腹腔镜分期牵引睾丸固定术(Shehata术)治疗小儿高位隐睾19例并文献复习  

Staged laparoscopic traction-orchiopexy(Shehata technique)for pediatric high cryptorchidism:a serial report of 19 children with a literature review

作　　者：张宝欣 余中景 李焕源 袁马保 林镇营 Zhang Baoxin;Yu Zhongjing;Li Huanyuan;Yuan Mabao;Lin Zhenying(Department of Pediatric Surgery,Bao'an District Women&Children's Hospital,Shenzhen 518102,China)

机构地区：[1]深圳市宝安区妇幼保健院儿外科,深圳518102

出　　处：《中华小儿外科杂志》2023年第3期243-247,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨腹腔镜下分期牵引睾丸固定术(Shehata术)治疗小儿高位隐睾的疗效。方法回顾性分析2018年2月至2022年5月深圳市宝安区妇幼保健院收治的19例一次性手术无法将睾丸无张力下降至阴囊、使用Shehata术治疗的患儿,患儿年龄范围为1.02~13.50岁,平均年龄为4.12岁。同时检索Pubmed、Embase、Cochrane、中国知网及万方数据库,对有关Shehata术的临床研究进行系统复习及分析。结果所有患儿Ⅰ期手术通过彻底的游离精索血管和输精管,同时将患侧睾丸固定在对侧髂前上棘内上方附近,Ⅱ期手术均发现患侧睾丸血管及输精管较Ⅰ期手术明显增长,睾丸血管及输精管与腹壁无严重粘连,睾丸无萎缩,血运良好,顺利下降并固定睾丸于阴囊中。术后随访睾丸均固定于阴囊内,血运良好,较术前无萎缩。Wilcoxon配对秩和检验分析提示术后睾丸体积大于术前睾丸体积且差异具有统计学意义(P=0.032)。文献检索显示共有4篇文献报道了187例Shehata术治疗小儿高位隐睾的病例,发生睾丸滑脱有18例(9.62%,18/187);140例患儿中Ⅱ期术后有20例(14.28%,20/140)睾丸位于阴囊顶部或更高部位、睾丸血管受损或睾丸缩小;47例患儿中Ⅱ期术后有1例(2.13%,1/47)睾丸发生轻度萎缩。结论Shehata术保留了睾丸的主要血管,可利用肠管重力缓慢牵拉并延长精索血管及输精管,具有一定的安全性和可靠性。Objective To explore the efficacy of staged laparoscopic traction-orchiopexy(Shehata technique)for high cryptorchidism in children.Methods From February 2018 to May 2022,retrospective analysis of Shehata technique was performed for testes with a failed return to scrotum in one operation.The average age was 4.12(1.02-13.50)years.The databases of PubMed,Embase,Cochrane Review,China National Knowledge Infrastructure and WanFang were searched for retrieving the studies of evaluating the clinical efficacy of Shehata technique for high cryptorchidism.Results Testicular vessels and vas deferens were completely mobilized initially and testis was fixed in upper part of anterior superior iliac spine.Blood supply of testis was satisfactory without atrophy or severe adhesion and testis could be brought to scrotum in stage Ⅱ surgery.Postoperative ultrasonic reexamination revealed that testis was fixed with a decent blood supply in scrotum.Wilcoxon matched-pair signed rank test indicated that volume of postoperative testes was significantly higher than preoperative testes(P=0.032).Four studies involving 187 children were retrieved.Slippage of traction stitch occurred in 18/187 cases(9.62%).Testes at high scrotal position or higher,impaired vascularity on Doppler or smaller size(<75%of another side or normal control)after stage Ⅱ surgery occurred in 20/140 cases(14.28%).Mild testicular atrophy occurred in 1/47 cases(2.13%).Conclusions With some level of security and reliability,Shehata technique preserves the major vessels of testis.And intestinal gravity may slowly pull and lengthen testicular vessels and vas deferens.

关 键 词：腹腔镜 高位隐睾 Shehata术 Fowler-Stephens睾丸固定术 

分 类 号：R726.9[医药卫生—儿科]