腹腔镜治疗可触及腹股沟型隐睾的疗效分析

Laparoscopic orchiopexy for inguinal palpable cryptorchidism

目的:探讨腹腔镜技术治疗可触及腹股沟型隐睾的可行性及优势。方法:腹股沟型隐睾患者773例,左侧218例、右侧459例、双侧96例,共869个睾丸。年龄6个月至8岁,平均20个月。超声刀腹腔内切开腹膜后壁,游离高位精索接近肾下极,并将后腹膜与输精管分离开,再分离松解腹股沟管内精索粘连,离断睾丸引带,将睾丸回拉入腹腔内,保护输精管,将睾丸下拉入阴囊固定于肉膜囊。结果:773例869个睾丸手术均顺利,无中转开放手术。手术时间(34.8±5.4) min。患侧鞘状突未闭692侧(89.5%);677例单侧隐睾对侧隐匿性疝233例(34.4%),术中一并行疝囊高位结扎。术中无皮下气肿发生,术后无呕吐、腹胀不适,无伤口出血及明显疼痛。术后定期复查彩超,随访6~18个月,睾丸均位于阴囊内,无睾丸回缩及萎缩,未发现腹股沟疝或鞘膜积液。结论:腹腔镜治疗腹股沟型隐睾安全、有效,具有明显的微创优势,且可同时探查及治疗对侧隐匿性疝,避免了异时性腹股沟疝的发生。

Objective: To investigate the feasibility and advantages of laparoscopic orchiopexy in the treatment of inguinal palpable cryptorchidism. Methods: This study included 773 cases of inguinal palpable cryptorchidism with 869 undescended testes, 218 on the left, 459 on the right and 96 bilaterally. The patients were aged 6 months to 8 years, averaging 20 months. The surgical procedures involved cutting open the posterior peritoneal wall with the ultrasonic scalpel, dissecting the spermatic cord close to the inferior pole of the kidney, separating the posterior peritoneum from the vas deferens, severing the testicular gubernaculum, pulling the testis back into the abdominal cavity and, with the vas deferens protected, bringing the testis down into the scrotum and getting it fixed.Results: All the operations were successfully performed, with an average operation time of 34.8 ± 5.4 minutes and no conversion to open surgery. Ipsilateral patent processus vaginalis was found in 692(89.5%) of the 773 cases, and contralateral concealed hernia in 233(34.4%) of the 677 cases of unilateral cryptorchidism, which were all treated by high ligation of the hernial sac. There was no subcutaneous emphysema intraoperatively or vomiting, abdominal distension, wound bleeding and obvious pain postoperatively. The patients were followed up for 6 to 18 months, during which, regular Doppler ultrasonography revealed that the testes were located in the scrotum with no testicular retraction and atrophy, inguinal hernia or hydrocele. Conclusion: Laparoscopic orchiopexy is safe and effective for the treatment of inguinal palpable cryptorchidism, and meanwhile can be used for the detection and management of contralateral concealed hernia and the prevention of metachronous inguinal hernia.