Lindgren B W, Franco I, Blick S, Levitt S B, Brock W A, Palmer L S, Friedman S C, Reda E F
Long Island Jewish Medical Center-Schneider Children's Hospital, New Hyde Park, Illinois, USA.
J Urol. 1999 Sep;162(3 Pt 2):990-3; discussion 994. doi: 10.1016/S0022-5347(01)68042-X.
Laparoscopic orchiopexy is extremely effective for treating patients with nonpalpable testis. However, despite the high dissection and wide mobilization it allows in some cases, vessel length prevents the testis from reaching the scrotum. There have been only incidental cases reported in which laparoscopy has been used for vessel transection and testicular mobilization orchiopexy. We reviewed our cases treated with the Fowler-Stephens orchiopexy performed laparoscopically in 1 or 2 stages.
We reviewed the records of all boys who underwent laparoscopy for a nonpalpable testis at our institutions since 1992. Patients who underwent testicular vessel transection and orchiopexy performed laparoscopically in 1 or 2 stages were selected for evaluation. Office charts and operative reports were reviewed in detail.
Of the 126 nonpalpable testes in 108 patients 51 (40%) were intra-abdominal, including 18 (35%) in 14 patients in whom the Fowler-Stephens procedure was performed laparoscopically. Five testes were treated with a 2-stage procedure, while 11 were managed by laparoscopic mobilization followed by laparoscopic vessel clipping and orchiopexy in 1 stage. In 2 additional patients nearly all dissection was performed laparoscopically but due to extenuating circumstances inguinal incision was required as well. Thus, 13 testes were managed by 1-stage Fowler-Stephens orchiopexy, including all cases since August 1996 which required vessel transection. Two patients were hospitalized postoperatively for prolonged ileus after the second stage. All other 2-stage and all 1-stage cases were managed on an outpatient basis. There were no complications. At a mean followup of 6 months all cases without previous surgery that were managed by laparoscopic orchiopexy are without atrophy and the testes are in a scrotal position. Two testes in which previous surgery had been done atrophied postoperatively.
Laparoscopic transection of the testicular vessels is safe in boys with high abdominal testes that do not reach the scrotum after laparoscopic high retroperitoneal dissection. The magnification and wide mobilization of laparoscopy likely allow better preservation of the collateral vascular supply than open exploration. Previous surgery is a risk factor for atrophy. The success rate of 89% overall and 100% in patients who did not previously undergo testicular surgery equals or exceeds that of open orchiopexy in patients with abdominal testes. The 1-stage procedure avoids repeat anesthesia and the extensive, sometimes tedious, dissection that is occasionally required during reoperation.
腹腔镜睾丸固定术对于治疗隐睾患者极为有效。然而，尽管在某些情况下它允许进行高度解剖和广泛游离，但血管长度可能会阻碍睾丸降至阴囊。仅有少数病例报道过使用腹腔镜进行血管切断及睾丸游离固定术。我们回顾了采用腹腔镜下分1期或2期进行的Fowler-Stephens睾丸固定术治疗的病例。
我们回顾了自1992年以来在我们机构接受腹腔镜检查以评估隐睾的所有男孩的记录。选择那些接受腹腔镜下分1期或2期进行睾丸血管切断及睾丸固定术的患者进行评估。详细查阅门诊病历和手术报告。
108例患者中的126个隐睾，51个（40%）位于腹腔内，其中14例患者中的18个（35%）采用腹腔镜下Fowler-Stephens手术。5个睾丸采用2期手术治疗，11个睾丸先经腹腔镜游离，然后在1期进行腹腔镜血管夹闭及睾丸固定术。另外2例患者几乎所有解剖操作均在腹腔镜下完成，但由于特殊情况也需要腹股沟切口。因此，13个睾丸采用1期Fowler-Stephens睾丸固定术治疗，包括自1996年8月以来所有需要血管切断的病例。2例患者在第2期手术后因肠梗阻延长住院时间。所有其他2期及所有1期病例均在门诊处理。无并发症发生。平均随访6个月，所有未经先前手术且采用腹腔镜睾丸固定术治疗的病例睾丸均无萎缩且位于阴囊内。2个曾接受过先前手术的睾丸术后发生萎缩。
对于腹腔镜下高位腹膜后游离后仍无法降至阴囊的高位腹腔内睾丸的男孩，腹腔镜下切断睾丸血管是安全的。腹腔镜的放大作用和广泛游离可能比开放探查更有利于保留 collateral 血管供应。先前手术是发生萎缩的危险因素。总体成功率为89%，未接受过先前睾丸手术的患者成功率为100%，这等同于或超过了开放睾丸固定术治疗腹腔内睾丸患者的成功率。1期手术避免了再次麻醉以及再次手术时偶尔需要进行的广泛、有时繁琐的解剖操作。
