小儿腹股沟不可触及睾丸的隐睾症诊治

Management of the Impalpable Testis in Children

目的:总结腹股沟不可触及睾丸的小儿隐睾症诊治经验。方法:回顾性分析收治腹股沟不能触及睾丸的隐睾患儿36例临床诊治资料。分析腹腔镜手术指征,腹股沟探查指征,术前超声检查的作用和术式的选择。结果:腹股沟不能触及的隐睾共36例(41侧),占总数的10.0%(36/361),经腹腔镜和腹股沟探查确定睾丸缺如18例(侧),腹内型隐睾16例(21侧),阴囊内睾丸残余2例(侧)。将腹腔镜下所见分4型,I型9例(侧),II型9例(侧)(其中IA型7例,IB型2例),III型11例(13侧),IV型7例(10侧)[其中IVA型5例(7侧),IVB型2例(3侧)]。分别采用经腹股沟睾丸下降固定,腹腔镜辅助睾丸下降固定术,分期Fowler-Stephen术。术前超声结果阳性诊断率为75%(27/36),睾丸缺如患儿对侧睾丸体积明显大于腹内型隐睾及睾丸残余患儿对侧睾丸体积。术后随访睾丸萎缩1例。结论:对于腹股沟未能查到睾丸的小儿隐睾症应行腹腔镜检查,腹腔镜下II型者,无需再行腹股沟探查,I型需探查腹股沟及阴囊。III型和IVB型可经腹股沟或腹腔镜辅助下行睾丸下降固定术,IVA型隐睾需在腹腔镜辅助下行睾丸下降固定或行分期Fowler-Stephen术。术前超声检查对侧睾丸大小有利于判断是否有睾丸缺如。

Objective ： To explore the management of the impalpable testis in children. Methods ： From April 2003 to August 2005, 36 children aged 20 months to 8 years with impalpable testes underwent inguinal and laparoscopy explorations. The clinical data were reviewed, including the indications of laparoscopy and inguinal explorations and the correspondence between the ultrasonic and surgical results. Results： Of the 36 cases （36 / 361 ） of impalpable testis （41 testes）, laparoscopy and inguinal explorations revealed 18 testes to be vanishing ones, 21 located intra-abdominally and 2 scrotal nubbins. Manifestations were divided into 4 types according to the laparoscopic findings, and 9 testes fell into Type Ⅰ, 9 TypeⅡ, 13 Type Ⅲ and 10 Type Ⅳ. Orchidopexies were performed by traditional and laparoscopic techniques. The positive diagnoses by ultrasound accounted for 75% （27/36）. The volumes of the contralateral testes of the cryptorchid children were larger than those with intra-abdominal testes and testicular nubbins. One case of testicular atrophy was detected by ultrasound in the follow-up period. Conclusion： Laparoscopy should be performed as a routine in children with impalpable testes. Children with Type Ⅱ testes need not undergo inguinal exploration. Inguinal and scrotal explorations are necessary for children with Type Ⅰ testes Preoperative ultrasonic examination of the contralateral testis helps to evaluate vanishing testes or testicular nubbins.