腹腔镜下手术治疗腹股沟型隐睾

Laparoscopic orchiopexy for inguinal cryptorchidism

目的探讨腹腔镜下睾丸固定术治疗腹股沟型隐睾的可行性及微创优势。方法腹股沟型隐睾患儿90例。年龄8个月～6岁，平均17个月。左侧24例、右侧53例、双侧13例，共103个睾丸。腹腔镜下离断鞘状突或疝囊，松解腹膜后精索，将睾丸拉入腹腔，离断引带；将睾丸拉人阴囊固定。结果90例103个睾丸手术均顺利，无中转开放手术者。平均手术时间（32．7±5．2）min。103个睾丸患侧鞘状突未闭93侧（90．3％）；77例单侧隐睾对侧鞘状突未闭12例（15．6％）。术中发生皮下气肿3例（3．3％），拔出套管后，经切口排出气体，气肿消失。术后随访6～12个月，103个睾丸均在阴囊内，无萎缩及睾丸回缩。结论腹腔镜下腹股沟型隐睾固定手术安全、有效，弥补了开放术式破坏腹股沟管解剖完整性、腹膜后高位松解困难等缺陷。

Objective To investigate the feasibility and efficacy of laparoseopic orchiopexy for inguinal palpable undescended testes. Methods Ninety patients with 103 inguinal undescended palpable testes were treated by laparoseopie orchiopexy performed by the same surgeon. There were 24 （26.7%） left and 53 （58. 9%） right palpable cryptorchidism cases, plus 13 cases （14.4%） with bilat- eral undescended testes. The mean age of the patients was 17 months （range 8 months--6 years）. The surgical procedures were described as following. First, the peritoneum was opened at the anterior surface of the spermatic vessels and vas deferens before the testis was pulled into the abdominal cavity so that the spermatic vessels and vas deferens were released and easily manipulated. Second, the inter- space between internal spermatic fascia （transversalic fascia） and processus vaginalis was divided so that the testis could be pulled into the abdominal cavity. Finally, the trocar which was inserted from scrotum was placed through the outer ring. Finally, the testis was placed at position and fixed. Re- suits The mean operative time was 32.7-4-5.2 min. The processus vaginalis unclose was found in 93 （90.3%） cases; and contralateral processus vaginalis unclose were found in 12 （15.6%） cases of 77 unilateral undescended testes. The complication rate was 3 （3.3 %）cases, all in bilateral cases. All 103 testes were descended by laparoscopy. On follow-up ranging 6--12 months, all testes maintained good size and a proper position. Conclusions The laparoscopic approach may be a safe way to descend the inguinal palpable testes. Orchiopexy of palpable undescended testes can be done with advantages in the laparoscopic approach.