腹腔镜脐内侧韧带离断在Fowler-Stephens二期隐睾下降固定术中的应用效果分析  

Effect of laparoscopic medial umbilical ligament dissection in two-stage Fowler-Stephens orchiopexy

作　　者：郭战[1] 杨艳芳[1] 毕建朋 李梁斌 陈小朋 樊宏杰 李星[1] 院恩萌[1] 花朝阳 Guo Zhan;Yang Yanfang;Bi Jianpeng;Li Liangbin;Chen Xiaopeng;Fan Hongjie;Li Xing;Yuan Enmeng;Hua Chaoyang(Department of Urology,Children′s Hospital Affiliated to Zhengzhou University,Henan Children′s Hospital,Zhengzhou Children′s Hospital,Zhengzhou 450018,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院泌尿外科,郑州450018

出　　处：《中华实用儿科临床杂志》2024年第10期770-773,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：河南省科技攻关项目(182102310413)。

摘　　要：目的:总结腹腔镜脐内侧韧带离断在Fowler-Stephens(F-S)二期隐睾下降固定术中的临床应用效果。方法:病例系列研究。回顾性分析郑州大学附属儿童医院泌尿外科2020年3月至2022年7月行F-S二期隐睾下降固定术患儿的临床资料,统计手术时间、出血量、术后术区疼痛程度,术后1个月、6个月、1年手术侧睾丸位置、大小、质地及家长满意度等指标。正态分布的计量资料用±s表示,采用独立样本及配对样本t检验。结果:共计18例患儿临床资料完整,年龄7个月至10岁,平均2岁,其中左侧10例,右侧8例,术中未离断脐内侧韧带直接将睾丸降至阴囊的12例(A组),其中左侧7例,右侧5例;6例不能降至阴囊,后给予离断脐内侧韧带(B组),睾丸无张力拉至阴囊内,其中左侧3例,右侧3例。A组年龄[(0.88±0.26)岁]小于B组[(4.32±2.96)岁](t=-4.11,P<0.05);B组手术时间[(47.50±1.87)min]稍长于A组[(46.17±1.47)min](t=-1.66,P>0.05)。B组手术出血量[(5.18±0.42)mL]稍多于A组[(4.96±0.20)mL](t=-1.56,P>0.05),两组术后术区均轻度疼痛,患儿可耐受。术后1个月复查睾丸位置、大小、质地及满意度两组无明显差异。术后6个月复查:A组1例睾丸轻度回缩,位于阴囊上级;B组睾丸无明显回缩;两组睾丸大小、质地均较术前无明显变化,彩超提示血供可;家长满意度尚可。术后1年复查:A组1例睾丸位于阴囊上级,2例无明显发育;余术后睾丸体积[(0.51±0.03)mL]较术前[(0.31±0.02)mL]增加(t=-22.97,P<0.05);B组睾丸位置正常,1例无明显发育,余睾丸体积[(0.45±0.02)mL]较术前[(0.24±0.01)mL]增加(t=-32.87,P<0.05);A组睾丸体积增加值[(0.20±0.03)mL]与B组[(0.20±0.01)mL]比较差异无统计学意义(t=-1.19,P>0.05)。结论:在脐内侧韧带明显影响F-S二期睾丸下降的情况下,给予离断,可明显缩短睾丸下降至阴囊距离,术后睾丸位置好,睾丸发育较F-S二期术后无明显影响。ObjectiveTo summarize the clinical effect of laparoscopic medial umbilical ligament dissection in two-stage Fowler-Stephens orchiopexy(FSO).MethodsA case-series study was conducted.Clinical data of children who underwent two-stage FSO from March 2020 to July 2022 in the Department of Urology,Children′s Hospital Affiliated to Zhengzhou University were retrospectively analyzed.Indexes such as operation time,amount of blood loss,degree of postoperative pain in the operative area,testicular position,size,texture and parental satisfaction at the operative side 1 month,6 months and 1 year after surgery were collected.Measurement data of normal distribution were expressed as Mean±SD and compared using the independent sample and paired sample t-tests.ResultsA total of 18 children with complete clinical data were included in this study.Their age ranged from 7 months to 10 years,with an average of 2 years.There were 10 cases of FSO on the left side and 8 cases on the right side.Twelve cases(group A)had the testis directly descending to the scrotum without amputation of the umbilical medial ligament during the operation,including 7 cases on the left side and 5 cases on the right side;6 cases(group B)with testis not descending to the scrotum received amputation of the umbilical medial ligament,and the testicle was pulled into the scrotum without tension,including 3 cases on the left side and 3 cases on the right side.The age of patients in group A[(0.88±0.26)years]was lower than that in group B[(4.32±2.96)years](t=-4.11,P<0.05).The operation time of patients in group B was(47.50±1.87)min,slightly longer than that in group A[(46.17±1.47)min](t=-1.66,P>0.05).The intraoperative bleeding volume in group B was(5.18±0.42)mL,slightly higher than that in group A[(4.96±0.20)mL](t=-1.56,P>0.05).Patients in both groups had mild pain in the operative area,which could be tolerated by the children.There were no significant differences in testicular position,size,texture and satisfaction between the two groups 1 month after surger

关 键 词：隐睾 脐内侧韧带 Fowler-Stephens手术 

分 类 号：R726.9[医药卫生—儿科]