腹腔镜与开放手术治疗腹股沟隐睾的疗效及生殖器发育参数的比较

Comparison of clinical efficacy and genital development-related parameters between laparoscopic and open surgery in the treatment of inguinal cryptorchidism

目的探讨腹腔镜手术治疗腹股沟隐睾的疗效和治疗优势。方法将84例隐睾患儿分为观察组(腹腔镜手术,42例)和对照组(开放式手术,42例),比较2种手术方式的手术时间、术中出血量、术后住院时间及术后并发症等各项临床指标,以及作生殖器发育参数的比较。结果观察组的手术时间、术中出血量和术后住院时间均优于对照组(P均<0.05)。观察组出现术后发热2例,无出现伤口感染情况;对照组出现术后发热2例,伤口感染3例,2组比较差异无统计学意义(P均﹥0.05);观察组无出现睾丸回缩、睾丸萎缩等严重并发症,但2例因睾丸位置不佳需接受二次手术;而对照组出现睾丸回缩3例、睾丸萎缩2例,4例需接受二次手术(P﹤0.05)。2组患儿术后1年的血清抗苗勒管激素(AMH)和抑制素B均高于术前(P均<0.05),观察组术后1年的AMH和抑制素B均高于对照组(P均<0.05)。结论腹腔镜手术治疗腹股沟隐睾疗效优于开放手术,术后并发症较少,且对睾丸功能损伤小。

Objective To compare the clinical efficacy and safety between laparoscopic and open surgery in the treatment of inguinal cryptorchidism.Methods A total of 84 children diagnosed with inguinal cryptorchidism were divided into the observation(laparoscopic surgery,n=42)and control groups(open surgery,n=42).The operation time,intraoperative blood loss,length of postoperative hospital stay,postoperative complications and genital development-related parameters were observed and statistically compared between two groups.Results In the observation group,the operation time,intraoperative blood loss,length of postoperative hospital stay were significantly superior to those in the control group(all P<0.05).In the observation group,two patients suffered from fever,whereas no wound infection was noted postoperatively.In the control group,two cases presented with fever and 3 children had wound infection.No statistical significance was seen between two groups(both P>0.05).No severe postoperative complications,such as testicular retraction or atrophy were noted in the observation group,whereas two cases had to undergo secondary surgery due to improper testicular position.In the control group,three children suffered from testicular retraction,two with testicular atrophy and four undergoing secondary surgery with statistical significance(all P<0.05).In both groups,the serum levels of anti-Mullerian hormone(AMH)and inhibin B at postoperative 1 year were considerably higher compared with preoperative levels(both P<0.05).The serum levels of AMH and inhibin B in the observation group were significantly higher than those in the control group(both P<0.05).Conclusions Compared with open surgery,laparoscopic surgery is more efficacious and safer in the treatment of inguinal cryptorchidism,which yields less postoperative complications and less injury to the testicular function.