腹腔镜经腹腹膜前入路治疗成人腹股沟型隐睾合并腹股沟斜疝的临床研究

Laparoscopic transabdominal preperitoneal approach in the treatment of inguinal undescended testis combined with indirect inguinal hernia in adults

目的探讨成人腹股沟型隐睾合并腹股沟斜疝腹腔镜手术的方法和经验。方法回顾性分析2016年8月至2019年9月,北京协和医院收治的9例腹腔镜经腹腹膜前途径一期行隐睾下降固定及腹股沟斜疝无张力修补的成年患者资料,观察患者手术时间、术中出血量、手术效果及并发症,总结手术技术要点及临床经验。结果9例患者年龄18~37岁,平均27.4岁。双侧隐睾1例,右侧隐睾6例,左侧隐睾2例。双侧隐睾合并的腹股沟斜疝为右侧,左侧为隐匿性疝,其余8例均为隐睾同侧疝。隐睾均为腹股沟管型,睾丸肿瘤标志物检查均为正常范围。均顺利一期完成手术,手术时间90~260 min,平均161 min。术中出血量2~30 ml,平均17 ml。术后住院4~9 d,平均5 d。术后随访时间15~52个月,中位随访时间27个月,未出现睾丸回缩、萎缩及恶变,未出现疝复发。结论腹腔镜下经腹腔腹膜前入路一期手术治疗成人腹股沟型隐睾合并腹股沟斜疝是一种安全有效的方法。

Objective To explore the method and experience of laparoscopic surgery for inguinal undescended testis combined with indirect inguinal hernia in adults.Methods We retrospectively reviewed the data of 9 adult patients who underwent one-stage laparoscopic orchidopexy for inguinal undescended testis and transabdominal preperitoneal hernia repair for indirect inguinal hernia from August 2016 to September 2019,observed the operation time,amount of bleeding,operation effect and complications,and summarized the technical points of the operation and clinical experience.Results The 9 patients were 18 to 37 years old and the average age was 27.4 years old.There was 1 case of bilateral cryptorchidism,6 cases of right cryptorchidism and 2 cases of left cryptorchidism.The indirect inguinal hernia with bilateral cryptorchidism was on the right side,and the left was occult hernia.The other 8 cases were all ipsilateral hernia with cryptorchidism.All the undescended testes were in inguinal canal,and the testicular tumor markers were all normal.All the operations were successfully completed in one stage,with an average operation time of 161 min,ranging from 90 to 260 minutes.The intraoperative blood loss ranged from 2 to 30 ml,with an average of 17 ml.The hospital stay was 4 to 9 days,with an average of 5 days.The follow-up time was 15 to 52 months,and the median follow-up time was 27 months.There was no testicular retraction,atrophy or malignant change,and no recurrence of hernia.Conclusion Laparoscopic one-stage operation via transabdominal preperitoneal approach is safe and effective in the treatment of inguinal undescended testis combined with indirect inguinal hernia in adults.