[1]李 骥,张 谦,郭立华,等.经海氏三角下降途径的腹腔镜Fowler-Stephens分期睾丸固定术治疗儿童腹腔型隐睾[J].郑州大学学报(医学版),2021,(01):128-131.
　LI Ji,ZHANG Qian,GUO Lihua,et al.Laparoscopic staged Fowler-Stephens orchiopexy for the intra-abdominal cryptorchidism through the tunnel of Hesselbach in children[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2021,(01):128-131.
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经海氏三角下降途径的腹腔镜Fowler-Stephens分期睾丸固定术治疗儿童腹腔型隐睾()
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《郑州大学学报(医学版)》[ISSN:1671-6825/CN:41-1340/R]

卷:
期数:
2021年01期
页码:
128-131
栏目:
应用研究
出版日期:
2021-01-20

文章信息/Info

Title:
Laparoscopic staged Fowler-Stephens orchiopexy for the intra-abdominal cryptorchidism through the tunnel of Hesselbach in children
作者:
李 骥; 张 谦; 郭立华; 王 磊; 孙 权; 刘艳飞; 刘 宁; 王冰蕊; 范应中
郑州大学第一附属医院小儿外科 郑州 450052
Author(s):
LI Ji;  ZHANG Qian;  GUO Lihua;  WANG Lei;  SUN Quan;  LIU Yanfei;  LIU Ning;  WANG Bingrui;  FAN Yingzhong
Department of Pediatric Surgery, the First Affiliated Hospital,Zhengzhou University, Zhengzhou 450052
关键词:
腹腔型隐睾;  Fowler-Stephens术;  海氏三角;  睾丸引带;  儿童
Keywords:
intra-abdominal cryptorchidism;  Fowler-Stephens;  the tunnel of Hesselbach;  testicular gubernaculum;  children
分类号:
R726.9
摘要:
目的:分析经海氏三角下降途径的腹腔镜Fowler-Stephens分期手术在儿童腹腔型隐睾治疗中的可行性和优势。方法:回顾性分析2017年6月至2019年6月期间郑州大学第一附属医院小儿外科收治的体表不能触及睾丸的患儿,均进行腹腔镜探查,将腹腔内可探及睾丸的病例纳入本研究,对所有纳入患儿均进行 Fowler-Stephens分期手术,观察分期首次术中睾丸引带、输精管血供及分期二次术中输精管血供侧支循环建立情况,术后彩超随诊睾丸体积及实质回声情况。结果:16例腹腔型隐睾患儿纳入该研究序列,分期首次手术发现睾丸位置越高,睾丸引带发育越差或未发育,睾丸位置较低者输精管在内环口区域有返折。分期二次手术发现患侧输精管的血供较前增生明显,所有隐睾患儿术后彩超提示实质回声均匀,无萎缩现象出现。结论:腹腔型隐睾的睾丸引带随着睾丸位置越高而发育越差,分期手术有助于输精管建立充分的侧支循环,经海氏三角下降途径的腹腔镜Fowler-Stephens分期睾丸固定术安全有效,可将睾丸下降至满意位置。
Abstract:
Aim:To analyze the feasibility and advantage of laparoscopic staged Fowler-Stephens orchiopexy for the intra-abdominal cryptorchidism through the tunnel of Hesselbach in children.Methods:A retrospective analysis was conducted on children with nonpalpable cryptorchidism admitted to Department of Pediatric Surgery, the First Affiliated Hospital,Zhengzhou University from June 2017 to June 2019.All the cases accepted laparoscopic exploration, whose testicle could be found entered into the study sequence.All the cases underwent the laparoscopic first and second stage Fowler-Stephens orchiopexy within 6 or 8 months.In the first stage, testicular gubernaculum and blood supply of vas deferens should be observed.In the second stage, collateral circulation of intraoperative blood supply of vas deferens should be noticed.Testicular volume and ultrasound of testicular parenchyma were paid attention in the postoperative follow-up.Results:Sixteen cases with intra-abdominal testis entered into the study sequence.During the first stage of surgery, it was observed that the testicular gubernaculum was more poorly dysplastic with the testicle higher and some of vas deferens returned to abdominal cavity after they went into the groin.During the second stage of the operation, all the blood supply of vas deferens was significantly increased compared with the previous one.All testes were pulled into the middle of the scrotum.There was no atrophied testis and all parenchymal echo were normal.Conclusion:The higher the testes locate, the poorer the testicular gubernaculum grows in the intra-abdominal cryptorchidism.Two staged Fowler-Stephens method can help intra-abdominal testis and vas deferens to establish the collateral circulation.It is safe and effective for laparoscopic staged Fowler-Stephens orchidopexy through the tunnel of Hesselbach in children.The testes can be pulled into the satisfied position in the scrotum.

