两种手术治疗小儿隐睾的临床效果

Clinical effects of two surgical methods for children with cryptorchidism

目的:观察腹腔镜手术与开放手术治疗小儿隐睾的临床效果及安全性。方法:以2017年1月至2020年12月南京医科大学附属儿童医院泌尿外科收治的120例隐睾患儿为对象,按治疗方法不同分为对照组(n=58)与研究组(n=62)。对照组采用开放手术治疗,研究组采用腹腔镜手术治疗。比较两组手术时间、术中出血量、切口长度、住院时间,观察手术前后两组炎症因子反应指标[白细胞介素-6(interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)]、一次下降成功率、再手术率及术后并发症发生率。结果:研究组术中出血量、切口长度明显小于对照组,住院时间较对照组明显缩短(P<0.05),手术时间较对照组略长(P>0.05)。术后1、3、5 d仅对照组IL-6、CRP水平较术前明显增高,且术后研究组IL-6、CRP水平较对照组明显降低(P<0.05)。两组手术一次下降成功率、再手术率比较差异无统计学意义(P>0.05),研究组术中精索血管损伤较对照组明显减少(P<0.05)。研究组术后并发症发生率较对照组明显降低(P<0.05)。结论:腹腔镜手术治疗小儿隐睾的一次下降成功率与开放手术相当,但前者手术创伤小、术后炎性反应轻,更利于患儿术后康复,同时明显降低精索血管损伤风险。

Objective:To observe the clinical effect and safety of laparoscopic surgery and open surgery in the treatment of children with cryptorchidism.Methods:A total of 120 children with cryptorchidism treated at the Department of Urology,Children’s Hospital of Nanjing Medical University were selected as the research subjects between January 2017 and December 2020.Among them,children treated with open surgery were included in the control group(n=58),while those treated with laparoscopic surgery were included in the study group(n=62).The operation time,intraoperative blood loss,length of incision,and hospital stay were compared between the 2 groups.Inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP)]before and after the surgery,the success rate of one-time descent,re-operation rate,and incidences of postoperative complications were observed.Results:The intraoperative blood loss,the length of incision and length of hospital stay of the study group were significantly less or shorter than those of the control group (P<0.05), and the operation time was slightly longer than that of the control group (P>0.05). At the 1st, 3rd and 5th days after the surgery, only IL-6 and CRP levels in the control group were significantly higher than those before the surgery. After the surgery, IL-6 and CRP levels in the study group were significantly lower than those in the control group (P<0.05). There was no significant difference in the success rate of one-time descent and re-operation rate between the 2 groups (P>0.05). The incidence of postoperative testicular atrophy was significantly higher, and the rate of intraoperative spermatic cord vascular damage was significantly lower in the study group than those in the control group (P<0.05). The incidence of postoperative complications was significantly lower in the study group than those in the control group (P<0.05). Conclusion: Laparoscopic surgery is equivalent to open surgery in the treatment of children with cryptorchidism from the perspective of the success rate of one-time descent. However, the former has less trauma and milder postoperative inflammatory response, which is more conducive to the children’s postoperative recovery. Meanwhile, it can significantly reduce the risk of spermatic cord vascular damage.