隐睾手术方式选择及疗效分析
은고수술방식선택급료효분석
The optimal selection and curative efficacy of surgical procedures for children with cryptorchidism
  • 万方数据
    中华小儿外科杂志 중화소인외과잡지
    CHINESE JOURNAL OF PEDIATRIC SURGERY
    2012年 12期 923-927 ,共5页

    易钦君%何大维%林涛%李旭良%刘星%卞则栋%刘俊宏%刘丰%华燚%陆鹏%张德迎%魏光辉

    역흠군%하대유%림도%리욱량%류성%변칙동%류준굉%류봉%화일%륙붕%장덕영%위광휘

    隐睾%外科手术,微创性%治疗结果 隱睪%外科手術,微創性%治療結果
    은고%외과수술,미창성%치료결과
    Cryptorchidism%Surgical procedures,minimally invasive%Treatment outcome
    目的 分析对隐睾患儿采用不同手术方式的疗效,探讨隐睾最适宜的微创治疗方式.方法 回顾性分析2003年9月至2011年5月间在泌尿外科首次接受手术治疗的1720例(1933侧)隐睾患儿,年龄0.5～17.5岁(中位年龄3.3岁).术前麻醉状态下可扪及隐睾1365例(1536侧),未扪及隐睾355例(397侧).分别采用经腹腔镜、经腹股沟、经阴囊三种手术方式治疗,比较相同位置隐睾不同手术方式的睾丸降入阴囊率、术后睾丸萎缩或回缩并发症发生率,以及不同手术方式的围手术期并发症.结果 排除睾丸缺如或萎缩、横过异位睾丸以及腹腔镜下行Fowler-Stephens手术隐睾,共1661例(1869侧)隐睾纳入手术方式疗效分析.其中,1014例(1153侧)腹股沟型隐睾分别采用经腹腔镜(197侧)和经腹股沟(956侧)手术方式,术中睾丸降入阴囊率分别为100％(197/197)和99.4％(950/956),术后随访率分别为93.9％(185/197)和90.9％(869/956),睾丸萎缩率分别为0和0.2％(2/869),均无睾丸回缩,两种手术方式上述指标间比较,差异均无统计学意义(P＞0.05).351例(383侧)外环口型隐睾分别采用经腹腔镜(10侧)、经腹股沟(307侧)、经阴囊(66侧)手术方式,三种手术方式的睾丸降入阴囊率均为100％,术后随访率分别为100％(10/10)、94.1％(289/307)和97.0％(64/66),均无睾丸萎缩或回缩.355例(397侧)术前麻醉状态下未扪及隐睾,分别经腹腔镜(144侧)和经腹股沟(253侧)两种手术方式探查,探及睾丸率分别为84.0％(121/144)和88.1％(223/253),差异无统计学意义(P＞0.05)；其中,296例(333侧)腹腔型隐睾分别采用经腹腔镜(110侧)和经腹股沟(223侧)两种手术方式,睾丸降入阴囊率分别为90％(99/110)和88.3％(197/223),术后随访率分别为91.8％(101/110)和92.4％(206/223),睾丸萎缩率分别为1.0％(1/101)和1.5％(3/206),睾丸回缩率分别为1.0％(1/101)和1.9％(4/206),两种手术方式上述指标间差异均无统计学意义(P＞0.05).经腹股沟(1486侧)、经腹腔镜(317侧)两种术式的围手术期并发症发生率分别为0.5％ (7/1486)和0.9％(3/317),差异无统计学意义(P＞0.05).经阴囊(66侧)术式无围手术期并发症发生.结论 首次接受手术治疗、术前在麻醉状态下能将睾丸推至外环口及以下的隐睾患儿,首选经阴囊切口睾丸下降固定术；腹腔型、腹股沟型隐睾,对于有成熟腹腔镜下手术经验的术者,可优先采用经腹腔镜探查及睾丸下降固定.
    목적 분석대은고환인채용불동수술방식적료효,탐토은고최괄의적미창치료방식.방법 회고성분석2003년9월지2011년5월간재비뇨외과수차접수수술치료적1720례(1933측)은고환인,년령0.5～17.5세(중위년령3.3세).술전마취상태하가문급은고1365례(1536측),미문급은고355례(397측).분별채용경복강경、경복고구、경음낭삼충수술방식치료,비교상동위치은고불동수술방식적고환강입음낭솔、술후고환위축혹회축병발증발생솔,이급불동수술방식적위수술기병발증.결과 배제고환결여혹위축、횡과이위고환이급복강경하행Fowler-Stephens수술은고,공1661례(1869측)은고납입수술방식료효분석.기중,1014례(1153측)복고구형은고분별채용경복강경(197측)화경복고구(956측)수술방식,술중고환강입음낭솔분별위100％(197/197)화99.4％(950/956),술후수방솔분별위93.9％(185/197)화90.9％(869/956),고환위축솔분별위0화0.2％(2/869),균무고환회축,량충수술방식상술지표간비교,차이균무통계학의의(P＞0.05).351례(383측)외배구형은고분별채용경복강경(10측)、경복고구(307측)、경음낭(66측)수술방식,삼충수술방식적고환강입음낭솔균위100％,술후수방솔분별위100％(10/10)、94.1％(289/307)화97.0％(64/66),균무고환위축혹회축.355례(397측)술전마취상태하미문급은고,분별경복강경(144측)화경복고구(253측)량충수술방식탐사,탐급고환솔분별위84.0％(121/144)화88.1％(223/253),차이무통계학의의(P＞0.05)；기중,296례(333측)복강형은고분별채용경복강경(110측)화경복고구(223측)량충수술방식,고환강입음낭솔분별위90％(99/110)화88.3％(197/223),술후수방솔분별위91.8％(101/110)화92.4％(206/223),고환위축솔분별위1.0％(1/101)화1.5％(3/206),고환회축솔분별위1.0％(1/101)화1.9％(4/206),량충수술방식상술지표간차이균무통계학의의(P＞0.05).경복고구(1486측)、경복강경(317측)량충술식적위수술기병발증발생솔분별위0.5％ (7/1486)화0.9％(3/317),차이무통계학의의(P＞0.05).경음낭(66측)술식무위수술기병발증발생.결론 수차접수수술치료、술전재마취상태하능장고환추지외배구급이하적은고환인,수선경음낭절구고환하강고정술；복강형、복고구형은고,대우유성숙복강경하수술경험적술자,가우선채용경복강경탐사급고환하강고정.
    Objective To explore the optimal selection of minimally invasive approach for cryptorchidism through evaluation of the curative efficacy of different surgical procedures for children with cryptorchidism.Methods Between September 2003 and May 2011,total 1720 patients (1933sides) with cryptorchidism underwent primary surgery in our department.A retrospective analysis of their clinical data was taken.The median age was 3.3 years (ranging from 0.5 to 17.5 years old).Among them,1365 patients (1536 