Dave Sumit, Manaboriboon Numchai, Braga Luis H P, Lorenzo Armando J, Farhat Walid A, Bägli Darius J, Khoury Antoine E, Salle Joao L Pippi
Divisions of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
J Urol. 2009 Nov;182(5):2435-9. doi: 10.1016/j.juro.2009.07.050. Epub 2009 Sep 17.
There is a paucity of literature on factors associated with testicular atrophy following second stage laparoscopic Fowler-Stephens orchiopexy. We hypothesized that dissection of a long looping vas during this procedure could compromise testicular blood supply, leading to testicular atrophy.
Following an initial laparoscopic testicular vessel ligation, a second stage Fowler-Stephens orchiopexy was performed in 73 testes (laparoscopic in 61, open in 12). The presence of a long looping vas was noted from the first stage operative notes. Doppler ultrasound was performed postoperatively to confirm testicular atrophy.
Atrophy rate at a mean followup of 13.5 months was 20.5% (15 of 61 in laparoscopic and 0 of 12 in open orchiopexy). None of the 5 long looping vas testes atrophied following open orchiopexy, compared to 5 of 6 (83%) following laparoscopic orchiopexy (p = 0.03). Analyzing the laparoscopic group alone, a long looping vas was significantly associated with risk of atrophy (p <0.01).
The presence of a long looping vas was associated with a higher atrophy rate following laparoscopic second stage Fowler-Stephens orchiopexy. Laparoscopic management of the long looping vas may be more challenging and, therefore, in such cases open Fowler-Stephens orchiopexy may result in better success rates by preserving the integrity of the collateral vessels.
关于二期腹腔镜Fowler-Stephens睾丸固定术后睾丸萎缩相关因素的文献较少。我们推测在此手术过程中游离较长的迂曲输精管可能会损害睾丸血供，导致睾丸萎缩。
在初次腹腔镜下结扎睾丸血管后，对73个睾丸进行二期Fowler-Stephens睾丸固定术（61个为腹腔镜手术，12个为开放手术）。从一期手术记录中记录是否存在较长的迂曲输精管。术后进行多普勒超声检查以确认睾丸萎缩。
平均随访13.5个月时，萎缩率为20.5%（腹腔镜手术的61个睾丸中有15个萎缩，开放睾丸固定术的12个睾丸中无萎缩）。开放睾丸固定术后，5个有较长迂曲输精管的睾丸均未萎缩，而腹腔镜睾丸固定术后6个中有5个（83%）萎缩（p = 0.03）。仅分析腹腔镜组，较长的迂曲输精管与萎缩风险显著相关（p <0.01）。
较长的迂曲输精管与二期腹腔镜Fowler-Stephens睾丸固定术后较高的萎缩率相关。腹腔镜处理较长的迂曲输精管可能更具挑战性，因此，在这种情况下，开放Fowler-Stephens睾丸固定术通过保留侧支血管的完整性可能会有更高的成功率。
