门诊针式切口治疗小儿腹膜鞘状突未闭

目的探讨门诊针式切口治疗小儿腹膜鞘状突未闭的可行性和手术效果。方法对803例876侧腹膜鞘状突未闭小儿在门诊行腹股沟针式切口高位缝扎鞘状突手术病例进行回顾性总结分析。结果全组病例均治愈,单侧手术时间5~30 min。手术切口甲级愈合率100%,术后阴囊肿胀32例,复发8侧,复发率0.91%。结论针式切口治疗小儿腹膜鞘状突未闭在门诊手术切实可行且手术效果满意。     

鞘状突高位结扎治疗小儿鞘膜积液120例体会

目的探讨治疗小儿鞘膜积液的方法。方法2003年2月至2006年12月采用腹横纹小切口鞘状突高位结扎治疗小儿鞘膜积液共120例。结果手术一般在8~20 min内完成,术后伤口均一期愈合,住院时间2~4 d。术后随访7个月~4年,120例无复发、无腹股沟疝发生。结论采用腹横纹小切口鞘状突高位结扎治疗小儿鞘膜积液,方法简单,并发症少,疗效确切。     

鞘状突整体剥除高位结扎治疗小儿精索鞘膜囊肿26例

鞘膜积液是小儿最常见的疾病之一。小儿多为先天性，为鞘状突未闭而引起。鞘状突在不同部位的闭合不全可形成各种类型的鞘膜积液，有时合并有腹股沟疝。鞘膜积液为鞘膜的两端闭合而中间部分未闭合且有积液。囊内积液与腹腔和睾丸鞘膜不相通，称之为精索囊肿。     

腹腔镜小儿睾丸鞘状突缝扎术的研究进展

回顾总结小儿睾丸鞘状突缝扎术的研究进展,研究小儿斜疝和睾丸鞘膜积液的微创治疗方法,重点讨论经脐腹腔镜手术的方法和意义。     

鞘状突管高位结扎加悬吊治疗小儿鞘膜积液

目的 探索一种治疗小儿鞘膜积液的手术方法。方法 以内环与阴茎根部连线为切口线，根据不同类型的鞘膜积液选择切口的位置和长短，高位结扎，悬吊未闭合的鞘状突，远端鞘膜开窗式部分切除，排尽鞘膜积液后旷置。结果 本组415例，术后403例切口Ⅰ类愈合，12例切口皮下脂肪液化；术后有39例阴囊轻度水肿。随访0．5～2年，平均1．2年，随访率82％，未发现复发、睾丸萎缩、医源性隐睾等情况。结论 本组手术方法简单，安全，疗效确切，容易掌握。术后并发症少，复发率低，对不同类型的鞘膜积液均能处理。     

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.     

经脐单切口双通道腹腔镜手术治疗小儿鞘状突未闭的临床疗效

目的探讨经脐单切口双通道腹腔镜手术治疗小儿腹股沟鞘状突未闭的临床价值。方法收治30例腹股沟鞘状突未闭男性患儿,其中斜疝18例,鞘膜积液12例;左侧17例,右侧13例。常规取脐上缘1.0cm弧形小切口,经切口两角分别置入5mm、3mm Trocar各一个,使用18号静脉留置针带线穿刺至腹膜与腹横肌层间隙,完全腹膜外环绕未闭内环口,并经留置针提线至腹壁皮下打结。结果所有手术均取得成功,术中未使用复合套管。术中发现对侧隐性鞘状突未闭11例;手术平均用时单侧8±3min,双侧15±5min,术后住院1～2d,所有患者术后随访时间中位数4个月（2～6个月）,未见斜疝及鞘膜积液复发,腹股沟、脐部切口未见明显瘢痕。结论该手术方法操作步骤简单,所需器材费用低,借助人体天然瘢痕来掩盖手术切口,美容效果满意,在小儿外科工作中有着重要的临床意义。     

