隐睾症手术方式对隐睾合并原发性腹茧症患者预后的临床研究

Effects of different surgical methods of cryptorchidism on the prognosis of cryptorchidism patients complicated with primary abdominal cocoon

目的探讨不同隐睾症手术方式对隐睾合并原发性腹茧症这种罕见疾病预后的影响。方法收集1992年12月至2019年12月中南大学湘雅三医院收治的共2例隐睾合并原发性腹茧症患者作为研究对象,分析其临床诊治过程,尤其关注手术方式及预后的差异,结合文献复习,探索隐睾合并原发性腹茧症的更合理诊疗方案。结果一例经腹股沟切口行隐睾切除术的患者预后良好,术后20余年未出现肠梗阻等不良预后,另一例经腹腔镜隐睾切除术后的患者术后6年出现了严重的肠梗阻症状。结论通过比较分析两病例诊疗资料,结合相关的文献调研发现:隐睾症合并原发性腹茧症在临床上极为罕见,隐睾具有恶变风险,必要时需行手术治疗。然而现阶段主流的腹腔镜下隐睾切除手术方式可能会对同时合并原发性腹茧症患者的预后造成严重不良影响。泌尿外科医生在对患者行隐睾手术前应充分评估其合并原发性腹茧症的可能性,尽可能选择对患者预后更有利的手术方式。

Objective To investigate the effects of different surgical methods of cryptorchidism on the prognosis of cryptorchidism complicated with primary abdominal cocoon.Methods Two cryptorchidism patients complicated with primary abdominal cocoon who were admitted to the Third Xiangya Hospital of Central South University from December1992 to December 2019 were selected as the research objects.Their clinical diagnosis and treatment process were comparatively analyzed,especially the differences in surgical methods.By reviewing the related literatures,the diagnosis and treatment of cryptorchidism complicated with primary abdominal cocoon were discussed.Results One patient who underwent cryptorchidectomy via an inguinal incision had a well prognosis,and no adverse prognosis such as intestinal obstruction for more than 20 years after the operation.The other patient who received laparoscopic cryptorchidectomy developed severe intestinal obstruction symptoms in the 6th years after the operation.Conclusion Through literature review,we know that cryptorchidism complicated with primary abdominal cocoon is extremely rare in clinic,and cryptorchidism has the risk of malignant transformation,and surgical treatment is important if necessary.However,the current mainstream laparoscopic cryptorchiectomy may have a negative impact on the prognosis of patients with primary abdominal cocoon at the same time.Urologists should fully evaluate the possibility of primary abdominal cocoon before performing cryptorchidism surgery on the patient,and choose a surgical method that is more favorable to the patient’s prognosis as much as possible.