2种腹腔镜睾丸固定术治疗小儿隐睾效果对比观察

A comparative study of two kinds of laparoscopic orchidopexy for cryptorchidism in children

目的对比观察常规三孔腹腔镜(traditional laparoscopic orchidopexy,TLO)与改良单孔腹腔镜睾丸固定术(laparoscopic assisted transcrotal orchidopexy,LATO)治疗小儿隐睾症的效果,分析2种手术方式的适应证和优缺点。方法 83例隐睾患儿按手术方式分为TLO组(28例)和LATO组(55例),记录隐睾位置、侧别、手术时间、气腹时间及并发症情况。结果 TLO组双侧隐睾数多于LATO组,差异有统计学意义(P<0.05)。所有睾丸均成功完成引降,未见术中大出血、精索损伤、膀胱损伤等并发症。2组平均手术时间差异无统计学意义(P>0.05)。LATO组气腹时间明显短于TLO组,差异有统计学意义(P<0.05)。TLO组双侧隐睾手术时间少于LATO组,差异有统计学意义(P<0.05)。2组睾丸位置是否可触及、是否合并腹股沟疝及手术时间差异均无统计学意义(P>0.05)。平均随访时间36个月,仅TLO组发生睾丸萎缩1例,2组间并发症差异无统计学意义(P>0.05)。结论 LATO手术气腹时间明显短于TLO,TLO手术更常用于治疗双侧隐睾,2种术式一样安全有效。对于腹腔内高位隐睾,一期手术引降困难时,可考虑分期手术避免睾丸萎缩。

Objective To compare the feasibility,indication and advantage of traditional laparoscopic orchidopexy(TLO)and laparoscopic assisted transcrotal orchidopexy(LATO)for cryptorchid children.Methods Retrospective reviews of 83 clinical data were conduced for cryptorchid children treated with TLO(28 case)and LATO(55 case).Testis location,operative time and complications were recorded.Results There were more bilateral cryptorchidism in TLO group than that of LATO group(P<0.05).All testis were delivered successfully.No intra-operative complications were observed,including bleeding,damagement of spermatic cord and bladder.There was no statistical difference in the mean operative time between the two groups(P > 0.05).The mean pneumoperitoneal time was shorter in LATO than that of TLO group(P<0.05).The operative time for bilateral cryptorchidism was shorter in TLO group than that of LATO group(P<0.05).No statistical difference in operative time was found by other classifications.Median follow-up time was 36 months.No post-operative complications were found,except for one atrophy found 24 months after TLO.No statistical difference was observed(P > 0.05).Conclusion LATO procedure is demonstrated with shorter pneumoperitoneal time while TLO is much more reliable in bilateral situations.Both of them are feasible and safe for management of cryptorchidism.Staged orchidopexy may be more appliable to avoid testicular atrophy.