经腹股沟与阴囊切口治疗睾丸鞘膜积液体会

目的 探讨睾丸鞘膜积液治疗方式.方法 对63例睾丸鞘膜积液病人行手术治疗,其中33例行经腹股沟切口治疗睾丸鞘膜积液;30例行经阴囊手术治疗睾丸鞘膜积液.结果 两组手术时间、出血量无明显差异,经腹股沟切口组术后复发、阴囊水肿、感染等方面优于经阴囊切口手术组,差异有统计学意义(P＜0.05).结论经腹股沟切口可替代传统的阴囊切口治疗睾丸鞘膜积液.     

低位阴囊切口治疗腹股沟型隐睾

<正>隐睾在新生儿中发病率约为2%~4%,到1岁时发病率降至1%左右[1]。传统的治疗腹股沟型隐睾的方法是经腹股沟切口的睾丸下降固定术。1989年Bianchi等[2]提出了单纯的经阴囊切口的睾丸下降固定术,这种手术方式可缩短手术时间并减少手术切口,创伤较小且更美观。我院采用该术式对低     

水囊扩张阴囊成形二期睾丸固定术1例

患者 ,3 3岁 ,已婚。双侧隐睾 ,结婚 4年未育 ,性生活正常。体检 :一般情况良好 ,双侧腹股沟均可触及约 3 .0ｃｍ× 4.0ｃｍ大小椭圆形包块 ,表面光滑 ,阴茎大小正常 ,阴囊如盘状紧贴会阴皮肤。利多卡因浸润麻醉 ,纵形切开阴囊根部皮肤及肉膜 ,分离阴囊内软组织间隙 ,由该切口放入 3 0ｍｌ容积的硅橡胶水囊扩张器 ,将水囊阀门分别置于耻骨联合下方皮下 ,缝合切口 ,每侧注入生理盐水 2 0ｍｌ使阴囊膨胀。 2个月后在硬脊膜外腔麻醉下取出水囊 ,同时行睾丸固定术。其间向水囊内加注 2次生理盐水 ,每次 5ｍｌ。在放置水囊前及取出水囊后分别切取…     

腹横纹切口保留睾丸引带阴囊皮下睾丸固定术治疗隐睾症的 …

为了研究治疗先天性隐睾症的最佳术式，以提高隐睾症的治疗水平，采用腹横纹切口保留睾丸引带阴囊皮下睾丸固定术（研究组）治疗隐睾症９６例１１０枚，获得随访者９４例１０８枚，同时采用患侧下腹斜切口肉膜囊睾丸固定术（对照组）治疗隐睾症５０例６２枚。结果研究组睾丸大小及硬度优９４枚，占８７．０％，良９枚，占８．３％，差５枚，占４．６％；睾丸位置优９３枚，占８６．１％，良９枚，占８．３％，差６枚，占５．６％；无     

经阴囊联合经脐腹腔镜隐睾无瘢痕下降固定术的临床研究

目的:探讨经阴囊联合经脐腹腔镜隐睾无瘢痕下降固定术的应用价值.方法:经改进Hesselbach三角路径,为38例、45侧隐睾患者施行经阴囊联合经脐腹腔镜隐睾无瘢痕下降固定术.结果:38例手术均一期完成,无需额外切口.术后平均3d痊愈出院.随访无睾丸回缩、萎缩、坏死、恶变等并发症发生,提睾反射存在.结论:经阴囊联合经脐腹...     