参考文献/References:

[1] SHEHATA SM,SHEHATA SM, A BAKY FAHMY M.The intra-abdominal testis: lessons from the past, and ideas for the future[J].Pediatr Surg Int,2013,29(10):1039
[2] 中华医学会小儿外科学分会内镜外科学组.隐睾症腹腔镜手术操作指南(2017版)[J].临床小儿外科杂志,2017,16(6):523
[3] 刘铭, 李富江, 迟仁杰, 等.单孔腹腔镜辅助Bianchi手术治疗合并鞘状突未闭的滑动性隐睾[J].中国微创外科杂志, 2018,18(1):36
LIU M,LI FJ,CHI RJ,et al.Single-port laparoscopic assisted Bianchi surgery for low cryptorchidism accompanied with anomalies of processus vaginalis[J].Chin J Min Inv Surg,2018,18(1):36
[4] 段光琦, 晋志远, 刘洁, 等.Shehata术治疗腹腔型高位隐睾5例[J].中国微创外科杂志, 2018,18(6):562
DUAN GQ,JIN ZY,LIU J,et al.Shehata technique in the treatment of 5 cases of high intraabdominal cryptorchidism[J].Chin J Min Inv Surg,2018,18(6):562
[5] POWELL C,MCINTOSH J,MURPHY JP,et al.Laparoscopic orchiopexy for intra-abdominal testes-a single institution review[J].J Laparoendosc Adv Surg Tech A,2013,23(5):481
[6] ALZAHEM A.Laparoscopy-assisted orchiopexy versus laparoscopic two-stage fowler stephens orchiopexy for nonpalpable testes: Comparative study[J].Urol Ann,2013,5(2):110
[7] YU C,LONG C,WEI Y,et al.Evaluation of Fowler-Stephens orchiopexy for high-level intra-abdominal cryptorchidism: a systematic review and meta-analysis[J].Int J Surg,2018,60(1):74
[8] BLOOM DA.Two-step orchiopexy with pelviscopic clip ligation of the spermatic vessels[J].J Urol,1991,145(5):1030
[9] CHAN E,WAYNE C,NASR A,et al.Ideal timing of orchiopexy: a systematic review[J].Pediatr Surg Int,2014,30(1):87
[10]DOCIMO SG,SILVER RI,CROMIE W.The undescended testicle: diagnosis and management[J].Am Fam Physician,2000,62(9):2037
[11]RITZéN EM,BERGH A,BJERKNES R,et al.Nordic consensus on treatment of undescended testes[J].Acta Paediatr,2007,96(5):638
[12]姜大朋, 李志星, 耿红全, 等.隐睾患儿手术年龄变化趋势及相关影响因素分析[J].中华小儿外科杂志, 2016,37(2):134
JIANG DP, LI ZX, GENG HQ, et al.Orchidopexy trends in pediatric population and timing factors associated with orchiopexy:a retrospective single-center study[J].Chin J Pediatr Surg,2016,37(2):134
[13]COSTA WS,SAMPAIO FJ,FAVORITO LA,et al.Testicular migration: remodeling of connective tissue and muscle cells in human gubernaculum testis[J].J Urol,2002,167(5):2171
[14]FAVORITO LA,COSTA SF,JULIO-JUNIOR HR,et al.The importance of the gubernaculum in testicular migration during the human fetal period[J].Int Braz J Urol,2015,40(6):722
[15]郭应禄,周利群.坎贝尔-沃尔什泌尿外科学[M].北京:北京大学医学出版社, 2009:3957
GUO YL, ZHOU LQ.Campbell-Walsh Urology[M].Beijing:Peking University Medical Press,2009:3957
[16]王冰洁, 周君梅, 李玲玲, 等.人类高低位隐睾睾丸引带内肌肉组分的探究[J].临床小儿外科杂志, 2019,18(6):523
WANG BJ, ZHOU JM, LI LL,et al, Muscle components of gubernaculum testis from high/low cryptorchidic children[J].J Chin Ped Surg,2019,18(6):523

备注/Memo

备注/Memo:
【作者简介】张谦,通信作者,男,1969年7月生,博士,教授,主任医师,研究方向:小儿泌尿外科,E-mail:sy110@sina.com
更新日期/Last Update: 2021-02-15