腹腔镜诊治不能触及睾丸的隐睾患儿127例

目的 总结和分析腹腔镜在诊治未触及睾丸的隐睾中的应用.方法 2000年1月-2006年12月应用腹腔镜对127例未触及睾丸的隐睾患儿进行诊治.手术时平均年龄55个月.全麻或加单次硬膜外麻醉下建立气腹,腹腔镜探察.术中发现腹腔内睾丸,行分期Fowler-Stephen手术或睾丸固定术;如精索在腹内为盲端或虽出内环但发育极差,诊断为睾丸缺如,无需进一步探查;如精索发育较好出内环,行腹股沟探查,发现睾丸存在则行睾丸固定术.对分期行Fowler-Stephen手术患儿术后随访睾丸大小和位置.结果 隐睾患儿127例中, 62例 (48.8%)直接诊断为睾丸缺如;24例 (18.9%) 经腹股沟探查后,11例睾丸缺如,13例直接行睾丸固定术;41例(32.3%)诊为腹腔内睾丸,26例行分期Fowler-Stephen手术,包括11例双侧,8例右侧,7例左侧,余15例患儿行睾丸固定术.127例中单侧病例104例(81.9%),其中左侧75例,右侧29例.左侧睾丸缺如57例,占左侧总例数的76%.右侧睾丸缺如12例,约占右侧的41%.双侧病例共23例(18.1%),左右均行分期Fowler-Stephen手术共11例,22只睾丸.双侧睾丸均缺如3例.127例患儿中9只睾丸发育极差,病理均未见曲细精管结构.行分期Fowler-Stephen手术患儿18例得到随访,睾丸大小较术前无缩小,1例术后睾丸上缩.结论 应用腹腔镜可准确诊断未触及睾丸的隐睾,对于腹内靠近内环口的睾丸可行腹腔镜或传统睾丸固定术,对于高位腹内睾丸可行分期Fowler-Stephen手术.     

改良小横切口手术治疗小儿隐睾77例

目的：探讨微创技术在小儿隐睾手术中的应用。方法：在77例(84侧)小儿可触及隐睾中,于腹股沟外环处作一与皮纹一致的长约1.5～2 cm的小横切口,不打开腹股沟管,在腹股沟外环口找到未闭鞘状突头部和睾丸,分离至内环处,将睾丸经隧道引至阴囊,固定于皮下与肉膜间囊窝内。结果：该组所有病例均能将睾丸无张力地拖至阴囊底部。有57例(61侧)获得随访,睾丸均位于阴囊内,其中50例(54侧)位于阴囊底部,其余7例位于阴囊中部。未发现睾丸萎缩。结论：该手术运用与皮纹平行的小横切口又未破坏腹股沟管的解剖,手术快捷、创伤小,术后痛苦小、恢复快,疤痕不明显,疗效满意。     

改良腹腔镜技术在小儿腹股沟巨大嵌顿性斜疝中的应用

目的探讨改良腹腔镜手术在小儿腹股沟巨大嵌顿性斜疝中的应用价值。方法2012年2月至2016年2月我们采用改良腹腔镜手术治疗小儿腹股沟巨大嵌顿性斜疝52例,均采取气管插管全身麻醉,于后腹腔镜下辅助手法复位,对复位失败者于腹股沟外环体表投影处做1.5 cm小切口,松解嵌顿,均行腹腔镜下双荷包加缝脐内侧襞内环口高位结扎术(改良法)。结果 52例患儿均顺利完成手术,腹腔镜下辅助复位36例,手术时间(35.4±9.16)min,住院时间(4.5±1.5)d,腹腔镜下嵌顿松解16例,手术时间(54.9±13.6)min,住院时间(5.5±1.7)d。无输精管、精索血管损伤,无阴囊血肿、切口感染等并发症。52例获随访,随访时间3~24个月,平均l4个月,术后无一例出现睾丸萎缩、医源性隐睾、切口疝、疝复发等。结论改良腹腔镜手术治疗小儿腹股沟巨大嵌顿性斜疝安全可行,疗效确切,腹腔镜下可同时发现和处理对侧隐性内环口未闭。     

