腹腔镜诊治未触及隐睾21例报告

目的 探讨腹腔镜技术在诊治未触及隐睾中的作用.方法 2001年5月至2007年8月对21例23侧未触及隐睾患者行腹腔镜探查及一期睾丸下降固定术.结果 21例患者均行腹腔镜探查成功,1例睾丸发育不良行腹腔镜隐睾切除术,1例睾丸缺如,其余19例行一期睾丸下降固定术.平均手术时间55 min,平均住院时间3 d.门诊或电话随访0.5～3年,平均1.2年,无一例睾丸萎缩和移位.结论 腹腔镜探查未触及隐睾定位诊断准确率高,创伤小,可同时行一期睾丸下降固定术.     

腹腔镜手术治疗不可触及睾丸的隐睾患儿体会

目的探讨腹腔镜手术治疗不可触及睾丸的隐睾的价值。方法选取2014-08—2016-01间在郑州儿童医院接受腹腔镜睾丸探查的78例(86侧)不可触及睾丸的隐睾患儿,对其临床资料进行回顾性分析。结果腹腔内睾丸26例(34侧),腹股沟内睾丸2例。其中行Ⅰ期睾丸下降固定术8例(10侧),(F-S)分期睾丸固定术20例(24侧)。睾丸缺如36例,睾丸残余14例。结论腹腔镜手术治疗不可触及睾丸的隐睾,创伤小、术野清晰、能明确睾丸位置及与精索和输精管之间的关系,有助于采取相应的手术方式。     

未触及隐睾的临床诊断和处理

目的 总结未触及隐睾的诊治经验。方法 回顾性总结行外科手术探查的82例98侧未触及睾丸患者的诊治资料。82例平均年龄17岁。其中左侧22例，右侧44例，双侧16例。术前B超探及睾丸17侧(17％)、ECT检查4例，探及3例。结果 98侧手术探查：睾丸位于腹股沟52侧(53％)，腹腔33侧(34％)；睾丸缺如13侧(13％)。92侧(94％)行腹股沟部手术或加局限腹腔探查。结论 腹股沟部探查或辅以局限腹腔探查是目前处理未触及睾丸的首选方法。如果探查无结果或仅发现输精管，建议行腹腔镜检查。     

腹腔镜诊治未触及睾丸的隐睾42例

目的 探讨腹腔镜在未触及睾丸的隐睾患儿中的诊断及治疗作用。方法 对42例未触及睾丸的隐睾患儿腹腔镜检查，根据睾丸的位置及发育情况，分别行睾丸一期固定术，分期Fowler-Stephens手术或切除术，结果 腹腔内睾丸28例（28/42，66.7%），其中4例行分期Fowler-Stephens手术，1例行分期睾丸固定术，余23例行一期睾丸固定术，睾丸发育不良4例（4/42，9.5%）,经腹腔沟区探查行切除术；睾丸缺如7例（7/42，16.7%）；腹股沟管内睾丸3例（3/42，7.1%），行常规睾丸固定术。术后随访6-60个月，平均38个月，患侧睾丸位置和发育基本正常。结论 腹腔镜能够准确诊断未触及睾丸的隐睾，并可做相应的治疗。     

腹腔镜隐睾探查和固定术

目的探讨腹腔镜隐睾探查和固定术的治疗效果。方法对12例腹腔型隐睾患儿应用腹腔镜探查和固定术,对患儿的临床资料进行回顾性分析。结果 8例隐睾患儿手术均获成功,平均住院5～7 d,费用(2 300±2 700)元。患儿痛苦小、术后恢复快,无明显手术瘢痕。随访6～12个月,睾丸均位于阴囊内,无睾丸萎缩及回缩。结论腹腔镜隐睾探查和固定术创伤小,恢复快,安全可行。可以在有腹腔镜设备及技术条件的基层医院开展。     

腹腔镜在体表未触及隐睾诊治中的应用(附1例报告并文献复习)

目的探讨腹腔镜在体表未触及隐睾诊治中的应用。方法通过对1例术前双侧均未触及睾丸的隐睾患者行腹腔镜检查和治疗并结合文献复习。结果对于在体表未触及的隐睾均可以通过腹腔镜达到明确诊断和治疗。结论腹腔镜诊治腹腔型隐睾是一种临床适用性较强的手术方法,在很大程度可以代替开放的剖腹探查术,具有较高的临床推广应用价值。     

