Bianchi睾丸下降固定术在治疗中低位隐睾中的应用

目的 比较Bianchi(经阴囊皮纹切口)睾丸下降固定术较传统经腹股沟及阴囊切口睾丸下降固定术的优缺点.方法 从2008年10月至2009年12月,手术治疗58例中低位隐睾病例,随机对其中28例(32侧睾丸)行Bianchi睾丸下降固定术.该组患儿年龄最小1.5岁,最大6岁,平均2.5岁.传统方法即经腹股沟和阴囊切口治疗30例(35侧),年龄最小0.5岁,最大6岁,平均2.5岁.在手术时间、术后住院天数、手术成功率、术后并发症尤其是遗留瘢痕等方面进行比较.结果 Bianchi组与传统手术组患儿的平均手术时间分别为20 min和35 min(P＜0.01);术后平均住院时间分别为3 d和5 d;经过1个月到14个月的随访比较,均未出现睾丸萎缩情况;Bianchi组患儿出现术后3例睾丸上缩情况,传统手术组出现1例术后睾丸上缩,发生率的差异没有统计学意义;术后均没有患儿出现腹股沟斜疝的并发症,但Bianchi组患儿术后几乎无法发现手术痕迹.结论 对于中低位隐睾,行Bianchi睾丸下降固定术与传统手术方法有着相同的手术成功率,但在手术时间、术后恢复时间等方面有一定的优势,且切口隐蔽.

Abstract：

Objective To evaluate prospectively the scrotal incision orchiopexy (Bianchi technique) for patients with an undescended testis in the mid or distal inguinal canal or beyond the external inguinal ring. Methods A total of 67 orchiopexies were performed in 58 patients with a primary undescended testis. Scrotal incision orchiopexy (Bianchi technique) were performed in 28 patients and the traditional orchiopexy were performed in 30 patients. Results Bianchi technique required shorter operative time than the traditional orchiopexy. At 7-month follow up,both groups had the same outcomes. No hernias were identified. Conclusions A scrotal incision for a palpable primary testis is well tolerated, Prescrotal orchiopexy is a successful procedure in select patients with a low complication rate. It has the advantage of a single incision which is cosmetically pleasing. It requires shorter operative time.     

Bianchi睾丸下降固定术在治疗中低位隐睾中的应用

目的 比较Bianchi(经阴囊皮纹切口)睾丸下降固定术较传统经腹股沟及阴囊切口睾丸下降固定术的优缺点.方法 从2008年10月至2009年12月,手术治疗58例中低位隐睾病例,随机对其中28例(32侧睾丸)行Bianchi睾丸下降固定术.该组患儿年龄最小1.5岁,最大6岁,平均2.5岁.传统方法即经腹股沟和阴囊切口治疗30例(35侧),年龄最小0.5岁,最大6岁,平均2.5岁.在手术时间、术后住院天数、手术成功率、术后并发症尤其是遗留瘢痕等方面进行比较.结果 Bianchi组与传统手术组患儿的平均手术时间分别为20 min和35 min(P＜0.01);术后平均住院时间分别为3 d和5 d;经过1个月到14个月的随访比较,均未出现睾丸萎缩情况;Bianchi组患儿出现术后3例睾丸上缩情况,传统手术组出现1例术后睾丸上缩,发生率的差异没有统计学意义;术后均没有患儿出现腹股沟斜疝的并发症,但Bianchi组患儿术后几乎无法发现手术痕迹.结论 对于中低位隐睾,行Bianchi睾丸下降固定术与传统手术方法有着相同的手术成功率,但在手术时间、术后恢复时间等方面有一定的优势,且切口隐蔽.     

微型腹腔镜下睾丸下降固定术40例

目的 探讨微型腹腔镜下睾丸下降固定术在儿童隐睾中的应用.方法 2010年6月至2011年6月,我们对40例隐睾患儿施行微型腹腔镜睾丸下降固定术.术中行单侧睾丸下降固定术33例,双侧5例,一期Fowler-Stephens手术4例.术中见睾丸萎缩2例,除2例睾丸萎缩病例外,其余病例均行患侧疝囊高位结扎术,对侧疝囊高位结扎术7例.结果 40例患儿均顺利完成手术,无中转开放手术.单侧手术时间30~45 min,平均38 min,双侧手术时间54~78 min,平均64 min.随访12～24个月,平均18个月,无睾丸回缩、睾丸萎缩、腹股沟疝等并发症.结论 微型腹腔镜下睾丸下降固定术治疗儿童隐睾创伤小,睾丸下降完全,安全有效,并发症少,可作临床推广应用.     

