经腹腔镜Fowler-StephensⅠ期手术及分期手术治疗儿童高位隐睾的临床对比研究  

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

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 苏哲 Song Jinqiu;Bai Dongsheng;Hao Chunsheng;Wang Hongyang;Qiu Ying;Niu Zhishang;Zhang Chenjie;Liu Xiaomeng;Su Zhe(Department of Urology Surgery,Children's Hospital Affiliated to 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：《北京医学》2020年第12期1193-1196,共4页Beijing Medical Journal

基　　金：北京市科技计划(Z171100001017223)。

摘　　要：目的评价腹腔镜下Fowler-StephensⅠ期手术及分期手术两种手术方式治疗高位隐睾的临床效果。方法选取2015年1月2019年12月首都儿科研究所附属儿童医院泌尿外科采用Fowler-StephensⅠ期手术治疗的32例高位隐睾患儿(F-SⅠ期组)及同期采用Fowler-Stephens分期手术治疗的30例高位隐睾患儿(F-S分期组),随访至术后6个月。两组手术前后均行睾丸超声检查及性激素检查并进行对比研究。结果两组手术均顺利将睾丸无张力固定于阴囊内,均在术后6个月复查睾丸位置无回缩。F-SⅠ期组有2例睾丸体积较术前有减小,术前平均容积(0.33±0.16)ml,术后(0.37±0.13)ml;F-S分期组有3例睾丸体积较术前减小,术前平均容积(0.34±0.18)ml,术后(0.38±0.15)ml,组间比较差异无统计学意义(P>0.05)。F-SⅠ期组及F-S分期组手术前后睾酮均<0.087 nmol/L(正常值0.42~0.72 nmol/L),雌二醇(estradiol,E2)均<18.35 pmol/L(正常值<76.1 pmol/L),黄体生成素(luteinizing hormone,LH)均<0.1 IU/L(正常值<1.4 IU/L),组间比较差异无统计学意义(P>0.05)。F-SⅠ期组术后催乳素(prolactin,PRL)较术前增高,F-S分期组术后较术前降低,组间比较差异无统计学意义(P>0.05)。两组术后促卵泡激素(follicle-stimulating hormone,FSH)均较术前增高,组间比较差异无统计学意义(P>0.05)。两组术后孕酮(progesterone,PROG)均较术前降低,差异有统计学意义(P<0.05)。结论腹腔镜Fowler-StephensⅠ期手术及分期手术是治疗精索长度不足以将睾丸降至阴囊的特殊高位隐睾的有效方法。两种术式效果差异不明显,Ⅰ期手术减少了手术次数,更值得推荐。精索血管离断对激素变化确有影响,选择此术式需谨慎及充分评估。Objective To evaluate the treatment effect of high cryptorchidism of children with single-staged and twostaged laparoscopic Fowler-Stephens orchiopexy.Methods A retrospective analysis was conducted on 32 cases of children with high cryptorchidism who were treated with single-staged Fowler-Stephens orchiopexy and 30 cases who were treated with two-staged Fowler-Stephens orchiopexy from January 2015 to December 2019.All the children in two groups had unilateral cryptorchidism.The age was 6-18 months in the single-staged group,with the average of 13.5 months,13 cases on left side,19 cases on right side.In the two-staged group,the age was 6-18 months,with the average of 12.5 months,13 cases on left side,17 cases on right side.Testicular ultrasonography and sex hormone were detected before operation.Two groups of children conformed to Fowler-Stephens surgical indications.In the two-staged group,the testicular vessels were doubly clipped at a site away from the testis in laparoscopic,and the second stage was scheduled about six months after the first.And in the single-staged group,the spermatic vessels were disconnected and testicular fixation in the same time.Testicular ultrasound and sex hormone were reexamined six months after operation.A self-control study on testicular volume and sex hormones measured by ultrasound before and after operation for each child were conducted.Results All the patients had a viable testis in scrotum after operation.Two cases in sing-staged group and three in two-staged group had an atrophic testis in the scrotum,and the others had a good vascularization detected on echo color doppler ultrasound.Testosterone(T),estradiol(E2)and luteinizing hormone(LH)did not change after operation.The change of follicle-stimulating hormone(FSH)and prolactin(PRL)had no statistical difference.Progesterone(PROG)was lower than that before operation.Compared with the control group,PROG had statistical significance.Conclusions Patients have a viable testis in the scrotum after single-staged and twostaged laparo

关 键 词：高位隐睾 Fowler-Stephens手术 腹腔镜 性激素 

分 类 号：R726.9[医药卫生—儿科]