腹腔镜治疗可触及腹股沟型隐睾的疗效分析

目的:探讨腹腔镜技术治疗可触及腹股沟型隐睾的可行性及优势。方法:腹股沟型隐睾患者773例,左侧218例、右侧459例、双侧96例,共869个睾丸。年龄6个月至8岁,平均20个月。超声刀腹腔内切开腹膜后壁,游离高位精索接近肾下极,并将后腹膜与输精管分离开,再分离松解腹股沟管内精索粘连,离断睾丸引带,将睾丸回拉入腹腔内,保护输精管,将睾丸下拉入阴囊固定于肉膜囊。结果:773例869个睾丸手术均顺利,无中转开放手术。手术时间(34.8±5.4) min。患侧鞘状突未闭692侧(89.5%);677例单侧隐睾对侧隐匿性疝233例(34.4%),术中一并行疝囊高位结扎。术中无皮下气肿发生,术后无呕吐、腹胀不适,无伤口出血及明显疼痛。术后定期复查彩超,随访6～18个月,睾丸均位于阴囊内,无睾丸回缩及萎缩,未发现腹股沟疝或鞘膜积液。结论:腹腔镜治疗腹股沟型隐睾安全、有效,具有明显的微创优势,且可同时探查及治疗对侧隐匿性疝,避免了异时性腹股沟疝的发生。     

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     

腹腔镜和开放性手术治疗非腹腔型隐睾的meta分析

目的分析和对比腹腔镜和开放性手术治疗非腹腔型隐睾的有效性和安全性,为临床决策提供循证医学依据。方法计算机检索Medline、CochraneLibrary、CNKI、WANFANG等国内外数据库以及对相关文献中的参考文献进行Googlescholar搜索,纳入相关随机对照试验和临床观察性研究文献。由2名评价员独立评价文献质量和提取资料,采用Revman5．0软件进行Meta分析,计数资料和计量资料分别以相对危险度（OR）、加权均数差（WMD）及其95％可信区间（CI）表示其结局效应量。结果按照预先制定的纳入和排除标准,纳入相关文献6篇（腹腔镜睾丸固定术LO：233例,开放睾丸固定术00：262例）,meta分析结果显示与开放手术组比较腹腔镜手术组平均住院时间短（WMD=．2．83,95％a=[-4．15,-1．511,P〈0．0001）,术后并发症少（OR=0．21,95％CI=[0．10,0．43],P〈0．0001）,二次手术率低（OR=0．22,95％a=[0．05,0．88],P=0．03）,但二者在手术时间（WMD=-3．77,95％CI=[-10．49,2．94],P=0．27）和术中出血量（wMD=-2．08,95％CI=[-4．33,0．16],P=0．07）没有统计学差异。结论腹腔镜手术治疗非腹腔型隐睾在平均住院日、术后并发症及二次手术率方面均优于开放手术;但考虑到纳入研究的文献质量不高且存在发表偏倚,故尚需大规模多中心的临床随机对照试验提供最佳循证医学依据。     

腹腔型隐睾腹腔镜下二期Fowler-Stephens术的经验总结

目的探讨腹腔镜下二期Fowler-Stephens术（F-S术）治疗腹腔型隐睾的可行性。 方法回顾性分析2014年9月至2018年10月,南方医科大学附属南方医院和张家界市中医医院收治的35例（37侧）腹腔型隐睾患儿,其中29例（31侧）完成了二期F-S术,第2期手术后6个月复查彩色多普勒超声（随访28例,1例失访）,评估睾丸有无萎缩。 结果26例单侧腹腔型隐睾患儿中术侧睾丸血供正常22侧（84.62%）,睾丸直径≥1 cm,且位于阴囊内;术后出现睾丸萎缩4侧（15.38%）。2例双侧腹腔型隐睾患儿4侧（100%）术后均出现双侧睾丸萎缩。单双侧隐睾睾丸萎缩率比较,差异有统计学意义（P=0.003）。而睾丸萎缩率在不同年龄段和腹腔内睾丸距离内环口不同的距离之间,差异均无统计学意义（P>0.05）。 结论腹腔镜下二期F-S术治疗腹腔型隐睾,术后睾丸萎缩率不低,需要谨慎选择患者。对于睾丸位置位于内环口2 cm以内的腹腔型隐睾,直接行腹腔镜下一期睾丸下降固定术,减少术后睾丸萎缩的发生率。对于双侧腹腔型隐睾,可考虑分侧手术,如果一侧睾丸术后出现萎缩,那么另一侧就要考虑不离断精索血管的手术方式。     

Multi-incisional transumbilical laparoscopic surgery for nonpalpable undescended testes: A report of 126 cases

Purpose

The aim of this study was to evaluate the feasibility of multi-incisional transumbilical laparoscopic surgery for the management of nonpalpable undescended testes.