机器人辅助单孔腹腔镜在小儿泌尿生殖系统手术中的应用

目的初步探讨达芬奇Xi机器人系统辅助单孔腹腔镜在小儿泌尿生殖系统手术中应用的可行性及安全性。方法回顾性分析2020年6月至2022年6月在武汉大学中南医院小儿外科施行机器人辅助单孔腹腔镜手术的29例患儿临床资料, 其中男13例, 女16例;年龄为(5±3.5)岁, 范围在1个月至10.5岁。所有患儿中肾盂输尿管连接部梗阻16例, 重复肾5例, 卵巢畸胎瘤3例, 发育不良肾2例, 膀胱输尿管反流2例, 输尿管膀胱连接部梗阻1例, 肾囊肿1例。所有患儿均采用多通道单孔腹腔镜手术穿刺器, 经脐单部位完成机器人辅助腹腔镜手术, 总结分析其手术时间、术后住院时间、并发症等情况。结果 29例机器人辅助单孔腹腔镜手术均顺利完成, 无术中中转开放手术。18例行肾盂成形术, 4例行输尿管膀胱再植术, 1例行输尿管输尿管端侧吻合术, 2例行发育不良肾切除, 1例行肾囊肿去顶减压术, 3例行卵巢肿瘤剔除术;其中15例患儿合并内环口未闭, 同时行内环口高位结扎。肾盂成形术、输尿管膀胱再植术和卵巢肿瘤剔除术手术时间分别为(168.5±42.3)min、(152.8±51.7)min、(146.3±32.0)mi...     

腹股沟小切口手术与腹腔镜手术治疗腹股沟区隐睾的对照研究

目的比较腹股沟横行小切口与腹腔镜下睾丸下降固定术在腹股沟区隐睾中应用的优缺点。方法选择川北医学院附属医院小儿外科自2014年3月至2015年9月明确诊断为腹股沟区隐睾症的患儿88例,年龄1.2~4岁,平均年龄2.6岁;按随机分组原则采取两种手术方式:开放手术组采用腹股沟横行小切口经腹膜外游离下降睾丸,阴囊小切口固定;腹腔镜手术组采用腹腔镜下腹腔内游离睾丸,阴囊小切口固定;分别对两组手术时间、睾丸下降后位置、术后并发症、手术前及术后半年双侧睾丸超声随访结果进行对比分析。结果开放手术组平均手术时间为(41.2±2.1)min,腹腔镜组为(55.6±1.9)min。腹腔镜手术组患儿术中出血量较开放组少,经统计学分析差异有意义。术后7 d及6个月查两组患侧睾丸下降位置发现:开放手术组44例睾丸均可降至阴囊内,其中5例位于阴囊入口处;腹腔镜手术组44例睾丸均可降至阴囊内,其中4例位于阴囊入口处;术后6个月患侧睾丸超声显示患侧睾丸发育较对侧稍差。结论在腹股沟区隐睾患儿中,腹腔镜下睾丸下降术在手术时间及术后效果上并无明显优势。建议对于腹股沟区隐睾应严格掌握腹腔镜手术指征,对于内环口及以上部位隐睾首选腹腔镜探查及腹腔镜下隐睾下降术。     

体检触不到睾丸的隐睾临床观察与分析

隐睾是常见的睾丸先天异常,指睾丸未能按照正常发育过程自腹膜后降至阴囊,而停留在下降途径中的任何部位,也称睾丸下降不全。约20%的隐睾患儿睾丸体检不能触及[1],体检触不到睾丸的隐睾临床治疗盲目性较大且复杂,现结合我院体检触不到睾丸的隐睾病例12例分析如下。1资料与方法1.1临床资料本组共12例13侧隐睾。左侧8例,右侧3例,双侧1例。年龄最小的1岁,最大的7岁,平均4.36岁,体检均未触及睾丸。1.2方法首先,对未触及睾丸的隐睾患儿,进行认真仔细的查体,在手术前、麻醉后患儿松弛的条件下,再检查1次,也是十分必要的;彩超、CT或MRI等辅助检查…     

