经脐单通道常规器械腹腔镜睾丸下降固定术治疗小儿隐睾症的疗效

Effect of transumbilical single channel laparoscopic cryptorchidopeXy by conventional instruments on cryp-torchidism in children

目的探讨经脐单通道常规器械腹腔镜睾丸下降固定术在治疗小儿隐睾症中的安全性及可行性.方法选取2017年11月至2018年3月广西医科大学第一附属医院收治的35例隐睾患儿,均行经脐单通道常规器械腹腔镜下睾丸固定术,统计患儿一般资料、手术时间、术中出血量、术后睾丸位置、术后并发症发生情况等临床资料.结果 35例患儿均一期完成睾丸下降固定术,其中单侧28例,双侧7例,共42侧;腹股沟型26例(33侧),腹腔型9例(9侧);平均手术时间单侧(40. 4 ± 8. 2)min,双侧(62. 5 ± 15. 3)min;术中平均出血量(3. 0 ± 1. 8)mL;术后平均住院时间(6. 4 ± 2. 1)h.32例(40侧)睾丸固定于阴囊中、底部,2例(2侧)固定于阴囊顶部,术后1例出现脐部切口愈合不良,经换药1周后痊愈,术后无阴囊血肿、切口感染、睾丸附睾炎、睾丸坏死、睾丸回缩、睾丸萎缩等并发症,术后2周复查腹部无明显可视瘢痕,并发症发生率为2. 9%(1/35例).结论经脐单通道常规器械腹腔镜下睾丸固定术治疗小儿隐睾症创伤小、恢复快、并发症发生率低,术后可达完全无可视瘢痕效果,美容效果确切,值得临床应用,但操作相对复杂,需掌握正确的操作技巧.

Objective To explore the safety and feasibility of transumbilical single channel laparoscopic cryp-torchidopexy with conventional instruments in treatment of cryptorchidism in children. Methods Thirty-five children with cryptorchidism were treated by transumbilical single channel laparoscopic cryptorchidopexy with conventional instru-ments from November 2017 to March 2018 at Department of Pediatric Surgery,the First Affiliated Hospital of Guangxi Medical University. Clinical data were recorded including the general information,operation time,intraoperative blood loss,postoperative testicular position and postoperative complications,etc. Results All 35 patients completed the cryptorchidopexy in one operation. Among those 35 patients,28 patients had unilateral lesions and 7 patients had bilateral lesions,with a total of 42 sides. Twenty - six patients were of groin type( 33 sides),9 patients abdominal type( 9 sides). The average operation time was(40. 4 ± 8. 2)min for unilateral lesion,and(62. 5 ± 15. 3)min for bilateral le-sions;the average intraoperative blood loss was(3. 0 ± 1. 8)mL;and the average postoperative hospital stay was(6. 4 ± 2. 1)h. Testis of 32 patients(40 sides)were fixed in the middle and bottoms of the scrotum,and testis of 2 patients (2 sides)were fixed on the top of the scrotum. One case had poor healing of naval incision,which was recovered in 1 week after dressing change. There were no postoperative complications such as scrotum hematoma,infection of incision, testicular epididymitis,testicular necrosis,testicular retraction or testicular atrophy,etc. No obvious visible scar was found in the abdomen review 2 weeks postoperatively,with the incidence of complications was 2. 9%(1/35 cases). Conclusions Transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments in treatment of cryptorchidism is characterized by small trauma,quick recovery,low complication rate and visible scar free result, which is worthy of clinical promotion,but the operation is relatively complex and the correct procedures are required.