Material and methods

A series of 126 patients with 162 nonpalpable undescended testes underwent transumbilical laparoscopic surgery. Their mean age was 1.8 years (range, 1.1–6.5 years). Of the 126 cases, 73 were left-sided, 17 were right-sided, and 36 had bilateral cryptorchidism. Primary orchidopexy and the Fowler–Stephens procedure were used to mobilize the testes.

Results

All the operations were successfully performed without intraoperative complications. No additional ports or any conversions to an open procedure were required. Of the 162 nonpalpable undescended testes, 21 were absent or atrophied. One-hundred thirteen testes underwent primary orchidopexy, and 28 cases underwent a Fowler–Stephens orchidopexy. Patients were followed-up for 6–15 months. Only one case of testicular retraction was observed, and all others maintained a good size and the correct position. The scars were hidden within the umbilicus.

Conclusion

Transumbilical laparoscopic surgery is safe and feasible for nonpalpable undescended testes, and leaves no obvious abdominal or inguinal scar.     

Torsion of undescended testis: Clinical,imaging, and surgical findings

Torsion of undescended testis located within the inguinal canal is a rare entity, represents a surgical emergency, and must be dealt with immediately. We present a case of torsion of undescended testis in a 44-year-old man, who had progressive left inguinal pain for 2 days and in whom surgical exploration showed a twisted gangrenous testis. Orchiectomy was performed and pathological examination confirmed the diagnosis of testicular torsion. The English literature since 1978 was also reviewed to illustrate the clinical characteristics and current treatments.     

Fowler-Stephens手术治疗高位隐睾12例报告

目的:探讨Fowler-Stephens手术方法治疗高位隐睾的效果。方法:报告12例高位隐睾患者的临床资料。12例均患侧阴囊空虚,并在腹股沟不能扪及隐睾,其中9例通过B超及CT明确定位了高位隐睾位置,3例不能明确定位。手术先找到隐睾,在输精管汇入精索以上位置行Fowler-Stephens试验,明确手术方法可行后在该处离断精索,将隐睾下降固定于阴囊,术中注意避免对精索进行广泛游离。结果:12例患者经6个月~3年的随访,10例睾丸的大小、质地及多普勒彩超结果满意,2例发生睾丸萎缩。结论:Fowler-Stephens手术是治疗高位隐睾的有效方法。提高手术成功率关键在于:选择好手术适应证;术中避免对精索的广泛游离,不要破坏精索血管与输精管间的系膜,以保全侧枝循环对睾丸的血供。     

The frequency of undescended testis from birth to adulthood: a review

We performed a systematic review and critique of the literature on the frequency of undescended testis (UDT) among boys from birth to adolescence. Special attention was given to whether previous testicular position was taken into account to distinguish between congenital and acquired UDT. We searched Medline, Embase, Cinahl and the Cochrane Library. Any study reporting on the frequency of UDT was included. Study population age, number of boys studied, period of examination, primary examiner, area of study, study design, ethnicity, definitions used and previous testicular position were analysed. A total of 46 studies met the inclusion criteria. Twenty-three of the 46 (50%) studies involved newborns. Definitions were described in half of the studies; however, the definitions used were heterogeneous. Previous testis position was described in 11% (5/46) of the studies. At birth, in term and/or birth weight >2.5 kg infants, the UDT rate ranged from 1.0 to 4.6%, and in premature and/or birth weight <2.5 kg infants from 1.1 to 45.3%. At the age of 1 year UDT in term and/or birth weight >2.5 kg infants was seen in 1.0-1.5%, at 6 years in 0.0-2.6%, at 11 years in 0.0-6.6% and at 15 years in 1.6-2.2% of boys. The frequency of UDT shows variable figures in the literature. The actual frequency of acquired UDT essentially remains unclear because of the shortage of studies performed at an older age, and of studies reporting on previous testicular position.     

