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目的:旨在对比分析腹腔镜下和开放式一期Fowler-Stephens手术治疗小儿腹腔型隐睾疗效的差异。方法:抽取本院儿外科于2014年6月-2016年10月收治拟行一期Fowler-Stephens手术的腹腔型隐睾患儿100例作为研究对象,按照随机数字表法分为腹腔镜组和开放组,各50例。腹腔镜组患儿行腹腔镜下一期Fowler-Stephens手术;开放组患儿行开放式一期Fowler-Stephens手术。记录和比较两组患儿手术时间、术中出血量、术后住院时间和住院费用;测定和记录两组患儿术后3 d和7 d血清超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)和白介素-17(IL-17)表达水平。采用问卷调查的方式调查和比较两组患儿家长治疗满意率。术后1个月~2年,定期行超声诊断复查患儿睾丸情况,记录和比较两组患儿术后并发症发生率。结果:治疗期间,腹腔镜组患儿的手术时间、术中出血量及术后住院时间均显著优于开放组(P<0.05),两组患儿住院费用比较,差异无统计学意义(P>0.05)。两组患儿术后7 d的hsCRP和IL-6表达均显著低于术后3 d(P<0.05),腹腔镜组患儿术后3、7 d的hs-CRP、IL-6和IL-17表达均显著低于开放组(P<0.05)。腹腔镜组患儿术后并发症率显著低于开放组(P<0.05)。腹腔镜组患儿手术成功率显著高于开放组患儿(P<0.05)。腹腔镜组患儿家长满意率显著高于开放组(P<0.05)。结论:术前应严格基于腹腔型隐睾患儿适应证和禁忌证决定是否采取一期Fowler-Stephens手术治疗,腹腔镜一期Fowler-Stephens则是首选术式。
Objective: To compare and analyze the difference between laparoscopic and open first-stage Fowler-Stephens operative treatment of pediatric peritoneal cryptorchidism. Methods: A total of 100 children with peritoneal cryptorchidism who underwent Fowler-Stephens operation in our hospital from June 2014 to October 2016 were enrolled in this study. According to random number table, they were divided into laparoscopic group Open group, 50 cases each. Laparoscopic group of children underwent laparoscopic Fowler-Stephens surgery; open group of children underwent open-phase Fowler-Stephens surgery. The operation time, intraoperative blood loss, postoperative hospital stay and hospitalization costs were recorded and compared. The serum levels of hs-CRP, interleukin -6 (IL-6) and interleukin-17 (IL-17) expression levels. A questionnaire survey was conducted to investigate and compare the treatment satisfaction rate of parents in both groups. One month to two years after operation, sonography was performed regularly to diagnose the testis in children. The incidence of postoperative complications was recorded and compared between the two groups. Results: The operation time, intraoperative blood loss and postoperative hospital stay in the laparoscopic group were significantly better than those in the open group (P <0.05). There was no significant difference in hospitalization costs between the two groups (P > 0.05). The expression of hsCRP and IL-6 on the 7th day after operation in both groups were significantly lower than those on the 3rd day after operation (P <0.05). The hs-CRP, IL-6 and IL -17 expression were significantly lower than the open group (P <0.05). The postoperative complication rate in laparoscopic group was significantly lower than that in open group (P <0.05). The success rate of operation in laparoscopic group was significantly higher than that in open group (P <0.05). The satisfaction rate of parents in laparoscopic group was significantly higher than that in open group (P <0.05). CONCLUSIONS: Preoperative treatment should be strictly based on indications and contraindications of peritoneal cryptorchidism in patients with Fowler-Stephens surgery. Laparoscopic stage Fowler-Stephens is the preferred surgical procedure.