腹腔镜下睾丸固定术治疗小儿隐睾临床观察

Clinical observation of laparoscopic testicular fixation in children with cryptorchidism

目的小儿隐睾为常见先天性疾病,激素治疗无效者,应行睾丸固定术。本研究探究腹腔镜下睾丸固定术治疗隐睾短、中期随访效果。方法选取2017-03-01-2019-01-01漯河市中心医院收治的92例隐睾患儿为研究对象,根据治疗方案不同分为对照组和观察组,各46例。对照组给予开放手术治疗,观察组给予腹腔镜下睾丸固定术治疗。对比两组手术指标、术后睾丸发育良好率、睾丸容积、卵泡刺激素(FSH)、雌二醇(E2)、睾酮(T)水平和并发症发生率。结果观察组术中出血量为(5.32±1.15)mL,低于对照组的(16.03±4.06)mL,t=17.214,P<0.001;手术时间为(46.82±5.58)min,短于对照组的(58.63±8.14)min,t=8.116,P<0.001;下床活动时间为(3.52±0.51)d,短于对照组的(5.83±0.72)d,t=17.757,P<0.001;切口疼痛时间为(5.10±0.61)d,短于对照组的(8.31±0.39)d,t=30.070,P<0.001;住院时间为(6.68±0.60)d,短于对照组的(9.41±1.42)d,t=12.011,P<0.001。术后6个月,两组睾丸容积、血清FSH、E2和T水平对比差异无统计学意义,均P>0.05。观察组并发症发生率为2.17%,低于对照组的17.39%,差异有统计学意义,χ2=4.434,P=0.035。结论隐睾患儿采用腹腔镜下睾丸固定术及开放手术治疗,均可取得良好疗效,但腹腔镜手术具有术中出血量少、手术时间短、术后恢复快和并发症少等优势,可作为此类患儿治疗的首选术式。

Objective Cryptorchidism in children is a common congenital disease,and those who have failed hormone therapy should undergo testicular fixation.To investigate the short-and medium-term follow-up results of laparoscopic testicular fixation in children with cryptorchidism.Methods A total of 92 children with cryptorchidism admitted to Luohe Central Hospital from March 1,2017 to January 1,2019 were selected as the study objects.According to different treatment schemes,they were divided into control group and observation group,46 cases each.The control group was treated with open surgery,and the observation group was treated with laparoscopic testicular fixation.The operative indexes,testicular development rate,testicular volume,follicle stimulating hormone(FSH),estradiol(E2),testosterone(T)and complications were compared between the two groups.Results The intraoperative blood loss(5.32±1.15)ml in the observation group was lower than that in the control group(16.03±4.06)ml,t=17.214,P<0.001.The operation time(46.82±5.58)min was shorter than the control group(58.63±8.14)min,t=8.116,P<0.001.Time to get out of bed was(3.52±0.51)d,shorter than control group(5.83±0.72)d,t=17.757,P<0.001.The incision pain time was(5.10±0.61)d,shorter than the control group(8.31±0.39)d,t=30.070,P<0.001.Hospital stay was(6.68±0.60)d,shorter than the control group(9.41±1.42)d,t=12.011,P<0.001.At 6 months after operation,there was no statistically significant difference in testicular volume,serum FSH,E2 and T levels between the observation group and the control group,all P>0.05.The incidence of complications in the observation group was 2.17%,which was lower than the control group 17.39%,χ2=4.434,P=0.035.Conclusion Laparoscopic testicular fixation and open surgery can achieve good results in children with cryptorchidism,but laparoscopic surgery has the advantages of less intraoperative blood loss,shorter operation time,faster postoperative recovery and less complications,and it can be used as the first choice for the treatment of such children.