Bianchi睾丸固定术治疗隐睾54例

目的探讨Bianchi阴囊单切口睾丸同定术治疗可触及隐睾的可行性。方法回顾性分析本院54例（71侧）隐睾患儿的临床资料。患儿年龄17个月至17岁,平均年龄4．6岁。其中单侧37例,双侧17例。21侧位于腹股沟管内,50侧位于腹股沟外环口,24侧并发腹股沟斜疝。术前均诊断为可触及隐睾,行Bianchi睾丸固定术。结果67侧可触及隐睾行一期Bianchi睾丸固定术,2侧位于腹股沟管处及1侧位于外环口处的病例转传统睾丸固定术。单侧手术时间为（25±8）min,住院天数为（4．2±1．2）d,均痊愈,无感染病例。随访3个月至1年,卅现睾丸回缩1侧,继发疝囊2侧,无睾丸萎缩病例。63侧睾丸停留在满意位置,并有良好的外观。结论对于小儿体表可触及低位隐睾的治疗,Bianchi术能缩短手术及住院时间,术后外形美观,疗效好,值得推广。     

腹腔镜辅助下鞘状突高位结扎术治疗儿童鞘膜积液327例

目的总结我们10年来采用腹腔镜辅助下鞘状突高位结扎术治疗小儿鞘膜积液的临床经验。方法自2002年1月至2013年1月,我们在腹腔镜辅助下采用"雪橇形"内环口修补针于腹膜外双重结扎未闭合的鞘状突内环口,同时穿刺抽净鞘膜囊内积液的手术方式,治疗2岁以上鞘膜积液患者327例,其中术前诊断为交通性鞘膜积液110例,非交通性鞘膜积液217例。结果 327例中,325例患侧鞘状突内环口未闭,孔径3~5 mm;64例(约占19.6%)术前诊断为单侧的患儿术中发现对侧内环口未闭。术后常规随访1年,4例术后1~3个月出现同侧鞘膜囊内中等量积液(3~6 mL),复发率约1.2%,其中3例门诊观察2~3个月自行消退;1例再次经皮细针抽吸后自愈。病理学检查发现鞘膜囊内膜主要由单层柱状上皮构成,有一定的吸收功能,但分泌功能极弱。结论儿童鞘膜积液发病机制与鞘状突未闭有关,鞘膜囊液体主要来自于腹腔。腹腔镜下鞘状突高位结扎术治疗鞘膜积液长期疗效满意,且可以及时发现对侧隐匿病变,是一种安全有效的治疗手段。     

小儿未触及隐睾的诊断和治疗

目的探讨小儿未触及隐睾的定位诊断和治疗方法。方法对64例75侧未触及隐睾的14岁以下手术病例作回顾性分析。结果B超探查未触及隐睾的假阴性率为82．8％(48／58)。行肉膜囊睾丸固定术52侧，Fowler-Stephens手术8侧，睾丸切除术4侧，分期睾丸固定术2侧，未找到睾丸9侧。需要广泛手术探查的腹内高位隐睾或无睾仅8侧。术后随访88．5％的睾丸位置良好，无进一步萎缩。结论手术是未触及隐睾定位和治疗的主要方法。探查首选经腹股沟入路，经正确的术中处理大多数小儿未触及隐睾可经Ⅰ期手术降入阴囊。     

非腹腔型隐睾的腹腔镜手术治疗

目的探讨腹腔镜技术在非腹腔型隐睾手术中的意义。方法2001年12月～2005年12月,应用微型腹腔镜治疗小儿非腹腔型隐睾53例,年龄10个月～12岁,左侧23例,右侧25例,双侧5例。其中腹股沟隐睾47例,异位睾6例(包括横过异位睾2例)。术中发现内环口已闭合者16例。结果53例全部在腹腔镜下完成手术;50例一期行睾丸下降固定术;2例因精索过短,行分期Fowler-Stephens手术;1例因睾丸发育不良行睾丸切除术。结论腹腔镜技术治疗非腹腔型隐睾,直观明了,解剖位置清楚,并发症少,微创美观,可作为隐睾手术的首选术式。     

