海氏三角途径腹腔镜下腹股沟管内高位隐睾引降固定术的临床分析

Clinical analysis and operation experience of laparoscopic orchidopexy for high cryptorchidism around inguinal canal via Hesselbach route

目的探究经海氏三角途径腹腔镜下"窥视睾丸"(指在腹股沟管内环口附近的高位睾丸)引降固定术的临床应用情况。方法回顾性分析2015年1月至2018年12月在河北省儿童医院行经海氏三角途径腹腔镜睾丸引降固定手术的"窥视睾丸"患儿56例的临床资料。年龄6个月至13岁,中位年龄1岁10个月;右侧37例,左侧19例。对术前及术后1、6、12个月复查患侧睾丸体积、患侧/健侧睾丸体积比情况进行对比分析。结果56例患儿均完成手术,睾丸均顺利引降并固定于阴囊。手术时间为(45.23±0.38)min,术中出血量约2~4 ml。56例患儿术后复查睾丸均正常生长发育,查体睾丸均位于阴囊内,无回缩,未见切口感染、腹股沟疝或鞘膜积液等并发症出现。术后12个月复查患侧睾丸体积为(0.48±0.08)ml与术前(0.30±0.04)ml比较,差异有统计学意义(P=0.035);患侧/健侧睾丸体积比为0.71±0.06与术前0.58±0.05比较,差异有统计学意义(P=0.028)。结论经海氏三角途径腹腔镜下睾丸引降固定术是治疗"窥视睾丸"的重要手术方式,具有安全、有效、术后并发症少的优势,值得临床推广。

Objective To explore the clinical application of laparoscopic orchidopexy for Peep testicles around intra-inguinal canal ring via Hesselbach route.Methods From January 2015 to December 2018,56 children of unilateral intra-abdominal Peep testicles underwent laparoscopic orchidopexy surgery via Hesselbach route.Clinical data were collected and postoperative testicular position and testicular growth statistically analyzed.Results After successful operations,all testes survived,descended and became fixed in scrotum.The operative duration was(45.23±0.38)min and bleeding volume(2-4)ml.Statistically significant difference in mean volume existed between affected and healthy testis at Month 12(0.30±0.04 vs.0.48±0.08 ml,P=0.035).The mean preoperative volume ratio between affected and healthy testis was(0.58±0.05)and the mean volume ratio(0.71±0.06)at Year 1 postoperatively.The difference between two volume ratios was statistically significant(P=0.028).Conclusion Laparoscopic orchidopexy via Hesselbach route for Peep testicles is an important surgical procedure for high cryptorchidism.It is worthy of wider clinical popularization.