Ferro F, Lais A, Bagolan P, Talamo M, Caterino S
Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Eur Urol. 1992;22(2):142-6. doi: 10.1159/000474742.
There is no univoque opinion about the place of preoperative studies in non-palpable testes. During a 6.5-year period, we operated on 296 impalpable testes in prepubertal boys. A combined inguinal-abdominal approach was used in all cases verifying the eventual abdominal testis and its exact vascular anatomy before any manipulation of the cord was undertaken. Forty-five testes (15.2%) were canalicular, 142 (48%) were abdominal, 5 (1.7%) dysgenetic and 104 (34.1%) absent (agenesis or vanishing testis). Of the abdominal testes, 122 underwent a standard orchidopexy in dartos pouch, 11 a staged repair, 8 a Fowler-Stephens operation and 1 orchiectomy. All means of investigation for impalpable testes are either unreliable, too expensive or too invasive for routine use, and in most cases, a surgical exploration has to be performed anyway. The primary surgical approach has the most favorable cost/benefit ratio, being diagnostic and therapeutic at one time. Provided the exploration is performed correctly, all the advantages of previous laparoscopy can be achieved with surgery alone.
对于术前检查在不可触及睾丸中的作用，目前尚无统一的观点。在6.5年的时间里，我们对青春期前男孩的296个不可触及睾丸进行了手术。所有病例均采用腹股沟-腹部联合入路，在对精索进行任何操作之前，先确认是否存在腹腔内睾丸及其确切的血管解剖结构。45个睾丸（15.2%）位于阴囊管，142个（48%）位于腹腔，5个（1.7%）发育不全，104个（34.1%）缺失（发育不全或睾丸消失）。在腹腔内睾丸中，122个在肉膜囊内进行了标准的睾丸固定术，11个进行了分期修复，8个进行了福勒-斯蒂芬斯手术，1个进行了睾丸切除术。对于不可触及睾丸的所有检查方法，要么不可靠，要么过于昂贵，要么侵入性过大而不适合常规使用，而且在大多数情况下，无论如何都必须进行手术探查。主要的手术入路具有最有利的成本效益比，一次即可诊断和治疗。只要探查操作正确，仅通过手术就能实现先前腹腔镜检查的所有优点。
