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。

Experience summary of Laparoscopic two-stage Fowler-Stephens operation in the treatment of abdominal undescended testis

ObjectiveTo investigate the feasibility of laparoscopic two-stage Fowler-Stephens operation (F-S operation) in the treatment of abdominal undescended testis. MethodsA retrospective analysis was performed on 35 children (37sides) with abdominal undescended testis from September 2014 to October 2018 in Nanfang Hospital affiliated to Southern Medical University and Zhangjiajie Hospital of Traditional Chinese Medicine. Among them, 29 patients (31sides) completed the secondary F-S operation, and the Color Doppler Ultrasound was performed 6 months after the secondary surgery to assess testicular atrophy (28 patients completed the follow up, 1 patient lost to follow up). ResultsAmong 26 children with unilateral abdominal undescended testis, 22 sides (84.62%)had normal testicular blood supply, testicles were located in the scrotum and the diameter of testicles ≥1 cm. 4 sides (15.38%) presented testicular atrophy post-operation. 2 cases of bilateral abdominal undescended testis (4 sides, 100%) all had bilateral testicular atrophy post-operation. There was significant difference in testicular atrophy rates between the two groups of unilateral abdominal undescended testis and bilateral ones (P=0.003). There was no significant difference in testicular atrophy rates between different age groups and different distance between the testicle and the inner ring mouth within the abdominal cavity (P>0.05). ConclusionThe rate of testicular atrophy after Laparoscopic two-stage F-S operation was not low, patients should to be selected carefully. For the cases with the testicular position located within 2cmof the opening of the inner ring, one-stage laparoscopic testicular descending fixation operation should be performed directly to reduce the incidence of postoperative testicular atrophy. For bilateral abdominal undescended testis cases, two-stage surgery can be considered. If atrophy occurs on one side after surgery, then the surgical method for the other side should be consider without cutting off the spermatic vessels.