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目的探讨腹腔镜在未触及睾丸的隐睾患儿中的诊治作用。方法对2005年8月-2011年1月在本科诊治的222例未触及睾丸的隐睾患儿行腹腔镜探查(229个睾丸)。年龄12个月～16岁(平均56个月)。术前常规行阴囊腹股沟和盆腔超声检查。术后随访2～72个月(平均32个月)。随访内容包括触诊睾丸位置,判断是否有回缩,超声测量睾丸大小,判断睾丸是否有萎缩。结果经腹腔镜、腹股沟探查及术后病理证实睾丸缺如158个;睾丸残余11个;腹股沟型高位隐睾5个;睾丸位于腹腔55个。其中低位型隐睾20个,高位型隐睾35个。并卵黄管退化不全4例;真两性畸形1例,条索状性腺1例。行常规腹股沟开放手术15个睾丸,腹腔镜辅助下一次性睾丸固定术10个睾丸,Fowler-Stephens(F-S)分期睾丸固定术25个睾丸,F-S一期睾丸固定术8个睾丸,2个发育不良睾丸行腹腔镜下睾丸切除术。卵黄管退化不全者行始基子宫切除,条索状性腺行性腺切除术,两性畸形性腺活检一侧为睾丸,一侧为卵巢。术后随访患侧睾丸萎缩4个,包括行F-S一期睾丸固定术2个睾丸,腹股沟切口睾丸一次固定术1个睾丸,F-S分期固定术1个睾丸;睾丸回缩2个,均为腹股沟切口睾丸一次固定术。结论腹腔镜能够准确诊断未触及睾丸并进行相应治疗。对于腹腔内低位隐睾,腹腔镜辅助下一次性睾丸固定术效果好,明显优于常规手术。腹腔内高位隐睾适合行F-S分期手术。
Objective To investigate the diagnosis and treatment of laparoscopy in children with cryptorchidism without touching the testes. Methods Totally 222 cases of cryptorchidism without testicular cryptorchidism were studied by laparoscopy (229 testes) from August 2005 to January 2011 in our department. Aged 12 months to 16 years (mean 56 months). Preoperative routine scrotal groin and pelvic ultrasound. Patients were followed up for 2 to 72 months (average 32 months). The follow-up includes palpation of testicular position, to determine whether there is retraction, ultrasound testicular size, to determine whether there is atrophy testicles. Results Laparoscopy, inguinal exploration and postoperative pathology confirmed the lack of testicular 158; testicular residual 11; inguinal high cryptorchidism 5; testis in the abdominal cavity 55. Including low type cryptorchid 20, high type cryptorchid 35. 4 cases of vas deferens incomplete degeneration; 1 case of true hermaphroditism, 1 case of cord-like gonad. Fifteen testes underwent conventional open groin surgery, ten testicles assisted by laparoscopic assisted one-time testicular fixation, 25 testes with Fowler-Stephens (FS) stage testicular fixation, 8 testes with FS stage I testicular fixation, and 2 dysplasia Testicular testicular laparoscopic orchiectomy. Yolk tube degenerative insufficiency line based hysterectomy, cord gonadal gonadotomy, amputation gonads biopsy side of the testis, ovarian side. A total of 4 testicular atrophy patients were included in the study, including 2 testis of FS stage 1 testicular fixation, 1 testicular fixation of groin incision, 1 testicular FS fixation, 2 testicular retraction, Testicular fixation. Conclusions Laparoscopy can accurately detect non-touched testes and treat them accordingly. For intra-abdominal low cryptorchidism, laparoscopic assisted single-time testicular fixation effect is better than conventional surgery. High intra-abdominal cryptorchidism for F-S staging surgery.