经海氏三角下降途径的腹腔镜Fowler-Stephens分期睾丸固定术治疗儿童腹腔型隐睾  

Laparoscopic staged Fowler-Stephens orchiopexy for the intra-abdominal cryptorchidism through the tunnel of Hesselbach in children

作　　者：李骥[1] 张谦[1] 郭立华[1] 王磊[1] 孙权[1] 刘艳飞 刘宁[1] 王冰蕊 范应中[1] LI Ji;ZHANG Qian;GUO Lihua;WANG Lei;SUN Quan;LIU Yanfei;LIU Ning;WANG Bingrui;FAN Yingzhong(Department of Pediatric Surgery, the First Affiliated Hospital,Zhengzhou University, Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院小儿外科,郑州450052

出　　处：《郑州大学学报（医学版）》2021年第1期128-131,共4页Journal of Zhengzhou University(Medical Sciences)

摘　　要：目的:分析经海氏三角下降途径的腹腔镜Fowler-Stephens分期手术在儿童腹腔型隐睾治疗中的可行性和优势。方法:回顾性分析2017年6月至2019年6月期间郑州大学第一附属医院小儿外科收治的体表不能触及睾丸的患儿,均进行腹腔镜探查,将腹腔内可探及睾丸的病例纳入本研究,对所有纳入患儿均进行Fowler-Stephens分期手术,观察分期首次术中睾丸引带、输精管血供及分期二次术中输精管血供侧支循环建立情况,术后彩超随诊睾丸体积及实质回声情况。结果:16例腹腔型隐睾患儿纳入该研究序列,分期首次手术发现睾丸位置越高,睾丸引带发育越差或未发育,睾丸位置较低者输精管在内环口区域有返折。分期二次手术发现患侧输精管的血供较前增生明显,所有隐睾患儿术后彩超提示实质回声均匀,无萎缩现象出现。结论:腹腔型隐睾的睾丸引带随着睾丸位置越高而发育越差,分期手术有助于输精管建立充分的侧支循环,经海氏三角下降途径的腹腔镜Fowler-Stephens分期睾丸固定术安全有效,可将睾丸下降至满意位置。Aim:To analyze the feasibility and advantage of laparoscopic staged Fowler-Stephens orchiopexy for the intra-abdominal cryptorchidism through the tunnel of Hesselbach in children.Methods:A retrospective analysis was conducted on children with nonpalpable cryptorchidism admitted to Department of Pediatric Surgery,the First Affiliated Hospital,Zhengzhou University from June 2017 to June 2019.All the cases accepted laparoscopic exploration,whose testicle could be found entered into the study sequence.All the cases underwent the laparoscopic first and second stage Fowler-Stephens orchiopexy within 6 or 8 months.In the first stage,testicular gubernaculum and blood supply of vas deferens should be observed.In the second stage,collateral circulation of intraoperative blood supply of vas deferens should be noticed.Testicular volume and ultrasound of testicular parenchyma were paid attention in the postoperative follow-up.Results:Sixteen cases with intra-abdominal testis entered into the study sequence.During the first stage of surgery,it was observed that the testicular gubernaculum was more poorly dysplastic with the testicle higher and some of vas deferens returned to abdominal cavity after they went into the groin.During the second stage of the operation,all the blood supply of vas deferens was significantly increased compared with the previous one.All testes were pulled into the middle of the scrotum.There was no atrophied testis and all parenchymal echo were normal.Conclusion:The higher the testes locate,the poorer the testicular gubernaculum grows in the intra-abdominal cryptorchidism.Two staged Fowler-Stephens method can help intra-abdominal testis and vas deferens to establish the collateral circulation.It is safe and effective for laparoscopic staged Fowler-Stephens orchidopexy through the tunnel of Hesselbach in children.The testes can be pulled into the satisfied position in the scrotum.

关 键 词：腹腔型隐睾 Fowler-Stephens术 海氏三角 睾丸引带 儿童 

分 类 号：R726.9[医药卫生—儿科]