Leung M W Y, Chao N S Y, Wong B P Y, Chung K W, Kwok W K, Liu K K W
Kowloon Central & East Cluster, Hospital Authority, Paediatric Surgical Centre, Hong Kong SAR, China.
Pediatr Surg Int. 2005 Sep;21(9):767-9. doi: 10.1007/s00383-005-1495-5. Epub 2005 Oct 20.
The testicular position after conventional inguinal orchidopexy for canalicular, "peeping" and redo undescended testes may not be satisfactory despite retroperitoneal dissection. Laparoscopy allows extensive mobilization of testicular vessels to gain additional length. We review our experience of using laparoscopic mobilization of testicular vessels (LMTV) in orchidopexy for these difficult undescended testes. From January 2003 to May 2004, LMTV was performed in 18 boys. The testicular vessels were mobilized from just proximal to the internal inguinal ring to the level of caecum and sigmoid colon respectively. Fifteen patients had clinically impalpable testes. Diagnostic laparoscopy revealed 13 "peeping" and 2 canalicular testes. LMTV was performed together with inguinal orchidopexy. There were three cases of redo orchidopexies because of unfavourable testicular position after previous surgery. LMTV was performed following inguinal dissection. The median follow-up period is 11.7 months. Sixteen testes are located at the base of scrotum, and two at mid-scrotum. The size is normal in 17 testes, whereas 1 testis is smaller than the contralateral one. LMTV is a safe and efficient adjunctive step in orchidopexy for impalpable and redo undescended testes.
对于管型、“隐匿型”及再次手术的隐睾，尽管进行了腹膜后解剖，但传统腹股沟睾丸固定术后的睾丸位置可能仍不理想。腹腔镜检查可广泛游离睾丸血管以增加长度。我们回顾了在这些困难的隐睾睾丸固定术中使用腹腔镜游离睾丸血管（LMTV）的经验。2003年1月至2004年5月，对18名男孩实施了LMTV。睾丸血管分别从腹股沟内环近端游离至盲肠和乙状结肠水平。15例患者临床触诊未触及睾丸。诊断性腹腔镜检查发现13例“隐匿型”和2例管型睾丸。LMTV与腹股沟睾丸固定术同时进行。有3例因既往手术后睾丸位置不佳而再次行睾丸固定术。LMTV在腹股沟解剖后进行。中位随访期为11.7个月。16个睾丸位于阴囊底部，2个位于阴囊中部。17个睾丸大小正常，1个睾丸小于对侧。LMTV是针对不可触及及再次手术的隐睾进行睾丸固定术时安全有效的辅助步骤。
