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目的探讨经脐进行单孔多通道腹腔镜下小儿的隐睾下降固定术的可行性并评价治疗效果。方法自09年6月至10月,共13例(14侧)患者接受该手术,均取脐作为操作通道,用切开法进入腹腔,将自制单孔多通道套管经脐置入腹腔,从通道内进腹腔镜及两个腹腔镜器械进行操作。将睾丸及精索血管充分游离后,通过腹股沟管将睾丸固定到肉膜外层,用可吸收线缝合伤口。结果手术均获成功,其中11例行一期隐睾下降固定术,2例因睾丸发育不良行睾丸切除术。套管制作平均时间为3min,通道建立时间为5±2min,手术时间17±7min,术中平均出血30±12ml,术后住院时间3.5±1.1d。术中、术后均无并发症发生,术后2周复查脐部切口无明显疤痕,睾丸位于阴囊内。结论经脐单孔腹腔镜隐睾下降固定术治疗小儿隐睾简单易行、安全有效,但操作难度较常规腹腔镜手术复杂,脐部单孔多通道套管及腹腔镜手术器械有待进一步完善和改进。单孔法创伤更小,几乎无疤痕,是一种具有一定优势的微创手术方法,但须掌握正确的操作方法。
Objective To investigate the feasibility of single-hole multi-channel laparoscopic pediatric cryptorchidism descending fixation through the umbilical cord and to evaluate the therapeutic effect. Methods From June 2009 to October 2009, a total of 13 patients (14 patients) underwent the operation. All the patients received umbilical cord as the operation channel. The incision method was used to enter the abdominal cavity. The self-made single-hole multi-channel cannula was placed into the abdominal cavity through the umbilical cord. From the channel into the laparoscopic and two laparoscopic instruments to operate. After the testes and spermatic vessels are fully free, the testes are fixed to the outer layer of the edema through the inguinal canal, and the suture is absorbable. Results All the operations were successful. Eleven cases underwent primary cryptorchis declination fixation and two cases underwent orchiectomy due to testicular hypoplasia. The average time of cannula preparation was 3min, the time of channel establishment was 5 ± 2min, the operation time was 17 ± 7min, the intraoperative average bleeding was 30 ± 12ml and the postoperative hospital stay was 3.5 ± 1.1d. No intraoperative and postoperative complications occurred, 2 weeks postoperative umbilical incision without significant scar, testis located in the scrotum. Conclusions The treatment of cryptorchidism in children with single hole umbilical laparoscopic descending cryptorchidism is simple, safe and effective, but the operation is more complicated than conventional laparoscopic surgery. Umbilicus single-hole multi-channel cannula and laparoscopic surgical instruments need to be further improved and Improve. Single-hole method less trauma, scar-free, is a kind of minimally invasive surgery has some advantages, but must grasp the correct method of operation.