经鞘突口腹腔镜抵入法在经阴囊入路睾丸引降固定术治疗腹股沟型隐睾中的应用

Application of laparoscope approaching scrotum via inner ring orifice in transcrotal orchidopexy for treatment of palpable inguinal canalicular cryptorchidism

目的介绍单孔腹腔镜监视下经阴囊入路睾丸引降固定术(laparoscopic assisted transcrotal orchidopexy,LATO)治疗腹股沟型隐睾中采用经鞘突口腹腔镜抵入法(laparoscope approaching scrotum via inner ring orifice,LASIRO)在体外快速准确找到鞘膜腔的方法。方法选择2018年1月至2019年4月行LATO治疗的35例37侧腹股沟型隐睾患儿为研究对象。采用LASIRO在体外快速准确找到鞘膜腔:经阴囊切口中心切开肉膜之后,重建气腹,将光源调暗的镜头经未闭鞘突口伸入患侧鞘突腔内,向阴囊切口抵进到阴囊内,经切口抵出。采用电刀打开鞘膜腔,牵出睾丸。之后采用桥法横断鞘状突,分离和松解精索,保护输精管,实施睾丸引降固定。术后随访手术效果、隐睾位置和并发症。结果37侧隐睾均在体外快速准确找到鞘膜腔,在腹腔镜监视下成功固定于阴囊。手术时间25~55 min,围术期未发现并发症。患儿均于术后第2 d出院。术后随访24例,随访时间1~16个月,睾丸均位于阴囊内,无回缩或萎缩,未见切口感染、腹股沟疝或鞘膜积液发生。结论采用LASIRO可在体外快速准确找到位置偏高的鞘膜腔,有助于暴露睾丸和实施引降固定,方法安全、准确、有效,操作简便灵活。保持了LATO的隐瘢痕特点,缩短了手术时间,符合微创精准和快速康复的治疗理念。

Objective To introduce a novel laparoscope approaching scrotum via inner ring orifice(LASIRO)technique in laparoscopic assisted transcrotal orchidopexy(LATO)for treatment of palpable inguinal canalicular cryptorchidism,in order to find extracorporally vaginal cavity quickly and precisely.Methods From January 2018 to April 2019,35 children(37 sides)with palpable inguinal canalicular cryptorchidism who underwent LATO were selected.Before descending testis,LASIRO was used to find and expose tunica vaginalis testis.We reconstructed pneumoperitoneu after opening thecae through scrotal incision.The laparoscopic light was turned down and laparoscope passed patent processus vaginalis(PPV)into affected cavity of tunica vaginalis,and approach into scrotum though scrotal incision and then jack the wall of tunica vaginalis testis out through scrotal incision,followed by opening of tunica vaginalis testis using electronic knife and dragging out of testis in it.Afterwards,transcrotal dissection for orchidopexy was conducted and inner ring orifice was closed by single port laparoscopic percutaneous extracorporeal closure.The clinical outcomes,cryptorchidism position,and complications were followed up.Results A total of 37 sides for palpable inguinal canalicular cryptorchidism were promptly found and exposed tunica vaginalis testis and delivered into the scrotum successfully.The operative time was 25-55 min.There were no intra-operative complications.All of the children were discharged from hospital in two days after operation.Twenty-four children were followed up for 1-16 months without iatrogenic cryptorchidism or testicular atrophy,wound infection,hernia or hydrocele.Conclusions LASIRO is a prompt and precise technique to find and expose tunica vaginalis testis elevating.It is helpful to expose orchis and carry out transcrotal orchidopexy,which is safe,accuracy and cosmetics in practice.The scars are invisible and the peration time is short,in keeping with the concept of the minimally invasive precison and rapid rehahilitation.