经腹腔镜Fowler-Stephens分期手术治疗患儿高位隐睾的临床观察  

Clinical efficacy of two-staged Fowler-Stephens laparoscopic orchidopexy in the treatment of children with high cryptorchidism

作　　者：宋晋秋[1] 白东升[1] 郝春生[1] 王弘扬 邱颖[1] 牛志尚[1] 张晨捷 刘晓萌 Song Jinqiu;Bai Dongsheng;Hao Chunsheng;Wang Hongyang;Qiu Ying;Niu Zhishang;Zhang Chenjie;Liu Xiaomeng(Department of Urology Surgery,the Children′s hospital capital institute of pediatrics,Beijing 100020 China)

机构地区：[1]首都儿科研究所附属儿童医院泌尿外科,北京100020

出　　处：《中华医学杂志》2020年第44期3520-3524,共5页National Medical Journal of China

基　　金：首都临床特色应用研究(Z171100001017223)。

摘　　要：目的:评价腹腔镜Fowler-Stephens分期手术治疗高位隐睾的临床效果,并与未离断精索血管进行腹腔镜睾丸固定术进行比较分析。方法:分析2015年1月至2019年4月首都儿科研究所附属儿童医院泌尿外科采用Fowler-Stephens分期手术治疗的20例高位隐睾患儿(简称F-S组);同时选取同年龄组未离断精索血管进行腹腔镜睾丸固定的20例患儿作为对照组。F-S组年龄6~18个月,平均年龄13.5个月;左侧7例,右侧13例;对照组年龄6~18个月,平均年龄12.5个月;左侧6例,右侧14例。F-S组患儿符合Fowler-Stephens手术指征,Fowler-stephens一期手术采用3孔腹腔镜技术。术后6个月二期手术经腹股沟开放完成。对照组患儿精索发育良好,不符合Fowler-Stephens手术指征,采用3孔腹腔镜技术一次手术完成睾丸固定。两组随访至术后6个月,测量术后两组患儿睾丸容积及性激素指标。F-S组和对照组患儿的术前、术后的超声测量的睾丸体积及性激素分别进行自身对照研究,两组患儿之间进行激素对比研究。结果:F-S组、对照组手术均顺利将睾丸无张力固定于阴囊内,两组均在术后6个月复查20例睾丸位置无回缩。F-S组睾丸体积2例较术前有减少,术前容积(0.34±0.16)ml,术后容积(0.38±0.13)ml,P=0.089,差异无统计学意义。对照组1例睾丸体积较术前减少,术前容积(0.40±0.14)ml,术后容积(0.40±0.15)ml,P=0.933,差异均无统计学意义。性激素复查:两组手术前后睾酮均<0.087 nmol/L,雌二醇均<18.35 pmol/L,促黄体生成素(LH)均<0.1 U/L,无明显变化,F-S组术前催乳素(PRL)中位数为13.44μg/L,术后中位数为12.3μg/L,对照组术前催乳素中位数为15.45μg/L,术后为10.34μg/L,比较手术前后变化,P=0.732,差异无统计学意义。F-S组促卵泡成熟激素(FSH)术前中位数为1.18 U/L,术后为1.61 U/L;对照组FSH术前中位数为1.21 U/L,术后1.10 U/L,两组比较,F-S组术后较术前增高,P=0.032,P<0.05,差异有统计学�Objective To Evaluate the clinic effect of two-staged laparoscopic Fowler-Stephens orchiopexy in the treatment of high cryptorchidism,and compare it with laparoscopic orchiopexy treatment without disconnecting spermatic vessels.Methods A retrospective analysis was conducted on 20 cases of children with high cryptorchidism who were treated with two-staged Fowler-Stephens orchiopexy from January 2015 to April 2019(F-S group).All the children in this group had unilateral cryptorchidism,age 6 to 18 months.The average age was 13.5 months.Seven cases were on the left side,and 13 cases were on the right side.There were 20 control children in the same age group who were treated with testicular fixation without disconnecting spermatic vessels,age 6 to 18 months.The average age was 12.5 months.Six cases were on the left side,and 14 cases were on the right side.Testicular ultrasonography and sex hormone examination were conducted before operation.F-S group met the indications for Fowler-Stephens surgical.In the first stage,the testicular vessels were doubly clipped at a site away from the testis in laparoscopic,and the second stage was scheduled about 6 months after the first stage.The children in the control group were treated with laparoscopic orchiopexy without disconnect spermatic vessels.The two groups were followed up to 6 months after the operation,and the testicular volume and sex hormone indexes of the two groups were measured.The testicular volume and sex hormones before and after the operation of the F-S group and the control group were respectively subjected to a self-control study,and a hormone comparison study was carried out between the two groups of children.Results Both the F-S group and the control group successfully fixed the testes in the scrotum without tension during the operation.In both groups,20 cases of testicular positions were reexamined 6 months after the operation without retraction.All the patients had a viable testis in scrotum after operation.Two of F-S group had an atrophic testis in the sc

关 键 词：隐睾 Fowler-Stephens分期手术 腹腔镜 性激素 

分 类 号：R726.9[医药卫生—儿科]