经腹腔镜辅助分期Fowler-Stephens手术治疗高位隐睾的随访分析

Follow-up of laparoscopic Fowler-Stephens procedures for high cryptorchidism

目的 探讨腹腔镜辅助分期Fowler-Stephens（F-S）的实用价值.方法 回顾性分析2003年6月至2009年5月分期F-S手术治疗的26例腹腔内高位隐睾患儿的临床资料.26例患儿年龄1岁6个月至10岁,平均54个月.左侧11例,右侧15例.F-S一期手术在腹腔镜下完成,二期手术经腹股沟开放手术完成,两期手术间隔时间6个月,平均随访时间29.6个月.手术前后检查睾丸位置,超声测量睾丸大小,将患睾术前术后体积与健睾比较.结果 26例患儿睾丸均无张力降入阴囊内,术后16例获随访,其中1例睾丸萎缩,15例术后不同时段（术后1个月、3个月、6个月、1～4年、＞4年）彩超血流信号无异常,对应时段患睾与健睾体积之比分别为0.77、0.57、0.73、0.72、0.66,而术前相应的患睾与健睾体积之比分别为0.65、0.54、0.63、0.47、0.47.显示术后不同时段患睾与健睾平均体积之比较术前变大.二期术后6个月至1年获得集中随访9例,患睾术前体积0.297 mL,术后为0.603 mL,经配对t检验,P=0.01,差异有统计学意义.结论 经腹腔镜探查证实睾丸位于腹腔内、无萎缩、精索血管长度不足以保证将睾丸无张力降至阴囊内理想位置者,可采用分期F-S手术,疗效可靠.

Objetive The aim of our study is to evaluate the practical value of Laparoscopic Fowler-Stephens.Methods We retrospectively reviewed the medical records of 26 children who underwent laparoscopic orchiopexy for a nonpalpable intra-abdominal testis from June 2003 to May 2009.The mean patient age was 54 months （range,18 ～120 months）,The right side was affected in 15 cases and the lcft sidc in 11 cases.One stage was perfomed in laparoscopic,and assisted-open second stage was undertaken in all case.Second stage was undertaken most in 6 months after the first.All were followed-up for average 29.6 months.Testicular positioning and size were evaluated before and after operation by the ultrasonic.Compared testis volume of the preoperative and postoperatiye to the healthy testis.Results 26 patients had a viable testis in the scrotum after operation.16 patients were agreed to undergo clinical and instrumental examination.One of them had an atrophic testis in the scrotum,and the others had a good vascularization detected on echo color doppler ultrasound at different postoperative points（1 m,3 m,6 m,1 ～ 4 y,＞ 4 y）.The ratio of the volume of the operated testis and the normal testis,which were 0.77,0.57,0.73,0.72,0.66 in corresponding period of postoperative,But the difference which were 0.65,0.54,0.63,0.47,0.47 in corresponding period of preoperative.It＇ s reveal that different times of it were lager postoperative than preoperative.9 cases,followed-up ranged from 6 months to 1 years,testis volume of 0.297 mL in the preoperative,but 0.603 mL in the postoperative,the difference has statistically significant.Conclusions According to the results,patients had a viable testis in the scrotum after assisted laparoscopic F-S procedure.We conclude that intra-abdominal testes with short spermatic vessels and no atrophy,which diagnostic by laparoscopy,should peffome laparoscopic assisted F-S surgery to avoid testicular atrophy.