单侧隐睾症患者睾丸大小及位置的术前超声评估

目的运用超声检查探讨单侧隐睾症患者年龄及睾丸所在部位与睾丸体积之间的关系。方法采用彩色多普勒超声检查双侧睾丸位置,测量睾丸各径线,计算睾丸体积。按年龄和睾丸所在位置分组。采用方差分析睾丸体积、年龄及睾丸所在位置的关系。结果608例年龄6个月至13岁经超声检查及手术证实的单侧隐睾患儿中,左侧306例,右侧302例。51例隐睾位于腹腔内,557例位于腹腔外。单侧隐睾患儿未下降睾丸位于腹腔内组与位于腹腔外组患侧睾丸体积比较无明显差异（P=0．658）;6个月至13岁各年龄组患儿患侧睾丸体积均明显较对侧睾丸体积小（P〈0．001）;单侧隐睾患儿双侧睾丸体积在1-11岁之间比较,差异无统计学意义（P〉0．05）。结论隐睾症对小于1岁的婴儿睾丸体积发育已造成影响,宜在1岁以前尽早手术。1-11岁双侧睾丸体积均未见明显变化,睾丸发育处于相对静止期。     

改良睾丸下降固定术式探讨

隐睾治疗的基本目的是将睾丸下降入阴囊并固定。本院采用下腹部腹横纹处横切口,术中保留睾丸引带,行阴囊肉膜囊固定术治疗1244例,疗效满意,现报告如下。     

腹腔镜下Fowler—Stephens分期睾丸固定术在高位隐睾中的应用

目的观察腹腔镜下Fowler-Stephens分期睾丸固定术治疗高位腹腔内隐睾的效果。方法对8例11侧高位隐睾患儿采用腹腔镜下Fowler-Stephens分期睾丸固定术,术后随访所有病例,观察睾丸血运,测量睾丸大小。结果所有病例睾丸均达到阴囊正常位置,无睾丸萎缩及睾丸回缩,睾丸明显增大。结论腹腔镜下Fowler-Stephens分期睾丸固定术治疗高位腹腔内隐睾疗效可靠。     

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。     

睾丸附件雄激素受体表达与睾丸下降及隐睾发育情况的相关性分析

目的 通过对隐睾患者的睾丸附件雄激素受体进行分析,探究睾丸附件的雄激素受体表达与睾丸下降及睾丸发育之间的潜在关系.方法 收集2019年11月至2020年5月由上海交通大学医学院附属上海儿童医学中心收治的39例隐睾患者的临床资料,对术中切除的睾丸附件标本进行免疫组化检查,并将隐睾患者分为先天性隐睾(n=28)与获得性隐睾...     

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.     

经阴囊单切口睾丸下降固定术治疗低位隐睾的临床研究

目的比较经阴囊上缘或中部单切口与经腹股沟阴囊双切口睾丸下降固定术治疗低位隐睾的临床效果。方法回顾性分析2013年3月至2014年4月复旦大学附属儿科医院收治的109例低位隐睾患儿的临床资料,分别经阴囊上缘单切口（A 组）、经阴囊中部单切口（B 组）和经腹股沟阴囊双切口（C 组）行睾丸下降固定术。比较三组手术时间、手术成功率及并发症的发生情况。结果109例患儿136侧手术均成功完成。A 组49例62侧,B 组23例33侧,C 组37例41侧。平均手术时间：A 组（38．14±12．80）min,B 组（37．48±11．07）min,差异无统计学意义（P ＞0．05）,但 A、B 两组均较C 组[（44．38±13．37）min]短（P ＜0．05）。随访2-15个月,3组患儿术后均未出现严重并发症。结论3种手术切口均可安全有效地治疗低位隐睾,经阴囊上缘或中部单切口行睾丸下降固定术具有手术时间短、创伤小的优势,特别是经阴囊上缘单切口更为隐蔽美观。     

