有腹股沟区手术史的隐睾患儿诊疗分析

Redo orchidopexy to treat the cryptorchidism after groin exploration.

目的探讨腹股沟区手术后隐睾的原因、预防措施及手术方法。方法回顾性分析2006年6月至2011年3月作者收治的13例（14侧）腹股沟区手术后再次行隐睾手术患儿的临床资料，其中隐睾手术后8例，腹股沟斜疝手术后4例，鞘膜积液手术后1例。均再次行睾丸下降固定术，手术前后超声测量睾丸容积。结果13例（14侧）患儿睾丸均降入阴囊内，术中见瘢痕粘连明显。术后12例（13侧）获随访2个月至4年，睾丸无回缩，彩超提示13侧睾丸位置、血流正常，睾丸容积4侧较术前缩小5％一15％，1侧与术前相当，8侧较术前增大。结论导致腹股沟区手术后隐睾的原因为隐睾合并斜疝或鞘膜积液时只处理了后者，或单纯行斜疝或鞘膜积液手术时操作不当使睾丸上移，或隐睾手术中未充分游离精索，未达到无张力下降，以致睾丸上缩。腹股沟区手术后隐睾应适时手术，再次手术要仔细分离腹股沟粘连，并注重腹膜后精索的游离。

Objective To explore the causes, protective measures and surgical treatments of the cryp- torchidism after groin exploration. Methods A total of 13 children suffered cryptorchidism following groin exploration from June 2006 to March 2011. Eight of these cases occurred following previous orchidopexy, 4 following inguinal hernia repair, and 1 following hydrocele repair. These patients subsequendy required orchidopexy. Results All testes were placed into scrotum by redo orchidopexy, and the scar adherence was severe during operation. After operation, 12 cases were followed up for 2 months to 4 years. The testes were inside the scrotum. Color Doppler showed that the location and blood flow were normal, and the volume of testis decreased by 5% to 15% in 4 cases, volume stayed the same in 1 case, the volume grown up in 8 cases. Conclusions There are three causes for cryptorchidism following groin exploration. For cryptorchidism accompanied with inguinal hernia or hydrocele, only solve the latter, or during the hernia repair, the testis was raised by misoperation, or during precious orchidopexy, the dissociation of spermatic cord was not enough, which cause the recurrence of cryptorehidism. The reoperation of cryptorehidism following groin exploration is necessary. It is important to separate the inguinal scar adherence in reoperation, and the dissociation of pest peritoneal spermatic cord is critical in reoperation.