腹腔镜睾丸下降固定术中关闭内环口的必要性  

Necessity of closing the internal ring in laparoscopic testicular descending fixation

作　　者：王婉蓉 程时刚 郭辉 WANG Wan-rong;CHENG Shi-gang;GUO Hui(School of Medicine,Wuhan University of Science and Technology,Wuhan Hubei 430065,China;Department of Surgery,Maternal and Child Health Hospital of Hubei Province,Tongji Medical College,Huazhong University of Science and Technology,Wuhan Hubei 430070,China)

机构地区：[1]武汉科技大学医学院,湖北武汉430065 [2]华中科技大学同济医学院附属湖北妇幼保健院外科,湖北武汉430070

出　　处：《局解手术学杂志》2023年第1期53-56,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：湖北省第二届医学领军人才工程。

摘　　要：目的 探讨腹腔镜睾丸下降固定术中不关闭内环口时腹股沟斜疝发生的可能性。方法 回顾性分析行腹腔镜睾丸下降固定术的142例(150侧睾丸,其中双侧8例)隐睾合并同侧内环口开放患儿的临床资料,按照术中是否缝合腹膜关闭内环口将患儿分为开放组(112例,118侧)和对照组(30例,32侧),开放组术中不缝合腹膜关闭内环口,对照组术中缝合腹膜关闭内环口。比较2组患儿的手术时间、睾丸下降情况及并发症发生情况。结果 开放组的手术时间为(62.06±7.83)min,对照组的手术时间为(67.31±8.42)min, 2组比较差异具有统计学意义(P<0.05)。所有患儿的睾丸均成功下降固定于阴囊,开放组中有1例患儿术中精索血管出血。术后随访6~18个月,睾丸回缩至阴囊上方9例(2例为双侧回缩),共11侧,占比7.3%,Fowler-StephensⅡ期手术后1例睾丸萎缩。开放组中有1例(0.8%)患儿术后发生腹股沟斜疝,对照组术后未发生腹股沟斜疝,2组比较差异无统计学意义(P>0.05)。结论 尽管存在腹股沟斜疝发生的风险,腹腔镜睾丸下降固定术中常规缝合腹膜关闭内环口可能不是必须的。Objective To investigate the possibility of indirect inguinal hernia without closing the internal ring during laparoscopic testicular descending fixation. Methods The clinical data of 142 children(150 testes, 8 of which were bilateral) with cryptorchidism combined with ipsilateral open internal ring who underwent laparoscopic testicular descending fixation were retrospectively analyzed. According to whether the internal ring was closed with suturing the peritoneum during the operation, the children were divided into the open group(112 cases, 118 testes) and the control group(30 cases, 32 testes). The open group did not close the internal ring with suturing the peritoneum during the operation, and the control group closed the internal ring with suturing the peritoneum during the operation. The operative time, profile of testicular descending and incidence of complication were compared between the two groups.Results The operative time of the open group was(62.06 ± 7.83) minutes, and that of the control group was(67.31 ± 8.42) minutes, the difference between the two groups was statistically significant(P<0.05). The testes of all children were successfully descended and fixed into the scrotum, and 1 child in the open group had intraoperative hemorrhage of spermatic cord blood vessel. After followed up for 6 to 18 months, 9 cases(2 cases were bilateral retraction) had testicular retraction above the scrotum, with a total of 11 testicles, accounting for 7.3%;1 case had testicular atrophy after stage Ⅱ operation of Fowler Stephens. 1 case(0.8%) occurred indirect inguinal hernia after the operation in the open group, while no cases of indirect inguinal hernia occurred in the control group, and there was no statistically significant difference between the two groups(P>0.05).Conclusion Despite the risk of an indirect inguinal hernia, it may not be necessary to close the internal ring with conventional suturing the peritoneum during laparoscopic testicular descending fixation.

关 键 词：腹腔镜 隐睾 内环口 腹腔内睾丸 腹股沟斜疝 

分 类 号：R683.42[医药卫生—骨科学]