腹腔镜在未触及睾丸的隐睾中的应用

目的 探讨腹腔镜在未角及睾丸的隐睾中的诊断及治疗应用。方法 应用腹腔镜对１３例未触及睾丸的隐睾患儿作检查。术中发现腹腔内如有精索盲或发育差的精索,诊断为睾丸缺如;如发育好的粗索进入内环,做腹股沟探查;如睾丸位处于腹腔内,诊断为腹腔内睾丸,做分期Ｆｏｗｌｅｒ－Ｓｔｅｐｈｅｎ手术,或一、二期睾丸固定术等处理。结果 睾丸缺如６例（４６．２％）;腹腔内睾丸４例（３０．８）;睾丸于腹股沟３例（２３．１％）。     

Experience with laparoscopy in nonpalpable testis.

AIM: The aim of this study was to investigate the feasibility and benefits of diagnosis and interventional laparoscopy in those paediatric patients with nonpalpable testes (NPT). PATIENTS AND METHODS: Between 1992 and 1999, 75 patients with NPT (mean age 3 years, range 6 months to 14 years) were treated. 86 testes were evaluated. RESULTS: According to the laparoscopic findings 4 groups of testes were identified: Vanishing testis (n = 32), low abdominal testis (< 2 cm to the internal ring) (n = 26), high abdominal testis (> 2 cm to the internal ring) (n = 24) and intersex patients (n = 4). Of the first group, 19 testes (one bilateral) had blind-ending spermatic cord and vessels and if an atrophic testicular tissue was identified, it was removed laparoscopically. For those with spermatic cord and vessels beyond the internal ring (13 testes), atrophic testes were removed through a high scrotal incision. 19 testes of the second group had a laparoscopy-assisted orchidopexy. In the same group a laparoscopic orchidopexy was performed on 7 testes. 24 testes in the 3rd group had a Fowler-Stephens (FS) stage 1 and 18 testes had a laparotomy performed for FS stage 2 procedure (laparotomy and orchidopexy) after 6 months. At laparotomy there was no evidence of testicular atrophy in all but one testis, which was removed and the FS stage 2 procedure was completed in 17 testes. The follow-up period was between 6 months and 4 years, and two more testicular atrophies were noted after FS stage 2. The results were satisfactory in 15 out of 18 testes (83%). In the intersex group, the patient with testicular feminization underwent laparoscopic orchiectomy. The other patient with bilateral nonpalpable testis was identified as having an uterus and two intraabdominally located gonads on laparoscopy and gonadal biopsies were obtained for diagnosis. Histology demonstrated bilateral ovotestes, confirming the diagnosis of a true hermaphrodite. CONCLUSION: We are of the opinion that laparoscopy decreases the number of laparotomies in NPT, allows a single-stage procedure in low abdominal testis, and facilitates clip ligation of the testicular artery in high abdominal testis. Laparoscopy also provides diagnostic and therapeutic options for vanishing testis and intersex patients.     

Incidence and management of the inguinal hernia during laparoscopic orchiopexy in palpable cryptoorchidism: preliminary report

During the laparoscopic approach of undescended testis, an associated inguinal hernia is a frequent finding that must be treated at the same time. The objective of this presentation is to show the incidence and management of the inguinal hernia that were found during laparoscopic orchidopexy, reporting how the scar tissue will join the edges of the canal and the parietal peritoneum will grow above. Between January 1999 and December 2002, 31 patients with 33 palpable and nonpalpable undescended testes were treated by laparoscopic orchidopexy. Patients were between 6 months and 9 years. We used four ports, and 2 mm instrument. When an associated inguinal hernia were found we only removed the membranes of the processus vaginalis and did not close the defect. All cases were treated by the same surgeon. The average surgical time was 50 min that included the orchiopexy and the treatment of the associated inguinal hernia. We found inguinal hernia in 23 cases (69.9%). We did not find any inguinal hernia in the opposite side of the undescended testis. In two patients with bilateral undescended testis that were approached in two stages 3 months later we confirmed the closure of the hernia defect. These 23 patients have 21.5 months average follow up and confirm no recurrence. With an average follow up of 21.5 months, we found no inguinal hernia in any of the patients. A larger volume study with longer follow up is needed to confirm that there is no need for closure of the internal inguinal ring during laparoscopic orchidopexy. Presented at the IPEGs 12th annual congress for endosurgery in children, in Los Angeles, CA, USA, March 2003.     

