Riquelme Mario, Aranda Arturo, Rodriguez Carlos, Villalvazo Humberto, Alvarez Guillermo
Department of General Surgery, Christus Muguerza Hospital, Monterrey, NL, Mexico.
J Laparoendosc Adv Surg Tech A. 2006 Jun;16(3):321-4. doi: 10.1089/lap.2006.16.321.
Most recent reports of laparoscopic orchiopexy concern nonpalpable testes. We report the results of this approach in patients with undescended palpable testes.
Between January 1999 and September 2004, 28 patients with 30 undescended palpable testes were treated by laparoscopic orchiopexy performed by the same surgeon. Patients with palpable cryptorchidism were included. Patients with nonpalpable testes, retractable, or vanishing testes were excluded. The mean age of the patients was 25 months (range, 8 months-5 years) and the mean weight was 16 kg (range, 8-24 kg). We used a 4-port technique (one 10-mm, two 2-3 mm, and one 5-mm), a 4-mm scope, and 2-3 mm instruments.
The mean operative time was 50 minutes. The complication rate was 13.3% (4/28), all in the first two years, at the beginning of the learning curve. The remaining testes were descended by laparoscopy; 5 (16.6%) were peeping testes. We had 10 (33.3%) left and 16 (53.3%) right palpable cryptorchidia cases, plus 4 testes (13.3%) that were bilateral undescended and palpable. No hernia was found in 8 (28.6%) cases; a homolateral hernia was found in 18 (64.3%) cases, and we did not close the processus vaginalis, we only resected the membranes. We found 2 (7.1%) with contralateral hernia in which we did close the processus vaginalis. On follow-up ranging 5 months-5 years, 29 of these testes maintain good size and a correct position, with no recurrent inguinal hernia.
The laparoscopic approach is a safe way to descend the palpable testicle. Although this is not a large series, it shows that laparoscopic orchiopexy of palpable undescended testes can be done without a higher complication rate than the open procedure (13.3% vs. 12.2%), with several of the advantages of the laparoscopic approach.
最近关于腹腔镜睾丸固定术的报道大多涉及不可触及的睾丸。我们报告了这种方法在可触及的隐睾患者中的应用结果。
1999年1月至2004年9月期间，同一位外科医生对28例患者的30个可触及的隐睾进行了腹腔镜睾丸固定术。纳入可触及隐睾的患者。排除不可触及的睾丸、回缩性睾丸或消失性睾丸患者。患者的平均年龄为25个月（范围8个月至5岁），平均体重为16千克（范围8至24千克）。我们采用四孔技术（一个10毫米、两个2 - 3毫米和一个5毫米）、一个4毫米的腹腔镜和2 - 3毫米的器械。
平均手术时间为50分钟。并发症发生率为13.3%（4/28），均发生在前两年，处于学习曲线初期。其余睾丸通过腹腔镜下降；5个（16.6%）为窥视性睾丸。我们有10例（33.3%）左侧和16例（53.3%）右侧可触及隐睾病例，另外4个睾丸（13.3%）为双侧不可触及且可触及。8例（28.6%）未发现疝；18例（64.3%）发现同侧疝，我们未关闭鞘突，仅切除了腹膜。我们发现2例（7.1%）对侧疝，对此我们关闭了鞘突。在5个月至5年的随访中，这些睾丸中有29个保持良好大小和正确位置，无复发性腹股沟疝。
腹腔镜手术是使可触及睾丸下降的一种安全方法。尽管这不是一个大样本系列研究，但它表明可触及隐睾的腹腔镜睾丸固定术并发症发生率并不高于开放手术（13.3%对12.2%），且具有腹腔镜手术的一些优点。
