Van Savage J G
Division of Urology, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
J Urol. 2001 Oct;166(4):1421-4. doi: 10.1097/00005392-200110000-00060.
Nonpalpable testicles may be due to the vanishing testis syndrome, intra-abdominal position, examination obscured by obesity or scar tissue and rarely testicular agenesis. Laparoscopy is an excellent means of distinguishing these entities without the need for open abdominal exploration. We investigated whether laparoscopy affects the need for an inguinal incision and exploration when no testicle is palpable and the vas and vas deferens are visualized exiting the internal inguinal ring on laparoscopy.
In 34 boys 6 to 18 months old (mean age 41) physical examination demonstrated a nonpalpable testicle, including on the right side in 12, on the left side in 17 and bilaterally in 5. The vanishing testis syndrome was diagnosed after laparoscopy when no testicle was palpable despite physical examination done with the patient under anesthesia, spermatic vessels were visualized exiting the internal inguinal ring or spermatic vessels were visualized in the abdomen with or without an identifiable intra-abdominal testicular nubbin.
Laparoscopy confirmed the vanishing testis syndrome in 16 patients, intra-abdominal testicles in 13 and peeping testes in 1. Adequate examination using anesthesia was not possible in 4 patients with obesity, or previous inguinal or lower abdominal surgery. These boys underwent inguinal exploration after laparoscopy showed the vas and vessels exiting a closed internal inguinal ring. Of the 16 cases of the vanishing testis syndrome orchiectomy with contralateral scrotal orchiopexy was performed in 14 through a median raphe scrotal incision and in 1 through an inguinal incision for an associated inguinal hernia. In the remaining patient who underwent laparoscopy only a blind ending vas and vessels were visualized in the abdomen without an identifiable nubbin. The infraumbilical and median raphe incisions healed without obvious scars. Followup was at least 1 year.
When spermatic vessels are visualized exiting the internal inguinal ring on laparoscopy in the setting of a nonpalpable testicle, a median raphe scrotal incision can be made to remove the testicular nubbin associated with the vanishing testicle syndrome. Orchiectomy is possible through this median raphe incision even when the testicle is in the inguinal canal because this distance in young children is small. Cosmesis is excellent since 1 incision is within the umbilicus and the other is on the median scrotal raphe.
不可触及的睾丸可能是由于睾丸消失综合征、腹腔内位置、肥胖或瘢痕组织掩盖检查所致，睾丸发育不全则较为罕见。腹腔镜检查是区分这些情况的极佳方法，无需进行开放性腹部探查。我们研究了在不可触及睾丸且腹腔镜检查显示输精管和精索血管从腹股沟内环穿出时，腹腔镜检查是否会影响腹股沟切口和探查的必要性。
对34名6至18个月大（平均年龄41个月）的男孩进行体格检查，发现睾丸不可触及，其中右侧12例，左侧17例，双侧5例。在腹腔镜检查后，若在麻醉状态下进行体格检查仍未触及睾丸、可见精索血管从腹股沟内环穿出或在腹腔内可见精索血管（无论有无可识别的腹腔内睾丸残端），则诊断为睾丸消失综合征。
腹腔镜检查确诊16例睾丸消失综合征、13例腹腔内睾丸和1例隐匿睾丸。4例肥胖或曾接受腹股沟或下腹部手术的患儿无法在麻醉状态下进行充分检查。这些男孩在腹腔镜检查显示输精管和血管从闭合的腹股沟内环穿出后接受了腹股沟探查。在16例睾丸消失综合征病例中，14例通过阴囊正中缝切口进行了睾丸切除术及对侧阴囊睾丸固定术，1例因合并腹股沟疝通过腹股沟切口进行手术。在仅接受腹腔镜检查的其余患者中，腹腔内可见盲端输精管和血管，无可识别的残端。脐下和阴囊正中缝切口愈合后无明显瘢痕。随访至少1年。
在不可触及睾丸的情况下，若腹腔镜检查可见精索血管从腹股沟内环穿出，可通过阴囊正中缝切口切除与睾丸消失综合征相关的睾丸残端。即使睾丸位于腹股沟管内，由于幼儿此距离较短，也可通过该阴囊正中缝切口进行睾丸切除术。由于一个切口在脐内，另一个在阴囊正中缝，美容效果极佳。
