三种术式治疗小儿不同位置隐睾效果的分析  

Comparison of three different surgical approaches to children with cryptorchidism in differet locations

作　　者：张慧敏 李科[1] 胡成[1] 黄文涛[1] 邱文瀚 李一渊 何建文 王德娟[1] 邱剑光[1] 高新[1] Zhang Huimin;Li Ke;Hu Cheng;Huang Wentao;Qiu Wenhan;Li Yiyuan;He Jianwen;Wang Dejuan;Qiu Jianguang;Gao Xin(Department of Urology,the Third Affiated Hospital of Sun Yat-sen University,Guang zhou 510630,China)

机构地区：[1]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2018年第3期177-181,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：2017广东省自然科学基金项目(2017A030313898)

摘　　要：目的总结及分析三种术式治疗儿童不同位置隐睾的效果。方法回顾性分析2010年1月至2017年6月我院泌尿外科收治的159例(213侧)隐睾患儿资料,年龄5个月至14岁(中位年龄4岁)。根据术前及术中对患儿隐睾部位、发育等情况的评估,分别采用腹腔镜高位隐睾下降固定、腹腔镜鞘状突高位结扎加经阴囊隐睾固定及经腹股沟切口开放手术治疗。比较三种术式治疗小儿隐睾的疗效。结果 90侧隐睾采取腹腔镜高位隐睾下降固定术,61侧隐睾采取腹腔镜鞘状突高位结扎加经阴囊手术,62侧隐睾采用开放经腹股沟切口手术。105例单侧隐睾病例中,术中探查见患侧鞘状突未闭者有85例(80.95%);对侧鞘状突未闭者有40例(38.10%)。54例双侧隐睾病例中,合并双侧鞘状突未闭者31例(57.41%),合并单侧(一侧及以上)鞘状突未闭者44例(81.48%),其中31例为双侧鞘状突均未闭,13例为只有一侧未闭。均行腹腔镜套管针法高位结扎闭合鞘状突。2侧睾丸术中见发育不良予以切除,其余所有睾丸均无张力固定于患侧阴囊。所有病例随访3个月至6年,发现1例复发,其余病例未见手术侧睾丸萎缩及回缩。三种术式对治疗小儿隐睾的效果差异无统计学意义(P>0.05)。结论腹腔镜对腹腔高位隐睾手术治疗具有优势,可同时处理未闭鞘状突。腹股沟部低位隐睾可行腹腔镜鞘状突结扎加经阴囊切口手术。经腹股沟切口手术在诊断睾丸缺如及睾丸发育不良等情况中仍有重要价值。Objective To evaluate the clinical efficacy of three different surgical approaches in the treatment of cryptorchidism. Methods One hundred and fifty nine patients（213 testes） diagnosed of cryptorchidism in different positions were admitted to our hospital from January 2010 to June 2017. The ages ranged from 5 months to 14 years. Three different surgical treatments（laparoscopic orchidopexy, scrotal incision surgery and open inguinal surgery） were performed in these cases according to the preoperative and intraoperative physical examination, the development of testes and so on. The effects and complications of these three treatments were compared. Results Ninety cases underwent laparoscopic orchidopexy, 61 cases underwent scrotal incision surgeries plus laparoscopic approach to find patnet processus vaginalis（PPV）, and 62 cases underwent open inguinal surgeries. Among 105 patients diagnosed of unilateral cryptorchidism, 85（80.95%） were found with PPV in the same side and 40（38.10%） with CPPV. While 31 cases（57.41%） were found bilateral PPV in 54 patients with bilateral cryptorchidism. Two testes were removed because of dysplasia. The rest were fixed at the bottom of scrotum without tension. The follow-up endured for 3 months to 6 years. One case was found recurrence. No testicular atrophy or retraction was found in all patients. There was no significant difference among the three surgical approaches in the treatment of cryptorchidism（P〈0.05）. Conclusion Laparoscopic orchidopexy is recommended as the first choice for intra-abdominal testes, and scrotal incision surgery is better for low cryptorchidism. Open inguinal surgery still has a major value and significance in diagnosing absence or dysplasia of testes.

关 键 词：小儿 隐睾 睾丸下降固定术 腹腔镜 

分 类 号：R726.9[医药卫生—儿科]