Diagnosis of nonpalpable testes in childhood: comparison of magnetic resonance imaging and laparoscopy in a prospective study.

In a prospective study, the accuracy of magnetic resonance imaging (MRI) and laparoscopy in the diagnosis of nonpalpable testes was evaluated. Advantages and disadvantages of the two procedures were compared. 29 boys with unilateral nonpalpable testis underwent MRI. When MRI failed to demonstrate a testis, laparoscopy with a 1.9 mm mini-laparoscope was performed. All cases were verified by operative exploration of the inguinal region. MRI demonstrated 10 inguinal and 7 abdominal testes. MRI revealed no testis in 12 boys. The false positive rate was 32%, correct negative findings were confirmed in four patients. When laparoscopy was performed, preservable testis could be demonstrated in 8 of 12 patients (1 abdominal, 7 inguinal) which otherwise were not visible on MRI. The correct positive rate was 100%. We encountered no complications with laparoscopy. In summary, laparoscopic evaluation is recommended as the preferable method in pediatric cases of nonpalpable testes.     

Diagnostic laparoscopy and management of the impalpable testis--a review of 10 years' practice at a non-paediatric specialist centre

BackgroundLaparoscopy is used for the diagnosis and treatment of impalpable testes. We reviewed practice and outcomes in our unit over the last 10 years.MethodsRetrospective case-note review of patients undergoing laparoscopy with or without orchidopexy for impalpable testes.ResultsEighty-three patients underwent laparoscopy. Twelve patients had bilateral impalpable testes; 25.3% of testes were identified intra-abdominally, 21% in the internal ring, and 29.5% of cases had vas and vessels entering the deep ring. A 76.5% success rate was achieved following diagnostic laparoscopy and standard open orchidopexy for testes in the region of the internal ring, compared to a 40.0% success rate following one-stage laparoscopic orchidopexy for ‘low’ intra-abdominal testes.ConclusionLaparoscopy is useful in managing patients with an impalpable testis from both a diagnostic and therapeutic standpoint. The success rate following laparoscopic orchidopexy in our non-paediatric specialist centre is lower than in most reports from paediatric specialist centres. This suggests the importance of centralization of such complicated, less frequently performed surgical procedures to a specialist centre.     

Laparoscopic mobilization of testicular vessels: an adjunctive step in orchidopexy for impalpable and redo undescended testis in children

The testicular position after conventional inguinal orchidopexy for canalicular, “peeping” and redo undescended testes may not be satisfactory despite retroperitoneal dissection. Laparoscopy allows extensive mobilization of testicular vessels to gain additional length. We review our experience of using laparoscopic mobilization of testicular vessels (LMTV) in orchidopexy for these difficult undescended testes. From January 2003 to May 2004, LMTV was performed in 18 boys. The testicular vessels were mobilized from just proximal to the internal inguinal ring to the level of caecum and sigmoid colon respectively. Fifteen patients had clinically impalpable testes. Diagnostic laparoscopy revealed 13 “peeping” and 2 canalicular testes. LMTV was performed together with inguinal orchidopexy. There were three cases of redo orchidopexies because of unfavourable testicular position after previous surgery. LMTV was performed following inguinal dissection. The median follow-up period is 11.7 months. Sixteen testes are located at the base of scrotum, and two at mid-scrotum. The size is normal in 17 testes, whereas 1 testis is smaller than the contralateral one. LMTV is a safe and efficient adjunctive step in orchidopexy for impalpable and redo undescended testes.     

