睾丸下降固定术的不同手术径路选择体会

The choice of the minimally invasive incision and the experiences of diagnosis and treatment of undescended testis

目的探讨分析选择不同路径行睾丸下降固定术的体会。方法 2012年5月至2014年3月期间,共103例患儿在广东省妇幼保健院小儿泌尿外科行睾丸下降固定术,高位隐睾者经腹腔镜下入路和低位隐睾者经阴囊弧形切口入路行睾丸下降固定术或睾丸探查术。分析不同手术径路的术后效果及随访观察患儿手术切口、睾丸位置、血供情况等来评价手术效果。结果 103例隐睾患儿,54例为左侧隐睾,21例为右侧隐睾,28例为双侧隐睾,总共114枚睾丸行睾丸下降固定术。39例(5例为双侧隐睾)患儿,共44枚睾丸经阴囊切口行睾丸下降固定术。64例(23例为双侧隐睾)患儿,共70枚睾丸通过腹腔镜下行睾丸下降固定术,其中20例患儿术中行Flower-Stephens I期术式;15例腹腔镜下行单侧睾丸样组织切除;单侧隐睾2例患儿术中发现输精管及精索血管未汇合。99例患儿获术后随访,时间为3个月~2年,术后随访中经阴囊切口行睾丸下降固定术者有1例患儿未能将睾丸完全下降至阴囊底部,仅位于阴囊上方。无患儿出现睾丸萎缩,无患儿伤口出现脂肪液化、感染。结论腹腔镜下入路和经阴囊弧形入口两种手术路径治疗隐睾安全、有效。

Objective To investigate the clinical experience of different pathways of orchiopexy. Methods In total, 103 affected children underwent orchiopexy in the Department of Pediatric Urology of Guangdong Women and Children Hospital between May 2012 and March 2014. High cryptorchidism were treated via laparoscopic route and low cryptorchidism were treated with orchiopexy or testicle exploration via scrotal arc incision approach. Postoperative efficacy, surgical incision, testicle position and blood supply were statistically compared to evaluate the clinical efficacy and safety between different surgical approaches. Results Among 103 children with cryptorchidism, 54 cases were diagnosed with left cryptorchidism, 21 cases with right cryptorchidism and 28 cases with bilateral cryptorchidism. A total of 114 undescended testes were treated with orchiopexy. Forty-four testes from 39 cases（5 with bilateral cryptorchidism） were treated with orchiopexy via scrotal incision approach. Seventy testes from 64 affected children（23 with bilateral cryptorchidism） were treated with laparoscopic orchiopexy. Twenty affected children underwent one-stage Flower-Stephens orchiopexy and 15 cases received unilateral laparoscopic testislike tissue resection. Intraoperatively, seminal duct and spermatic cord blood vessels did not converge in 2 affected children with unilateral cryptorchidism. Ninety-nine children were follow-up for 3 months to 2 years. After orchiopexy via scrotal incision approach, the testis was not completely descended to the scrotum and located above the scrotum in 1 child. No child presented with testicular atrophy, incisional fat liquefaction or infection. Conclusion Orchiopexy via laparoscopic and scrotal incision approaches are efficacious and safe in the management of pediatric cryptorchidism.