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     

小儿阴囊托带的设计与应用

腹股沟斜疝、鞘膜积液、隐睾是小儿外科常见疾病,常需要手术治疗。由于阴囊壁血运丰富,富于伸张性,缺乏压迫作用,故阴囊手术后易发生血肿、水肿、伤口感染[1]。适当托起阴囊可有效减轻或预防水肿,传统的方法是用毛巾、衣物、棉垫折叠起来或将整卷卫生纸垫在阴囊下,以抬高阴囊。以上方法要求患儿平卧于床上,不能随意活动,但术后患儿因切口疼痛及恐惧而产生不安全感,加之患儿好动的特点,不愿意卧床,常导致承托物移位、滑脱;另外,这些方法只有减轻重力作用,而对阴囊     

阴囊镜辅助小切口睾丸鞘膜切除术在睾丸鞘膜积液治疗中的应用

目的 探讨阴囊镜技术在睾丸鞘膜积液治疗中的应用价值。方法 回顾性分析比较南京医科大学附属江宁医院2017年12月1日—2021年12月31日间成功施行阴囊镜辅助小切口睾丸鞘膜切除术27例(MHS组)和传统开放手术32例(TH组)患者的临床资料。结果 MHS组和TH组在手术时间[(32.22±5.25) min vs.(57.34±8.71) min]、切口长度[(0.95±0.15) cm vs.(5.09±0.55) cm]和住院时间[(3.63±0.97) d vs.(4.72±0.89) d]上比较,MHS组明显短于TH组(P<0.01);术后切口疼痛评分MHS组显著低于TH组(P<0.01);术后第3、7天MSH组阴囊水肿程度均明显轻于TH组(P<0.05);术后24周MHS组与TH组复发率分别为14.81%、3.13%,差异无统计学意义(P=0.256)。结论 阴囊镜技术治疗睾丸鞘膜积液是安全的,具有手术时间短、切口小、术后疼痛轻、阴囊水肿程度轻和住院时间短等优点,但其复发率可能高于开放手术。     

Single scrotal incision orchiopexy for palpable undescended testis

OBJECTIVE: To prospectively evaluate the Bianchi single scrotal incision technique for orchiopexy in boys with palpable undescended testis. METHODS: A total of 35 orchiopexies were performed in 28 patients. The patent processus vaginalis was dissected and cut high without ligation, while in Bianchi's original procedure, the patent processus vaginalis is dissected up to the external inguinal canal, ligated high and divided. Testicular size and position were assessed at 2 and 6 weeks and 6 months. RESULTS: The single incision technique was successful in all cases. All testes were satisfactorily positioned in the scrotum. All testes showed good anatomical and cosmetic results at 6-month follow-up. CONCLUSION: Single scrotal incision orchiopexy without ligation of the patent processus vaginalis has proved to be simple, safe and effective in selected cases compared with the standard two-incision approach in the treatment of palpable undescended testis.     

Scrotal incision orchiopexy for undescended testes with or without a patent processus vaginalis

PURPOSE: Bianchi and Squire first described scrotal incision orchiopexy as an alternative to the traditional inguinal approach in the 1980s. The goal of this study was to review our series of scrotal orchiopexies to evaluate operative times, success rates and complications in patients with and without a patent processus vaginalis. MATERIALS AND METHODS: A total of 121 scrotal incision orchiopexies were performed in 103 patients with palpable undescended testes between November 2002 and January 2006. This technique involves manipulation of the testis down to the scrotum so that it is secured between the thumb and index finger as fixation is performed. Charts were retrospectively reviewed to assess operative times as well as position and size of the testes at followup. RESULTS: Patient age ranged from 6 months to 13 years (mean 4.5 years). The processus vaginalis was patent in 75 testes (62%). A total of 121 testes (100%) were successfully placed within the scrotum using a single incision. Operative times ranged from 7 to 36 minutes (mean 18.9). There were no cases of testicular atrophy or ascent, hernia or hydrocele formation with followup that ranged from 6 months to 1 year. The only complications were 4 wound infections (3.3%), which were successfully treated with antibiotics. CONCLUSIONS: The scrotal incision technique is an underused method of orchiopexy regardless of patency of the processus vaginalis. Shorter operative times, comparable success and complication rates, and a more cosmetically appealing result compared to the traditional inguinal approach make scrotal orchiopexy an attractive alternative.     