超声检查在大鼠腹腔镜Fowler-Stephens术后睾丸萎缩中的诊断价值

目的　探讨超声检查包括灰阶影像和能量多普勒在大鼠腹腔镜Fowler Stephens(F S)术后睾丸萎缩中的诊断价值。方法　 30d龄幼年Wistar大鼠行腹腔镜下右侧F S术 (精索血管腹腔内离断 ) ,术后从 9～ 5 4 0d 7个时段 (青春发育前期至中年期 ) ,分别用睾丸触诊和超声检查来判断睾丸萎缩情况 ,并与组织学检查结果进行对比。结果　腹腔镜F S术后该三种检查的睾丸萎缩检出率分别为 6 6 .7%、6 9.4 %和 84 .7% (P <0 .0 5 )。按超声诊断睾丸萎缩可分为三度 (0、Ⅰ、Ⅱ ) ,其相应组织学变化分别为正常或轻度萎缩、重度萎缩和完全萎缩。超声检查对重度和完全睾丸萎缩的检出率为 96 .0 %。用超声检查观察睾丸体积、边界、内部回声均匀情况、微结石和血流信号等指标可最早在术后 9d和 4 5d发现组织学上表现为完全萎缩和重度萎缩的睾丸。而睾丸触诊仅能发现术后 4 5d及其后的完全睾丸萎缩。结论　用超声检测睾丸体积、内部回声均匀于否、微结石和血流下降等指标能无损伤、客观地反映F S手术后不同阶段睾丸萎缩情况。F S术后的常规检查应为超声而非触诊     

Histological evaluation of the testicular nubbins in patients with nonpalpable testis: assessment of etiology and surgical approach

There is a controversy in the literature whether testicular nubbins carry malignancy risk and excision of the nubbin is necessary in patients with nonpalpable testis. It is also controversial whether vanishing testis has the same etiopathogenesis and risk with true undescended testis. The aim of this study is to investigate the histological findings of testicular nubbins in patients with nonpalpable testis and to question etiology and surgical indications for vanishing testis. We reviewed the histopathological results of 44 testicular nubbins in 40 patients (mean age: 4.1 years, range 1–13 years) with nonpalpable testis between 1992 and 2004, retrospectively. Exploration revealed 5 intraabdominal and 39 inguinal testicular nubbins. Of 44 specimens only 5 (11.3%) from inquinal testicular nubbins were found to have seminiferous tubules. Two of the five had seminiferous tubule structures with viable germ cells showing maturation correlating with age. The other two with scarce seminiferous tubules were seen on only a single area and one had Sertoli cells only. None of the excised tissue had malignant degeneration. The vas deferens was identified in 23 (52.2%), vessels in 26 (59%), calcification in 14 (31.8%) and hemosiderin in 12 (27.2%) of excised tissue. Presence of calcification in one-third of the nubbins supports vascular accident thesis in the etiopathogenesis of vanishing testis. The possibility for the presence of seminiferous tubules and viable germ cells in the testicular nubbin is low. These facts decrease theoritical risk of malingnancy. Therefore, an inguinal exploration for testicular nubbin in patients with vas deferens and vessels entering into the inquinal canal diagnosed at laparoscopy can be postponed untill testicular prosthesis implantation and the nubbin can be removed at this operation.     

Transscrotal orchidopexy: orchidopexy revised

In a study of 120 orchidopexies for palpable undescended testes, the observation of Schuller [9] and Bevan [1, 2] that most testicular undescent was associated with a shorter than normal processus vaginalis was confirmed. Division of the processus vaginalis allowed 1.5–3.5 cm of further testicular descent. The testicular vascular pedicle was always long enough to allow tension-free placement of the testis in an ipsilateral extradartos pouch except in those testes that had been retained at a high level within the inguinal canal. It is proposed that the majority of orchidopexies for palpable undescended testes should commence with a scrotal incision, and that an additional groin incision and retroperitoneal vascular pedicle mobilisation be reserved for the few high testes that will not otherwise reach the scrotum. The technique has the advantage of a single incision, much less dissection and disruption of tissue, greater comfort for the day-case child, rapid healing with excellent cosmesis, and a well maintained testicular position in the scrotum. The high scrotal incision allows such easy direct access to the processus vaginalis and external inguinal ring that we also recommend this approach for routine inguinal herniotomy in children. Offprint requests to: A. Bianchi     

The “atrophic” testicular remnant

Remnants of testicular tissue at the end of a diminutive spermatic cord are the end result of testicular infarction from torsion of the testis or spermatic cord, occurring either in utero or unrecognized in the neonatal period. Idiopathic testicular artery thrombosis is another possibility. The majority of 20 specimens examined microscopically showed fibrosis, hemosiderin deposits, and calcification. Fixation of the opposite testis is recommended for these patients.     