改良Bianchi睾丸下降固定术治疗中低位隐睾的临床疗效

目的:探讨改良Bianchi(阴囊中缝切口)睾丸下降固定术与传统(腹股沟联合阴囊切口)睾丸下降固定术的优缺点。方法:2013年2月至2014年2月收治的所有82例中低位隐睾患儿中,随机对其中46例(53侧睾丸)行改良Bianchi睾丸下降固定术作为观察组;传统方法即经腹股沟联合阴囊切口治疗36例(40侧)作为对照组。比较2组手术时间、术后并发症等方面的差异。结果:观察组与对照组患儿的手术时间分别为(25±6)min和(35±4)min,两组比较差异有统计学意义(P0.01);经过1~2年的随访比较,均未出现睾丸萎缩情况;观察组患儿出现3例睾丸上缩情况,对照组出现2例术后睾丸上缩,发生率的差异没有统计学意义;术后均未出现腹股沟斜疝、鞘膜积液的并发症,但对照组患儿有1例出现腹股沟处切口血肿且所有患儿切口均较明显,而观察组术后手术切口几乎观察不到。结论:行改良Bianchi睾丸下降固定术治疗中低位隐睾效果满意,较传统手术在手术时间和切口美观等方面具有一定的优势,值得临床推广。     

改良M形切口矫治小阴囊并睾丸下降不全

M形切口行阴囊矫治术应用于临床后，对矫治阴囊畸形及阴茎等有关疾患，效果满意。1996年至今，笔者再次改良该切口的设计，并应用治疗先天性阴囊发育不良的小阴囊及并发单侧或双侧睾丸下降不全者共6例，疗效良好，现报告如下。     

腹腔镜结合Bianchi手术治疗小儿腹股沟型隐睾

正隐睾是小儿泌尿系统常见先天畸形,手术是公认的治疗方法,由于隐睾位置的不同,手术方法也不同。目前对于高位隐睾选用腹腔镜手术已成共识,而对于腹股沟型隐睾,手术方法不一,开放手术、腹腔镜手术、Bianchi手术均有报道。腹股沟、阴囊双切口的开放式手术,是腹股沟型隐睾的经典术式。由于睾丸位置对手术的影响,腹腔镜及Bianchi手术治疗腹股沟型隐睾,仍然存在争议。作者于2016年6月至2017年6月采用腹腔镜与Bianchi手术相结     

经脐腹腔镜小儿睾丸下降固定术的护理配合

对30例隐睾患儿经脐腹腔镜行睾丸下降固定术,结果患儿手术均顺利完成,手术平均时间为30 min/侧,术后3~6 d出院,下降的睾丸无回缩、萎缩。提出术前做好访视工作,完善相关准备;术中巡回护士密切观察病情变化,妥善安置患儿体位;器械护士熟练配合,保持适当的气腹压力是手术成功的重要保证。     

经脐腹腔镜小儿睾丸下降固定术的护理配合

对30例隐睾患儿经脐腹腔镜行睾丸下降固定术,结果患儿手术均顺利完成,手术平均时间为30 min/侧,术后3~6 d出院,下降的睾丸无回缩、萎缩。提出术前做好访视工作,完善相关准备;术中巡回护士密切观察病情变化,妥善安置患儿体位;器械护士熟练配合,保持适当的气腹压力是手术成功的重要保证。     

Laparoendoscopic single site orchiopexy

We report a laparoendoscopic single site orchiopexy in a 2-year-old boy with a right nonpalpable testis. Diagnostic laparoscopy using a 5-mm port revealed a right intraabdominal testis. The 5-mm port site was extended to accommodate the smallest commercially available triport, and orchiopexy was performed. The operative time was 55 minutes, and the estimated blood loss was minimal. There were no complications, and surgical and cosmetic results were excellent. Laparoendoscopic single site surgery is a feasible technique for orchiopexy of the nonpalpable testis.     

Age at orchiopexy for undescended testis in the United States

Purpose

Undescended testis (UDT) is the most common congenital anomaly of the male genitalia. The American Urological Association guidelines recommend orchiopexy by age 18 months to ameliorate the risk of subfertility. The study aim was to assess adherence to these guidelines on a national level.

Transverse testicular ectopia discovered following reduction of an inguinal hernia

Transverse testicular ectopia is a rare condition in which both testicles occupy a single hemiscrotum. The aberrant positioning may lead to vascular compromise or impaired temperature regulation, which elevate the risks for torsion, infertility and testicular cancer. Definitive therapy consists of orchiectomy or orchiopexy. We report a case of a 10-month-old boy with an incarcerated inguinal hernia who was discovered to have transverse testicular ectopia following hernia reduction. The patient was treated with herniorrhaphy and open transseptal orchiopexy.     

