腹腔镜整体分离鞘状突和精索在小儿腹股沟型隐睾手术中的应用

Integral separation of processus vaginalis and spermatic cord used in laparoscopic orchiopexy for pediatric inguinal cryptorchidism

目的探讨腹腔镜整体分离鞘状突和精索在小儿腹股沟型隐睾手术中的应用价值。方法回顾性分析2008年2月至2014年2月,广东省佛山市第一人民医院施行小儿腹股沟型隐睾腹腔镜手术95例患儿临床资料,将其中应用腹腔镜整体分离鞘状突和精索实现隐睾松解的患儿与其他不同手术方式的患儿进行比较,对比手术时间、手术出血量,以及术中损伤和术后并发症的发生率。结果腹腔镜手术治疗小儿腹股沟型隐睾共95例、125侧,按鞘状突开闭状态和睾丸位置的不同进行分型并实施不同手术方式:鞘状突闭合低位睾丸型8例、12侧(A组),腹腔镜探查后转阴囊切口松解固定隐睾;鞘状突闭合高位睾丸型6例、7侧(B组),腹腔镜下经腹膜后松解精索血管及隐睾;鞘状突未闭低位睾丸型8例、11侧(C组),腹腔镜内环口结扎后转阴囊切口松解固定隐睾;鞘状突未闭高位睾丸型73例、95侧(D组),应用腹腔镜下整体分离鞘状突和精索实现隐睾松解固定。各组手术时间、手术出血量差异无统计学意义;各组均无术中副损伤;术后并发症发生率:A组0%,B组42.9%,C组9.1%,D组4.2%。结论对于鞘状突未闭的腹股沟型隐睾,整体分离鞘状突和精索的方法松解隐睾能避免精索血管和输精管损伤;对于鞘状突闭合的腹股沟型隐睾,因无鞘状突腹膜引导松解精索,术后缺血性并发症发生率较高,不推荐在腹腔镜下松解。

Objective To discuss the application value of integral separation of processus vaginalis and spermatic cord used in laparoscopic orchiopexy for pediatric inguinal cryptorchidism. Methods A retrospective analysis was conducted on 95 cases of pediatric inguinal cryptorchidism who underwent laparoscopic orchiopexy from February 2008 to February 2014,in the First People＇s Hospital of Foshan. The data of patients who underwent laparoscopic integral separation of processus vaginalis and spermatic cord,was compared with those received other surgical technique. The operation time, amount of bleeding,incidence of intraoperative injury and postoperative complications were analyze. Results 95 cases（ 125 sides） of pediatric inguinal cryptorchidism were treated. According to the anatomical characteristics of processus vaginalis and cryptorchidism,patients were divided into 4 types and received different operations：Closed processus vaginalis Low testis,in 8 cases（ 12 sides） as group A,underwent open orchiopexy after laparoscopic exploration; Closed processus vaginalis High testis,in 6 cases（ 7 sides） as group B,underwent laparoscopic orchiopexy by retroperitoneum approach; Patent processus vaginalis Low testis,in8 cases（ 11 sides） as group C,underwent open orchiopexy after laparoscopic inguinal ring closure; Patent processus vaginalis High testis,in 73 cases（ 95 sides） as group D,underwent laparoscopic orchiopexy used integral separation of processus vaginalis and spermatic cord. There were no significant differences in operation time and bleeding between 4 groups. No intraoperative injury occurred; the incidence of postoperative complications from group A to D was 0%,42. 9%,9. 1% and 4. 2%, respectively.Conclusions In cases of inguinal cryptorchidism with patent processus vaginalis,it can be avoided the spermatic vessels and vas deferens damage by using laparoscopic integral separation of processus vaginalis and spermatic cord. But in cases with closed processus vaginalis,it is not recommended in laparoscopy,due to a higher rate of postoperative ischemic complications.