中国微创外科杂志2016年第4期全文
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未触及睾丸隐睾的腹腔镜手术体会
段光琦王啸刘洁唐睿随帮志
（医院小儿外科，芜湖）
目的：探讨腹腔镜在未触及睾丸隐睾患儿中的应用价值。方法：选取年12月~年6月诊疗的未触及睾丸的隐睾患儿40例（45侧），根据患儿情况在腹腔镜下行相应手术治疗。腹腔内睾丸33例（38侧），其中行一期睾丸下降固定术29例（33侧），分期睾丸下降固定术4例（5侧）；精索血管进入腹股沟管6例（6侧），行腹股沟区探查术；1例（1侧）腹腔内见输精管呈盲端，镜下切除。结果：40例（45侧）均手术顺利。手术时间34~65min，平均46min。术后住院时间2~5d，平均3.2d。40例随访6~24个月，平均8.7月。睾丸回缩至阴囊上方4例，睾丸萎缩1例，阴囊水肿、血肿3例，无睾丸扭转坏死。结论：腔镜技术暴露清楚，解剖明确，不易损伤周围组织，对患儿创伤较小，有助于提高睾丸下降固定的成功率，尤其对腹腔内盲端输精管和很高位置的睾丸有较好的治疗效果，对治疗小儿高位隐睾具有重要的临床价值。
隐睾；未触及；腹腔镜
ExperienceofLaparoscopyforImpalpableTestisinChildrenDuanGuangqi,WangXiao,LiuJie,etal.DepartmentofPediatricSurgery,YijishanHospitalofWannanMedicalCollege,Wuhu,China
ObjectiveToinvestigatetheapplicationvalueoflaparoscopyinthetreatmentofimpalpabletestisinchildren.MethodsClinicaldataof40childrenwithimpalpabletestis(45sides)fromDecembertoJunewereretrospectivelyanalyzed.Thesitesandsizesofthetestiswereidentifiedbyabdominopelvicultrasonographyinallthepatients.Thefindingsandmanagementincluded:33casesofintra-abdominaltestis(38sides)weretreatedwithone-session(29cases,33sides)ortwo-staged(4cases,5sides)orchidopexy;6casesofcordstructureenteringtheinternalinguinalring(6sides)weretreatedwithinguinalexploration;1casewasgivenavasectomyafterlaparoscopeexplorationindicatingthatcordstructurewascaecum(1side).ResultsAllthe40cases(45sides)weresuccessfullyoperated.Theoperativetimewas34-65min(mean,46min)andthepostoperativehospitalstaywas2-5days(mean,3.2days).Fortycaseswerefollowedupfor6-24months(mean,8.7months).Therewere4casesoftesticularretractiontothetopofthescrotum,1caseofatrophyoftestis,and3casesofscrotaledemaandhematoma.Notesticulartorsionandnecrosishappened.ConclusionsLaparoscopicsurgerycanobtainclearexposureandanatomy,lessdamagethesurroundingtissue,andlesstraumainchildren,whichcanimprovethesuccessrateofthefixedtesticulardescent,especiallyforintra-abdominalblindvasdeferensandhighpositionoftestis.Laparoscopicsurgeryhasanimportantclinicalvaluefortreatingchildrenwithhighcryptorchidism.
Cryptorchidism;Impalpable;Laparoscopy
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