One third of patients with a unilateral palpable undescended testis have a contralateral patent processus

PurposeThe purpose of this study was to determine the incidence and predictive factors associated with a contralateral patent processus vaginalis in boys with a unilateral palpable undescended testis.MethodsWe retrospectively reviewed the records of 77 consecutive boys (median age, 15 months; range, 5 months to 17.7 years) who had undergone orchiopexy for a unilateral palpable testis. At inguinal orchiopexy, an 8F feeding tube and a 70° adult cystoscope lens were placed into the peritoneum through the hernia sac, and the contralateral internal ring was inspected. The clinical factors that might predict the presence of a contralateral patent processus vaginalis were determined.ResultsThe overall rate of a contralateral patent processus vaginalis was 34% in those with a significant ipsilateral hernia sac. After considering age, side, prematurity, location, and volume of the undescended testis, only the boys with a testis distal to the external ring compared with those with testes lying within the inguinal canal had statistically increased odds of a patent contralateral processus vaginalis (odds ratio, 3.1; 95% confidence interval, 1.08-9.08).ConclusionApproximately one third of boys with a unilateral palpable undescended testis will have a contralateral patent processus vaginalis as determined by transinguinal laparoscopy. The rate is higher (52%) if the undescended testis was distal to the external ring. Both the etiology and significance of this contralateral finding are unknown.     

Testicular atrophy after attempted pediatric orchidopexy for true undescended testis

Background/Purpose

A normal testis in the scrotum is the most important outcome of the attempted pediatric orchidopexy for a true undescended testis. The reports of post-orchidopexy testicular atrophy in the literature have ranged from non-existent to unclear. Our purpose in this study was to estimate the incidence of and associated risk factors for post-orchidopexy testicular atrophy.

Methods

We performed a retrospective review of data from children who had an attempted orchidopexy for a true undescended testis from 1969 to 2003 inclusive. REB approval 1000011987.

Results

There were 1400 attempted orchidopexies involving common (low) type (n = 1135), ectopic type (n = 174), and high type testes (n = 91). There were a total of 111/1400 (8%) atrophic testes, mostly right-sided. 66/111 (59%) were MADE atrophic, and 45 (41%) were FOUND atrophic. Of the 1135 common type, 56 (5%) were MADE atrophic. In the ectopic and high types, the incidence of post-operative testicular atrophy was 1% and 9%, respectively.The most significant risk factors associated with testes MADE atrophic were high testicle, vas problems, and pre-operative torsion.

Conclusions

In this series, the incidence of post-operative testicular atrophy that was MADE was 5% in the common (low) type and 9% in the high type. These numbers and the above risk factors should be quoted to the caregiver during pre-operative informed consent.     

Long-term testicular position and growth of acquired undescended testis after prepubertal orchidopexy

PurposeThe aim of the study was to determine long-term testicular position and growth of acquired undescended testis (UDT) after prepubertal orchidopexy.MethodsPatients who had undergone prepubertal orchidopexy for acquired UDT at our hospital between 1986 and 1999 were recruited to assess long-term testicular position and volume. Testis position was assessed by physical examination. Testis volume was measured with Prader orchidometry and ultrasound and was compared with normative values reported in the literature.ResultsA total of 105 patients (aged 14.0-31.6 years) were included with 137 acquired UDT (32 bilateral, 33 left sided, and 40 right sided). All but 1 of the orchidopexied testes (99.3%) were in low scrotal position. The mean volume of the orchidopexied testes in unilateral UDT (n = 73, 10.57 ± 3.74 mL) differed significantly from the size of the testes at the contralateral side (14.11 ± 4.23 mL) (P = .000). The operated testes (10.28 ± 3.45 mL) were smaller than the mean adult testis volume reported in the literature (13.4-13.6 mL; cutoff, 13.2 mL).ConclusionTestis position after prepubertal orchidopexy for acquired UDT was nearly always low scrotal. The volume of the orchidopexied testes was smaller than both the volume of the contralateral testes and the normative values reported in the literature.