Ait Ali Slimane Malika, Auber Frédéric, De Vries Philine, Kotobi Henri, Larroquet Michelle, Grapin Christine, Audry Georges
Service de Chirurgie Viscérale Infantile, Hôpital d'Enfants Armand-Trousseau, Paris, France.
Prog Urol. 2004 Feb;14(1):51-4.
The objective of this retrospective study was to assess the value of one-stage testicular descent without spermatic vessel ligation for intraabdominal impalpable testis.
This study was based on 90 children with 98 impalpable testes. Laparoscopic exploration was performed in each case. Forty-three testes were intra-abdominal and 55 were absent. One-stage surgical descent with vertical opening of the conjoined tendon and without spermatic vessel ligation was performed for 22 testes and two-stage descent (Fowler-Stephens two-stage technique) was performed for 16 testes. Three testes in bilateral forms are still waiting for treatment.
With a mean follow-up of 17 months (range: 1 month to 8 years), 18 of the 22 testes (81%) were situated in the scrotum and were viable in the one-stage treatment group, versus 10 out of 16 (62.5%) in the two-stage group. Two poor results, including one case of necrosis, were observed after one-stage testicular descent. Six poor results, including two cases of necrosis, were observed after the Fowler-Stephens two-stage technique.
One-stage testicular descent, without spermatic vessel ligation, after laparoscopic assessment of the presence and position of the testis, can be performed in the majority of cases of impalpable testis. The risks of failure due to secondary atrophy or incomplete testicular descent are minimal with this technique. One-stage surgical descent, when possible, appears to be preferable to the Fowler-Stephens two-stage procedure.
本回顾性研究的目的是评估对于腹腔内无法触及的睾丸，不进行精索血管结扎的一期睾丸下降固定术的价值。
本研究基于90例患有98个无法触及睾丸的儿童。对每例患儿均进行了腹腔镜探查。其中43个睾丸位于腹腔内，55个睾丸未探及。对22个睾丸实施了不进行精索血管结扎的联合肌腱垂直切开一期手术下降固定术，对16个睾丸实施了二期下降固定术（Fowler-Stephens二期技术）。3个双侧睾丸仍在等待治疗。
平均随访17个月（范围：1个月至8年），一期治疗组22个睾丸中有18个（81%）位于阴囊内且存活，而二期治疗组16个睾丸中有10个（62.5%）位于阴囊内且存活。一期睾丸下降固定术后观察到2例预后不良，包括1例坏死。Fowler-Stephens二期技术术后观察到6例预后不良，包括2例坏死。
在腹腔镜评估睾丸的存在及位置后，对于大多数无法触及睾丸的病例，可以实施不进行精索血管结扎的一期睾丸下降固定术。采用该技术，继发萎缩或睾丸下降不全导致失败的风险极小。一期手术下降固定术在可行时似乎优于Fowler-Stephens二期手术。
