经脐单部位多通道腹腔镜Fowler-Stephens分期手术治疗小儿高位隐睾疗效观察

Therapeutic efficacy of transumbilical single-site multichannel laparoscopic two-staged Fowler-Stephens orchiopexy for high intra-abdominal cryptorchidism in children

目的总结及分析经脐单部位多通道腹腔镜Fowler-Stephens(F-S)分期手术治疗小儿腹腔内高位隐睾的疗效。方法回顾性分析2016年6月至2019年6月首都儿科研究所附属儿童医院泌尿外科收治的行完全经脐单部位多通道腹腔镜F-S分期手术的52例腹腔内高位隐睾患儿的临床资料。年龄9月龄至8岁,平均17个月;单侧隐睾43例,双侧9例,共61只睾丸。F-S一期和二期手术皆采用经脐单部位腹腔镜完成,两期手术间隔6个月。术后定期随访,以腹壁伤口满意度、睾丸术后下降位置、睾丸血运情况及有无萎缩为评价指标,观察手术疗效及术后并发症。结果所有患儿均顺利完成经脐单部位腹腔镜分期F-S睾丸固定术,未额外增加切口,无中转开放手术者,无术中并发症发生。一期术后出现腹腔局部脓肿1例;二期术后出现阴囊切口感染及血肿各1例。所有患儿二期术后均获随访,随访时间为6个月至2年,平均14个月。患儿睾丸均位于阴囊内,无睾丸回缩,发生睾丸萎缩1例,其余睾丸彩色超声检查显示血运均正常。结论经脐单部位多通道常规操作器械腹腔镜F-S分期手术治疗小儿腹腔内高位隐睾疗效确切,术后腹壁无明显手术瘢痕,美容效果好,值得临床推广。

Objective To evaluate the clinical therapeutic efficacy of transumbilical single-site and multichannel laparoscopic two-staged Fowler-Stephens orchiopexy(FSO)for high intra-abdominal cryptorchidism in children.Methods Fifty-two hospitalized children(61 testes)of high intra-abdominal cryptorchidism underwent transumbilical single-site laparoscopic two-staged FSO from June 2016 to June 2019.The average age was 17(9-96)months.The involved side was unilateral(n=43)and bilateral(n=9).Transumbilical single-site laparoscopy was performed for both first and second stages.Two stages were scheduled 6 months apart.Postoperative follow-ups were conducted with such evaluation parameters as satisfaction of abdominal wall wound,testicular position and testicular blood supply with or without atrophy.Operative outcomes and postoperative complications were recorded.Results All operations were successful without intraoperative complications and additional incisions.Abdominal local abscess occurred in one case after an initial stage.Postoperative complications after a second stage included scrotum wound infection(n=1)and scrotum hematoma(n=1).During a median follow-up period of 14(6-24)months after a second stage,all testes were inside of scrotum without retraction.One of them had atrophic testis in scrotum while the others had decent vascularization on color Doppler ultrasound.Conclusions Transumbilical single-site multichannel laparoscopic two-staged FSO is both feasible and safe for children with high intra-abdominal cryptorchidism.With superior esthetics,it is worth wider popularization.