腹腔镜下开放鞘状突环扎技术在小儿隐睾手术中的应用：附视频

目的探讨腹腔镜下开放鞘状突（PPV）环扎技术在小儿隐睾手术中的作用。方法回顾分析2008年8月至2012年2月腹腔镜治疗42例小儿隐睾的病例资料，统计PPV和对侧开放鞘状突（CCPV）发生率并予以关闭。观察手术时间、并发症、住院日数等。结果患儿年龄中位数3岁（1-14岁），术前诊断左侧23例（54．8％），右侧12例（28．6％），双侧7例（16．6％）。术中探查PPV发生率73．8％（31／42），CPPV发生率35．7％（15／42）。术前诊断为单侧隐睾的病例既往有手术史占5．7％（2／35）。腹腔镜下行PPV／CPPV环扎，或缩小患侧内环开口。腹股沟不可触及隐睾超声术前诊断与术中探查结果符合比率64％（29／45），CT诊断符合比率69．2％（9／13）。手术时间（109．9±51．4）min。住院时间（6．3±3．6）d。术后随访时间为1个月。4年半，中位数时间3年，超声复查无睾丸萎缩、异时疝，无切口疝、肠粘连等。结论腹腔镜下PPV环扎技术应用于小儿隐睾手术，能最大限度保留腹股沟管壁完整性，手术微创、安全、有效。

The application of closing PPV by laparoscopy for pediatric ctyptorchidism

Objoetive To evaluate the salty and efficacy of closing PPV by laparoscopy for pediatric cryptorchidism. Mothoda A retrospective review was performed by evaluating the data of pediatric patients with cryptorchidism treated by laparoscopy from August 2008 to February 2012. The incidence of PPV and cPPV was analyzed. The PPV and cPPV were closed. Operation time, hospitalization days and complications were observed. Rosults Among 42 cases with a median age of 3 years （range 1 to 14 years）, 23 were left-sided （54.8%）, 12 were right-sided （28.6%）, and 7 were bilateral （16.6%） preoperatively. The cPPV rate was 35.7%（15/42）. History of contralateral inguinal surgery was observed in 5.7%（2/35 ） cases. PPV/cPPV was closed under laparoscopy, or the interior ring was constricted. The accuracy of ultrasound and computed tomography scanning was 64% and 69.2% compared with surgical result in non-palpable cryptorchidism respectively. The operation time was （109.9±51.4） minutes. The hospitalization days was （6.3 ±3.6）. During a median follow-up of 3 years （1 month to 4.5 years）, no atrophy of testis or metachronous hernia was detected in ultrasound examination. Neither incisional hernia nor adhesion of the intestine occurred. Conclusions Laparoscopy for PPV/cPPV is safe, effective, and simple in the treatment of cryptorchidism, with excellent cosmetic outcomes, and the maximum preservation of the integrity of the groin.