经脐单部位腹腔镜治疗小儿单侧隐睾并双侧鞘突未闭及内环口处理方法的选择

Choice of handling methods for internal ring during transumbilical single - site laparoscopic orchiopexy for cryptorchidism with bilateral processus vaginalis unclosed in children

目的探讨经脐单部位腹腔镜治疗小儿单侧隐睾并双侧鞘突未闭术中双侧内环口处理方法的选择，并评价其临床效果。方法回顾性分析2011年1月至2016年1月首都儿科研究所附属儿童医院收治的102例单侧隐睾并双侧鞘突未闭行经脐单部位腹腔镜手术患儿的临床资料。其中观察组55例，患儿患侧内环口周围筋膜及后腹膜破坏一圈，睾丸下降固定后，于精索血管外侧内环口上壁腹横肌弓状下缘及后腹膜的腹横筋膜间缝合一针缩小内环口。对侧内环口直径〈0.5 cm，破坏内环口一圈，不缝合；内环口直径≥0.5 cm，破坏内环口一圈，缝合一针。对照组47例，患儿睾丸下降固定及患侧内环口的手术方法与观察组相同，对侧内环口均荷包缝合。比较2组患儿手术时间、术中估计失血量、术后住院时间及术后并发症。结果2组患儿均成功保留精索血管后睾丸固定于阴囊内。观察组手术时间[（42.02±3.21） min]短于对照组[（48.43±4.18） min]，差异有统计学意义（t=-8.739，P〈0.01）。2组术中估计失血量、术后住院时间、术后并发症[（4.38±1.42） mL比（4.80±1.37） mL，（2.87±0.64） d比（2.98±0.61） d，1.8%（1/55例）比2.1%（1/47例）]比较，差异均无统计学意义（t=-1.533、-0.853，χ2=0.013，均P〉0.05）。术后随访1～6年，平均30个月，均未发现睾丸回缩或萎缩，均无腹股沟斜疝、鞘膜积液或脐疝发生。结论经脐单部位三通道腹腔镜治疗隐睾疗效确切。内环口破坏一圈并间断缝合一针的改良方法处理双侧内环口操作简单，效果满意。

ObjectiveTo explore the choice of handling methods for bilateral internal ring during the transumbilical single-site laparoscopic orchiopexy for cryptorchidism with bilateral processus vaginalis unclosed in children, and evaluate the clinical effect.MethodsRetrospective analysis was conducted for the clinical data of 102 children with cryptorchidism and bilateral processus vaginalis unclosed who were hospitalized at Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2011 to January 2016.They were divided into the observation group（55 cases） and the control group（47 cases）. In the observation group, the internal rings of the affected side were destroyed and stitched with a needle between the edge of arcuate of musculus trasversus abdominis and fascia trans versalis of posterior peritoneum.If the diameter of opposite internal ring was less than 0.5 cm, only a circle was destroyed.Otherwise, a circle was destroyed and sutured with a needle.In the control group, the processing methods for orchiopexy and affected side internal ring were same as the observation group.Purse string suture was done for opposite internal rings of all cases in the control group.The parameters of operative duration, intraoperative blood loss, postoperative hospital stay, postoperative complications were compared between 2 groups.ResultsAll operations were successful in both groups, spermatic cords were reserved and testicles were in scrotum of all cases.Operative duration was significantly shorter in the observation group than that in the control group[（42.02±3.21） min vs.（48.43±4.18） min, t=-8.739, P〈0.01]. The differences in intraoperative blood loss, postoperative hospital stay and postoperative complications between 2 groups were not statistically significant[（4.38±1.42） mL vs.（4.80±1.37） mL, t=-1.533, P〉0.05; （2.87±0.64） d vs.（2.98±0.61） d, t=-0.853, P〉0.05; 1.8%（1/55 cases） vs.2.1%（1/47 cases）, χ2=0.013, P〉0.05]. During a mean follow-up of 30（12-72） months, there was no case of testicular ascent or atrophy, or hernia, or hydrocele.ConclusionsThe transumbilical single-site 3-port laparoscopic orchiopexy for cryptorchi-dism has stable efficacy.The improved method for bilateral internal ring is simple and has satisfactory effect, which is worthy of clinical promotion.