The influence of human chorionic gonadotrophin (hCG) on the morphology of the prepubertal human undescended testis

The effect of hCG-treatment on the morphology of the undescended testis was studied in testicular biopsies from 36 prepubertal boys operated on at intervals of 1 day to 2 years after discontinuation of hormonal treatment. Immediately after treatment, mature Leydig cells were observed, and the Sertoli cells were increased in size; serum testosterone had increased to adult levels. All these changes were reversible as judged from the material taken one month or more after the last hCG injection. Based on the observations and the results of a previous study it is suggested that hCG treatment does not induce any premature onset of Sertoli cell or germ cell maturation either in the undescended or in the contralateral testis.     

Differential expression of androgen and estrogen receptor of appendix testis in patients with descended and undescended testes

Objectives:   The incidence of appendix testis has been shown to be 76% in descended and 24% in undescended testis in our previous intraoperative survey. To determine the possible role of the appendix testis in the process of testicular migration, we compared the androgen and estrogen receptor status of appendix testis in descended and undescended testes.
Methods:   Thirty-seven appendix testes were collected intraoperatively and the expression of androgen and estrogen receptors were examined with immunostaining and immunofluorescence labeling. Based on the diagnosis, the specimens were divided into three groups. Group H (groin hernia, n  = 11, as a group of descended testis), Group AU (acquired undescended testis, n  = 14), and Group CU (congenital undescended testis, n  = 12).
Results:   The testicular appendages were found to express both androgen and estrogen receptors in Group H and Group AU, but specimens in Group CU were only estrogen receptor positive, whereas androgen receptors were not present.
Conclusion:   The presence of the androgen receptor in the appendix testis of the descended testes and acquired undescended testes and its absence in patients with congenital undescended testis suggests that the appendix testis might play a role in the process of testicular descent.     

The morphology of the human undescended testis with special reference to the Sertoli cell and puberty

The morphology of the undescended testis was studied in 50 boys aged 1-15 years. A low mean number of spermatogonia was found, but there were marked differences between the boys, some having high numbers whereas others were devoid of spermatogonia. Most Sertoli cells did not undergo normal maturation during puberty, but instead seemed to proliferate at a slow rate. It is concluded that treatment of undescended testes should be performed during the prepubertal period. It is also suggested that some undescended testes have a primary defect whereas others are damaged during the onset of puberty.     

Update on congenital versus acquired undescended testes: incidence, diagnosis and management

Congenital and acquired undescended testes are two distinct entities. Current management is surgery in the first 6-12 months of life for congenital undescended testes. Current management of acquired undescended testes is surgery at the time of diagnosis. Accurate diagnoses and expedient management are imperative in this condition to minimize the long-term sequelae of infertility and testicular cancer.     

Laparoscopic diagnosis and treatment of nonpalpable testis

OBJECTIVE: Laparoscopy has become one of the important diagnostic modalities of nonpalpable testis and has been developed and applied in the treatment of this disease. In the present study, we investigated the usefulness of laparoscopy in the diagnosis and treatment of nonpalpable testis. METHODS: Laparoscopy was carried out under general anesthesia on 21 patients (23 testes) from October 1991 to October 1999. If the internal spermatic vessels and vas deferens made their way into the internal inguinal ring, the inguinal canal was dissected with an incision in the inguinal region to look for the testis. Patients with intra-abdominal testis underwent laparoscopic orchiopexy or orchiectomy. If the internal spermatic vessels terminated with a blind end intraperitoneally, making it impossible to identify the testis, the case was judged to be vanishing testis and the operation was finalized without any further examination. RESULTS: In eight of 23 testes (35%), the internal spermatic vessels and vas deferens made their way into the internal inguinal ring. The inguinal region was examined in all the eight testes. Orchiopexy was carried out on two testes and orchiectomy was carried out on six testes. An intra-abdominal testis was detected in eight of 23 testes (35%). Laparoscopic orchiopexy was carried out on seven testes. One-stage orchiopexy was carried out on two of the seven testes and two-stage Fowler-Stephens orchiopexy was carried out on five of the seven testes. Orchiectomy was carried out on the remaining testis. Blocking or lack of the internal spermatic vessels and vas deferens was seen in seven of the 23 testes (30%) and this condition was diagnosed as vanishing testis. CONCLUSION: Laparoscopy for nonpalpable testis is considered to be the most effective technique for diagnosing the presence or absence of the testis and the location of the testis.