CAJ | 학술논문

目的探讨改良Bianchi(阴囊中缝单一切口)手术治疗低位双侧隐睾的可行性、手术操作要点以及近期效果.方法 2010年9月至2011年5月采用改良Bianchi术式治疗先天性双侧隐睾共9例,年龄1岁2个月至11岁4个月,平均5岁10个月.所有患儿平卧位均可在腹股沟区触及未降的睾丸.术前B超均未提示合并鞘膜积液或者斜疝.手术采取经阴囊中缝切口入路,将睾丸鞘膜囊分离至外环水平,如鞘状突呈开放状,则完整分离鞘突并充分游离至高位后双层结扎.根据精索松解的具体情况采取保留或切断睾丸引带,术后睾丸均位于各自阴囊中部或底部.术后2～3 d换药,伤口无渗出、红肿即可出院.所有患儿平均随访8个月.观察手术前后睾丸体积变化,睾丸有无回缩,有无斜疝或鞘膜积液等并发症,家长和(或)患儿本身是否满意.睾丸体积根据B超数据使用Lambert公式进行计算.结果 9例患儿均顺利完成手术,所有睾丸术后位置满意,无回缩,无斜疝或鞘膜积液等并发症.手术前后体积比较未见萎缩(P＜0.01),家长及患儿均对手术效果表示满意.结论改良Bianchi手术治疗可触及隐睾损伤小,伤口隐蔽性很强、符合微创理念.尤其是在治疗双侧的低位以及滑动性隐睾时有较好的安全性和可操作性,中短期随访无并发症,有一定的临床运用价值.
목적 탐토개량Bianchi(음낭중봉단일절구)수술치료저위쌍측은고적가행성、수술조작요점이급근기효과.방법 2010년9월지2011년5월채용개량Bianchi술식치료선천성쌍측은고공9례,년령1세2개월지11세4개월,평균5세10개월.소유환인평와위균가재복고구구촉급미강적고환.술전B초균미제시합병초막적액혹자사산.수술채취경음낭중봉절구입로,장고환초막낭분리지외배수평,여초상돌정개방상,칙완정분리초돌병충분유리지고위후쌍층결찰.근거정색송해적구체정황채취보류혹절단고환인대,술후고환균위우각자음낭중부혹저부.술후2～3 d환약,상구무삼출、홍종즉가출원.소유환인평균수방8개월.관찰수술전후고환체적변화,고환유무회축,유무사산혹초막적액등병발증,가장화(혹)환인본신시부만의.고환체적근거B초수거사용Lambert공식진행계산.결과 9례환인균순리완성수술,소유고환술후위치만의,무회축,무사산혹초막적액등병발증.수술전후체적비교미견위축(P＜0.01),가장급환인균대수술효과표시만의.결론 개량Bianchi수술치료가촉급은고손상소,상구은폐성흔강、부합미창이념.우기시재치료쌍측적저위이급활동성은고시유교호적안전성화가조작성,중단기수방무병발증,유일정적림상운용개치.
Objective To explore the feasibility, surgical techniques and efficacy of modified Bianchi (single incision on scrotal median line) orchiopexy in children with low bilateral undescended testes. Methods From September 2010 to May 2011, 9 children aging from 14 to 136 months (average 70 months) with congenital bilateral undescended testes underwent modified Bianchi procedure in our department. The testis of them could be touched in groin area in supine position; hydrocele and hernia were not complicated in them via pre-operative ultrasonic examination. Operation was performed via scrotal median line approach to dissect the perididymis to the external inguinal ring. High ligation was performed if the processus vaginalis was found open. No need to dissect gubernaculums if the testis was released and remain in a scrotal position for less tension. Finally, testis was fixed onto the dartos pouch. All children were averagely followed up for 8 months (ranging from 3 months to 1 year). The occurrence of hernia or hydrocele formation, change of position and size of testes, were observed. Results All cases were successfully operated without complications. No testicular retract and atrophy, hernia and hydrocele formation was noted. The efficacy was satisfactory. Conclusions Bianchi procedure is feasible and safe procedure for low palpable undescended testes, especially for those gliding bilateral testes, and can be utilized in clinics.