sides) were touched palpable testis and 355 patients (397 sides)were impalpable under anesthesia.We investigated and compared the rate of testis falling into scrotum,testicular atrophy and retraction after operation using differential surgical approaches including laparoscopic procedure,traditional inguinal procedure and transcrotal orchidopexy procedure.We also analyzed the perioperative complications in three procedures.Results Referring to the selection stand ard,the patients with absence or atrophy testis and transverse ectopic testis,as well undertaking Fowler-Stephens orchidopexy procedure were excluded.1661 patients (1869 sides) were involved in this study.Among them,1014 cases of (1153 sides) cryptorchidism with inguinal canalicular undescended testis respectively underwent laparoscopic (197 sides) and traditional inguinal (956 sides) orchidopexy,the rate of testis descent into the scrotum were 100％ (197/197) and 99.4％ (950/956),the follow-up rate were respectively 93.9 ％ (185/197) and 90.9 ％ (869/956) for both group,the incidence of testicular atrophy were 0 and 2 ％ (2/869),and testicular retraction was not found in both group,which indicated no statistically significant differences between them.For the 351 cases (383 sides) of cryptorchidism with external inguinal ring testis respectively underwent laparoscopic (10 sides),traditional inguinal (307 sides) and transcrotal (66 sides) orchidopexy,the rate of testis descent into the scrotum were 100％.The follov-up rate was 100％ (10/10),94.1％ (289/307) and 97.0％ (64/66) respectively in three groups,and testicular atrophy and retraction after operation was not found in them.The testes of 355 cases (397 sides) were preoperatively impalpable under anesthesia.The surgical exploration was respectively conducted by laparoscopic (144 sides) and inguinal (253 sides) procedures.84％(121/144) and 88.1％ (223/253) of patients was found testis in each group,and no statistically significant difference in them.Furthermore,296 cases (333 sides) of cryptorchidism with intra-abdominal testis respectively underwent laparoscopic (110 sides) and traditional inguinal (223 sides) orchidopexy,the rate of testis descent into the scrotum were respectively 90 ％ (99/110) and 88.3 ％ (197/223).The follow-up rate for both groups was 91.8％ (101/110) and 92.4％ (206/223),testicular atrophy after operation was 1.0 ％ (1/ 101)and 1.5 ％ (3/206) in them,while testicular retraction were 1.0 ％(1/101) and 1.9％ (4/206) respectively,which showed no statistically significant differences.The incidence of perioperative complications were respectively 0.5％ (7/1486) and 0.9％ (3/317) in traditional inguinal (1486 sides) and laparoscopic orchidopexy (317 sides),and no significant difference could be found between them.There were no perioperative complications in the 64 patients (66 sides)who underwent transcrotal orchidopexy.Conclusions For the patients undertaking primary operation or reducible cryptorchidism under anesthesia,transcrotal orchidopexy procedure should be preferred to adopt.For those patients with intra-abdominal and inguinal canalicular testes,the pediatric surgeon with proficient laparoscopic technique can take the laparoscopic transcrotal orchidopexy as the optimal procedure.
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