testis. Twenty-six patients underwent Fowler-Stephen procedure, including 11 patients on both sides, 8 patients on the right and 7 patients on the left. More than 15 children underwent testicular fixation. Among the 127 cases, there were 104 unilateral cases (81.9%), of which 75 on the left and 29 on the right. Left testicular absence of 57 cases, accounting for 76% of the total number of cases on the left. The right testicular absence of 12 cases, accounting for about 41% of the right side. Bilateral cases were 23 cases (18.1%), about staging Fowler-Stephen surgery in 11 cases, 22 testicles. Bilateral testes are missing in 3 cases. Nine of 127 children had very poor testicular development and no seminiferous tubules were found in the pathology. Eighteen patients underwent Fowler-Stephen surgery were followed up, the size of the testis was not reduced compared with that before operation, and one patient was on the testis. Conclusions Laparoscopy can accurately diagnose cryptorchidism without touching the testis. It is feasible to perform laparoscopic or traditional testicular fixation in the testis near the internal ring mouth in the abdominal region. Fowler-Stephen surgery is feasible for high intra-abdominal testis.