迷你腹腔镜治疗隐睾合并同侧腹股沟疝的临床研究

目的探讨迷你腹腔镜治疗隐睾合并腹股沟疝的安全性和有效性。 方法收集2010年10月至2018年10月于河北省肃宁县人民医院泌尿外科收治的21例隐睾合并同侧腹股沟疝患者。应用迷你腹腔镜（5.0 mm直径高清晰腹腔镜,2.8 mm的分离钳,持针器等）行微创治疗。对本研究患者进行回顾性分析。 结果本组患者平均手术时间（95.0±12.3）min。因隐睾、精索发育不良,行阴睾切除疝囊高于结扎2例。6例患儿因分离精索、输精管时后腹膜缺损,内环口后腹膜未关闭。3例成人患者完成隐睾松解固定术后,内环口过大,遂将5.0 mm Trocar更换为10 mm Trocar。置入补片,缝合后腹膜。21例患者术后无阴囊血肿、阴囊感染、切口感染等并发症。术后无慢性腹股沟痛。2例术后分别为5.5年和1.7年一直睾丸较小,超声示睾丸萎缩。随访（6.6±3.4）年（0.3～8.7年）,无疝复发。 结论应用迷你腹腔镜治疗隐睾合并腹股沟疝是安全可靠的,损伤小、恢复快、并发症少。     

隐匿小切口疝囊高位结扎术治疗儿童腹股沟斜疝

目的：研究隐匿小切口疝囊高位结扎术治疗儿童腹股沟斜疝的临床效果。方法回顾性分析2013年2∽8月,赤峰学院附属医院新城院区应用隐匿小切口疝囊高位结扎术治疗儿童腹股沟斜疝32例患儿的临床资料。结果手术时间10∽25 min,平均14 min;住院时间2．0∽4．5 d,平均3d;皮肤切口小且隐匿,无需缝合,医用胶水粘合即可。全组患儿均随访6个月,术后切口均一期愈合。随访期间无复发,无并发症发生。结论隐匿小切口疝囊高位结扎术治疗儿童腹股沟斜疝具有创伤小,切口隐匿,术后恢复快的优点,便于临床广泛推广。     

腹横纹切口保留睾丸引带阴囊皮下睾丸固定术治疗隐睾症的研究

为了研究治疗先天性隐睾症的最佳术式，以提高隐睾症的治疗水平，采用腹横纹切口保留睾丸引带明囊皮下睾丸固定术（研究组）治疗隐睾症96例110枚，获得随访者94例108枚，同时采用患倒下腹斜切口肉膜囊睾丸固定术（对照组）治疗隐睾症50例62枚。结果研究组睾丸大小及硬度化94枚，占87．0％，良9枚，占8．3％，差5枚，占4．6％；睾丸位置优93枚，占86．1％，良9枚，占8．3％，差6枚，占5．6％；无睾丸萎缩及回缩，外表美观。对照组睾丸大小及硬度优41枚，占66．1％，良7枚，占11．3％，差14枚，占22．6％；睾丸位置优43枚，占69．4％，良8枚，占12．9％，差11枚，占17．7％。经统计学处理，两组睾丸大小及硬度方面比较有极显著性差异（P＜0．01），睾丸位置比较也有显著性差异（P＜0．05）。认为腹横纹切口保留睾丸引带阴囊皮下睾丸固定术损伤小，外表美观，明显降低了睾丸萎缩及回缩等并发症，符合生理要求，疗效满意。     

Testicular torsion in adults: Demographics and 30-day outcomes after orchiopexy or orchiectomy

