腹腔镜下分期Fowler-Stephens手术治疗小儿腹腔内高位隐睾的体会  

Clinical Application of Laparoscopic Two-stage Fowler-Stephens Surgery for Intraabdominal High Cryptorchidism in Children

作　　者：齐灿[1] 周云[1] 褚登伟 侯璇 靳红霞 张铁军[1] 贾鹏宇 许鹏 高靖达 史丽萍[1] 胡岩[1] 柴红超[1] Qi Can;Zhou Yun;Chu Dengwei(Department of Urology, Children’s Hospital of Hebei Province, Shijiazhuang 050000, China)

机构地区：[1]河北省儿童医院泌尿外科,石家庄050000

出　　处：《中国微创外科杂志》2021年第5期450-453,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：河北省重点研发计划项目-民生科技专项(19277796D);2019年度河北省医学科学研究课题计划(20190793)。

摘　　要：目的探讨腹腔镜下分期Fowler-Stephens手术治疗腹腔内高位隐睾的临床效果。方法2012年1月~2018年11月我院采用分期Fowler-Stephens手术治疗单侧腹腔内高位隐睾32例。一期手术时评估睾丸位置符合分期Fowler-Stephens手术条件,离断精索血管,尽量减少游离范围,注意保护输精管和精索血管吻合支。一期手术后6个月行Fowler-Stephens二期手术,游离输精管及周围组织,钳夹精索血管残端,“翻跟头”牵引睾丸下降至阴囊并无张力固定睾丸于阴囊内。结果32例均完成顺利手术,一期手术后睾丸均存活,二期手术顺利引降固定于阴囊。一期手术时间(17.6±0.7)min,二期手术时间(58.9±0.9)min。术后复查30例睾丸正常生长发育,2例术后睾丸萎缩。30例术中测量睾丸最大直径(1.31±0.05)cm,术后12个月测量睾丸最大直径(1.82±0.07)cm。术前患侧睾丸与健侧睾丸体积比0.341±0.029,显著小于术后体积比0.389±0.019(t=-8.768,P=0.024)。结论腹腔镜下分期Fowler-Stephens手术是治疗腹腔内高位隐睾具有安全、有效、术后并发症少的优势。Objective To explore the clinical efficacy of laparoscopic two-stage Fowler-Stephens surgery in the treatment of high cryptorchidism in children.Methods A total of 32 cases of unilateral intraabdominal high cryptorchidism were treated by two-stage Fowler-Stephens surgery in our hospital from January 2012 to November 2018.During the first stage of the operation,the testicular position was evaluated to do the Fowler-Stephens operation.The spermatic vessels were severed as the first stage of the operation.The surgical range was controlled as much as possible,and the vas deferens and anastomotic branches of spermatic cord should be protected.The second operation was performed after 6 months.The vas deferens and surrounding tissues were dissociated and the spermatic vascular stump was clamped.The testicle was"Somersault"brought down to the scrotum by traction and then was fixed in the scrotum without tension.Results All the 32 operations were successful.All the testes survived after stageⅠoperation and were successfully brought down and fixed in scrotum during stageⅡoperation.The operation time was(17.6±0.7)min in the first stage and(58.9±0.9)min in the second stage.There were 2 cases of testicular atrophy and 30 cases of normal development.The maximum testicular diameter was measured in 30 children during operation(1.31±0.05)cm and after 12 months(1.82±0.07)cm.The volume ratio of the affected testis to the healthy testis was 0.341±0.029 before operation,which was significantly smaller than the volume ratio after operation(0.389±0.019,t=-8.768,P=0.024).Conclusion Laparoscopic Fowler-Stephens surgery for the treatment of high cryptorchidism is safe and effective,with less postoperative complications.

关 键 词：隐睾 Fowler-Stephens手术 腹腔镜 睾丸萎缩 

分 类 号：R726.9[医药卫生—儿科]