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目的探索腹腔镜在未触及睾丸的隐睾患儿中的应用。方法总结2005年1月至2007年7月我院收治53例临床未触及睾丸的隐睾患儿的临床资料,年龄1~15岁,平均3.17岁;左侧24例,右侧16例,双侧13例,总计66侧。根据睾丸位置高低,腹腔镜辅助下行精索松解、睾丸固定或探查。结果53例中24例(32侧)睾丸均在腹腔镜下确定位置,其中22例(28侧)为低位腹腔内隐睾,2例(4侧)为高位腹腔内隐睾。28侧低位、1侧高位腹腔内隐睾行精索松解一期睾丸固定术,2侧高位行分期睾丸固定,1侧高位行分期Fowler-Stephens(FS)手术。术后随访3~24个月(平均8个月),无睾丸萎缩、回缩。3例(右侧)精索稀疏发散,为腹腔内睾丸缺失,终止手术。26例(31侧)精索输精管入内环,其中3例(左侧)患儿家长拒绝手术探查;9例(14侧)于腹股沟发现睾丸,行睾丸固定术;14例睾丸扁片状,发育不良予以切除。结论腹腔镜对触及不到的睾丸有诊断及治疗作用。对于腹腔内睾丸,精索游离松解后睾丸活动程度良好,则行一期睾丸固定术,否则可行分期睾丸固定术。对于精索输精管入内环的患儿有腹股沟探查的必要。
Objective To explore the use of laparoscopy in children with cryptorchidism without touching the testes. Methods The clinical data of 53 children with cryptorchism who had not touched the testis in our hospital from January 2005 to July 2007 were aged from 1 to 15 years (average 3.17 years). There were 24 cases on the left and 16 cases on the right. 13 cases of side, a total of 66 sides. According to the level of testicular position, laparoscopic assisted descending spermatic cord, testicular fixation or exploration. Results Twenty-four cases (32 sides) of testis in 53 cases were confirmed laparoscopically. Among them, 22 cases (28 sides) had low intraperitoneal cryptorchidism and 2 cases (4 sides) had high intraperitoneal cryptorchidism. 28 low side, 1 side of the high intra-abdominal cryptorchidism spermatic cord release a testicular fixation, 2 high-line staging testicular fixation, 1 high staging Fowler-Stephens (FS) surgery. All patients were followed up for 3-24 months (average 8 months), without testicular atrophy and retraction. Three cases (right) sparse spermatic dissection, intraperitoneal testicular loss, termination of surgery. Twenty-six cases (31 sides) of the spermatic tube were injected into the inner ring, of which 3 cases (left side) of the children refused surgery; 9 cases (14 sides) found the testes in the inguinal groin and testicular fixation; Malnourished to be removed. Conclusions Laparoscopy has diagnostic and therapeutic effects on inaccessible testicles. For intraperitoneal testis, spermatic cord after free release of testicular activity is good, then a testicular fixation, or viable testicular fixation. For the spermatic tube into the inner ring of children with groin exploration necessary.