Background:Most often studied in the pediatric population, testicular torsion also affects the adult male population. Little data exists on demographics, patient risk factors, and associated outcomes for the surgical management of testicular torsion. This study sought to describe differences in demographics and outcomes for those patients requiring orchiopexy or orchiectomy.Materials and methods:An analysis of the American College of Surgeons National Surgical Quality Improvement Program database (2015–2018) was performed, capturing patients with a postoperative diagnosis of testicular torsion. Patients were stratified into 2 groups if they received orchiopexy or orchiectomy. Demographics, perioperative variables, surgeon specialty, and outcomes were analyzed.Results:A total of 769 patients undergoing surgical treatment of testicular torsion were captured. Most of these patients were White (46.81%) and young adults (28.33 ± 12.04 years) and 28.8% required orchiectomy. Those undergoing orchiectomy were more likely to be older, have more comorbidities, and have a systemic inflammatory response syndrome. Mean operative time was longer in the orchiectomy group (48 ± 23 vs. 44 ± 20 minutes, p < 0.0124). There were no deaths at 30 days. Length of stay and rate of superficial wound infection were higher in the orchiectomy group and discharge to home was more likely in the orchiopexy group.Conclusions:Adult testicular torsion should be considered in an acute scrotum differential. Adult patients requiring orchiectomy for testicular torsion are more likely to have confounding medical conditions compared to those undergoing orchiopexy. Clinically, rates of complications between the 2 procedures are small, making the decision to perform orchiopexy or orchiectomy based on the scenario.     

膝关节置换术中可吸收倒刺缝线与常规可吸收缝线缝合切口的效果比较

目的比较初次全膝关节置换术(total knee arthroplasty,TKA)中可吸收倒刺缝线与常规可吸收缝线缝合切口的临床效果。方法本研究回顾性地选取2017年1月至2018年12月我科收治的80例TKA病人为研究对象,2017年1～12月使用常规可吸收缝线间断缝合关节囊的40例病人纳入对照组,2018年1～12月采用可吸收倒刺缝线连续缝合关节囊的40例病人纳入观察组,比较两组的切口缝合时间、手术时间、拆线时间、住院时间和术后切口并发症发生率等指标的差异,收集两组术后切口疼痛、肿胀、活动度等一般情况及Lysholm膝关节功能评分。结果观察组的切口缝合时间和手术时间分别为(8.02±2.15)min、(65.05±9.15)min,明显少于对照组的(20.45±2.65)min、(94.45±5.28)min,两组相比,差异均有统计学意义(P均<0.05),但两组病人的拆线时间、住院时间比较,差异均无统计学意义(P均>0.05)。观察组的切口总并发症发生率、轻微并发症发生率和严重并发症发生率分别为17.5%、15.0%、2.5%,对照组分别为7.5%、7.5%、0,两...     

The effect of electromagnetic field on undescended testis after orchiopexy

Undescended testis is a common problem leading to infertility. After orchiopexy some studies support the necessity of hormonal therapy. Electromagnetic field stimulation on living tissues increase cell proliferation, protein and DNA synthesis.Sixteen prepubertal rats was objected to the fixation of left testes to the anterior abdominal wall for 30 days, right testes were removed. Another group of sixteen rats objected only to the right orchiectomy and a manipulation simulating study group without fixation. After orchiopexy, animals were divided into two groups. Both groups had eight rats. Electromagnetic field (EMF) stimulation group had the stimulation for two hours every day for ten days, while the second group did not. The sham group also divided into two groups. The first one applied EMF and name as Group CEM, the second one was sham. Weight of removed testes were measured and fixed in 10% formaldehyde for histopathological evaluation. At the creating of undescended testis and right orchiectomies a blood sample was obtained for testosterone level of prepubertal rats. After finishing EMF stimulation the rats were mated with females for 17 days. After fertility study a blood sample was obtained for testosterone assay and body weight were measured and fixed in formaline for histopathologic evaluation. All the rats were killed with overdose ether anesthesia and number of fetuses were recorded. Histopathological evaluation was based on Johnsen criteria and seminiferous tubule diameter measurements.We conclude that EMF stimulation resulted in Leydig cell proliferation, increase in testosterone level, testis weight, but decrease in germ cell population.