Single stage Fowler–Stephens orchidopexy: a preferred alternative in the treatment of nonpalpable testes

In this present study we aimed to discuss the surgical efficacy of single stage Fowler–Stephens orchidopexy (FSO) technique, with an emphasis on its practical and logical application that may be kept in mind during a standard orchidopexy procedure. Twenty-two children have undergone a single stage FSO procedure for nonpalpable testes during the last 9 years in our department. Surgical procedure was initiated with a standard inguinal oblique incision keeping in mind that depending on the position and the anatomic features of the testes a FSO method might be needed. While an excellent result was defined as a testis with good scrotal position, size and adequate blood flow on Doppler sonogram, acceptable result was a palpably normal sized testis in a high scrotal position with adequate blood supply and lastly an unacceptable result was the atrophy of the testis with compromised blood supply. During regular follow-up visits although some cases revealed testicular atrophy; long-term examination (12 months) did show that majority of the testes maintained their normal position and tissue consistency (21/24, 87.5%). Due to the necessity of surgical approach either in the evaluation or the treatment of nonpalpable testes in most cases along with the unsatisfactory data of the time consuming and invasive radiological procedures; we believe that a classical orchidopexy approach together with further single stage FSO will be a rational and satisfactory algorithm in the majority of such cases.     

The role of laparoscopy in the management of impalpable testes

Both diagnostic and operative laparoscopy were used in the management of 68 impalpable testes. Twenty-three were either vanishing or atrophied, and were associated with a precarious blood supply. Two were found in the groin, 12 in the inguinal canal, and 32 at variable distances from the internal ring; of these, 2 were in a patient with persistent müllerian duct syndrome. Two atrophied abdominal testes were removed laparoscopically, 3 patients underwent a two-stage Fowler-Stephens procedure, and 28 underwent one-stage, laparoscopically assisted orchidopexy. An algorithm for surgical management of the impalpable testis based on laparoscopic findings is proposed.     

The value of laparoscopy in the management of non-palpable testis

ObjectTo retrospectively review the value of laparoscopy in the management of impalpable testis.Materials and methodsIn 1993–2006, 182 laparoscopies for impalpable testis were performed for a total of 194 testicular units. Five laparoscopic findings were considered: testicular ectopia, intra-abdominal testis, and cord structures that are blind ending, completely absent (agenesis) or entering the internal inguinal ring.ResultsIn 62 cases an intra-abdominal testis was found; 18 were classified as high and managed by a laparoscopic Fowler–Stephens procedure. Cord structures entering the inguinal ring were observed in 77 patients and 45 underwent an inguinal exploration: a testis was found in 12 cases and in 33 a remnant was excised. In 35 cases, intra-abdominal blind ending vas and vessels were observed and eight showed testicular agenesis. No major surgical complications were recorded. Follow up ranged from 1 to 3 years.ConclusionsOur study confirms the value of laparoscopy in the management of non-palpable testis, providing a definitive diagnosis by the direct view of spermatic bundle and testis. Ninety-three patients were managed by laparoscopy only, and in 44 it was essential for the subsequent surgical approach. When the internal inguinal ring is patent and/or normal spermatic vessels are present an inguinal exploration is mandatory.     

Laparoscopyvs inguinal exploration for nonpalpable undescended testis

Objective : The optimal initial surgical approach for nonpalpable undescended testis (UDT) is debated. The aim of the present study is to compare the results of initial laparoscopy and inguinal exploration in the management of unilateral nonpalpable undescended testes.Methods : The results of 20 children with unilateral nonpalpable UDT managed by initial laparoscopy (group I) were compared with 20 age-matched children managed by inguinal exploration (group II). The location of testes and results of orchiopexy were compared in both groups. A single surgeon performed all the operative procedures.Results : The majority of testes (16/20 group 1,17/20 group II) in both groups were canalicular or low abdominal. Vanishing testes accounted for one-third (13/40) of the testes, the majority (85%) of which were located in the inguinal canal. All children were discharged within 24 hours of the operation. The success of orchiopexy at 4–6 weeks post-operatively was 85% and 86% in the two groups respectively. Retrospectively, only 7/40 (18%) of the testes would benefit from laparoscopy.Conclusions : Initial laparoscopic and inguinal approaches to nonpalpable UDT give comparable results. This report failed to demonstrate any specific advantage of initial laparoscopy in the majority of children with unilateral nonpalpable UDT.