Early insertion of trans-scrotal port during laparoscopic orchidopexy: A new concept

Laparoscopic orchidopexy has become the routine tool in managing abdominal testes. Many techniques have been used to deliver the dissected testis to the scrotal position; a trans-scrotal port is one of them. We present a technique in which the trans-scrotal port is inserted early on, and used not only for testis delivery but also to aid the testicular dissection. We used the technique for 15 abdominal testes in 13 boys and it was safe, and very helpful in dissecting the vascular pedicle to higher levels in an ergonomically easier plane. In addition, it helped in establishing the tract and eventually guiding the dissected testis to the desired scrotal position (12 low and 3 mid-scrotal).     

The effects of orchidopexy and orchidectomy on testes of rats subjected to ipsilateral abdominal testis with vas deferens obstruction

An experimental study was planned to evaluate and compare the effects of orchidopexy and orchidectomy on the testes of rats subjected to unilateral abdominal testis with vas deferens obstruction. Four groups were established. Rats in the control group underwent a sham procedure. While the testis was maintained in the abdomen with the vas deferens ligated for 8 weeks in group 2, rats in groups 3 and 4 underwent orchidopexy or orchidectomy after 4 weeks. Remaining testes were harvested at the end of the 8-week period. Testis and body weights were obtained during harvest. Samples were evaluated through DNA flow cytometry, and percentages of haploid cells were determined. Groups were compared through unpaired t-test, and p-values less than 0.05 were considered significant. All three treatments had decreased testis weight over body weight values of ipsilateral testes. Ipsilateral orchidectomy increased the value among contralateral testes. However, none of the groups had a contralateral testicular value less than the sham-operated group. All three treatments decreased the percentage of haploid cells among ipsilateral testes, but only an abdominal testis was associated with a decrease in the percentage of haploid cells among contralateral testes. Maintaining a testis with an obstructed vas deferens in the abdomen for 8 weeks damages both ipsilateral and contralateral testes. Orchidopexy, while showing amelioration of the ipsilateral testis, spares the contralateral testis as well as orchidectomy. Orchidopexy for an undescended testis with vas deferens obstruction is a rational approach.     

Long term follow-up study of fertility after orchidopexy in children with cryptorchidism

目的 通过分析生育率及精液来评价单双侧隐睾患者睾丸固定术后远期生育力.方法 随访1981年10月至1997年11月期间做过隐睾手术的患者342例,分析已婚者的生育及不育治疗情况和未婚者的精液质量,来评价患者生育力.结果 共有49例患者获得完整资料,随访率为14.3％,其中单侧33例,双侧16例.已婚者中单侧隐睾患者生育率为92.9％,双侧为37.5％,生育者怀孕时间(从计划怀孕至成功怀孕的时间)单侧隐睾平均为3个月,双侧为6.3个月;不育者中有4例经药物治疗后精液正常,3例已经生育.未婚者中单侧隐睾患者的精液正常率为84.2％,双侧为25.0％.双侧隐睾精液异常者中腹腔内型隐睾占66.7％.结论 单侧隐睾患者术后远期生育力接近正常人,而双侧隐睾生育率及精液正常者远低于单侧;双侧隐睾患者怀孕时间大于单侧;部分不育患者治疗后可以生育.双侧腹腔内型隐睾更易致精液异常.     

有腹股沟区手术史的隐睾患儿诊疗分析

目的探讨腹股沟区手术后隐睾的原因、预防措施及手术方法。方法回顾性分析2006年6月至2011年3月作者收治的13例（14侧）腹股沟区手术后再次行隐睾手术患儿的临床资料,其中隐睾手术后8例,腹股沟斜疝手术后4例,鞘膜积液手术后1例。均再次行睾丸下降固定术,手术前后超声测量睾丸容积。结果13例（14侧）患儿睾丸均降入阴囊内,术中见瘢痕粘连明显。术后12例（13侧）获随访2个月至4年,睾丸无回缩,彩超提示13侧睾丸位置、血流正常,睾丸容积4侧较术前缩小5％一15％,1侧与术前相当,8侧较术前增大。结论导致腹股沟区手术后隐睾的原因为隐睾合并斜疝或鞘膜积液时只处理了后者,或单纯行斜疝或鞘膜积液手术时操作不当使睾丸上移,或隐睾手术中未充分游离精索,未达到无张力下降,以致睾丸上缩。腹股沟区手术后隐睾应适时手术,再次手术要仔细分离腹股沟粘连,并注重腹膜后精索的游离。