Powell Christopher, McIntosh James, Murphy J Patrick, Gatti John
Department of Urology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
J Laparoendosc Adv Surg Tech A. 2013 May;23(5):481-3. doi: 10.1089/lap.2012.0578. Epub 2013 Apr 6.
To report success, complication, and atrophy rates, as well as cost analysis and surgeon preference, for standard laparoscopic versus laparoscopic Fowler-Stephens (FS) approaches to intra-abdominal testes.
The records of children who underwent laparoscopic orchiopexy for impalpable testes at our institution were reviewed. Two groups were assessed: Group 1, who underwent a standard laparoscopic orchiopexy; and Group 2, who underwent either a single-stage or two-stage FS orchiopexy. Success was defined as an intrascrotal testis without atrophy. Cost analysis was performed by obtaining operating room charges for the procedures. Surgeon preference was evaluated by calculating the number of each type of orchiopexy performed.
From 1998 to 2005, 61 laparoscopic orchiopexies were performed on 46 patients. In Group 1, 31 orchiopexies were performed on 22 patients. In Group 2, 30 orchiopexies were performed in 26 patients. Eight orchiopexies were performed on 7 patients in a single stage, whereas 22 orchiopexies in 19 patients were performed in two stages. Two patients underwent both unilateral FS and laparoscopic orchiopexy. Success rates for Groups 1 and 2 were 96.7% and 83.3%, respectively. There were three complications in Group 1 (9.7%) and nine complications in Group 2 (30%). Atrophy rates for the two groups were 6.5% (2/31) and 16.7% (4/24), respectively. The average operating room cost for a standard laparoscopic approach was $3686, $3604 for the first stage and $3909 for the second stage of a two-stage FS approach, and $3785 for a single-stage FS approach.
Data from this series suggest that completing a laparoscopic orchiopexy in a single operation without ligating the testicular vessels has comparable, if not better, success rates to those of FS procedures, while reducing cost and potentially reducing complications. Outcomes between single- and two-stage FS approaches are similar, but the former can be accomplished at half the cost.
报告标准腹腔镜手术与腹腔镜Fowler-Stephens（FS）手术治疗腹腔内睾丸的成功率、并发症发生率、萎缩率，以及成本分析和外科医生偏好。
回顾我院因隐睾接受腹腔镜睾丸固定术患儿的病历。评估两组：第1组接受标准腹腔镜睾丸固定术；第2组接受单期或两期FS睾丸固定术。成功定义为睾丸位于阴囊内且无萎缩。通过获取手术的手术室费用进行成本分析。通过计算每种类型睾丸固定术的实施例数评估外科医生偏好。
1998年至2005年，46例患者接受了61例腹腔镜睾丸固定术。第1组，22例患者接受了31例睾丸固定术。第2组，26例患者接受了30例睾丸固定术。7例患者单期接受了8例睾丸固定术，19例患者两期接受了22例睾丸固定术。2例患者同时接受了单侧FS手术和腹腔镜睾丸固定术。第1组和第2组的成功率分别为96.7%和83.3%。第1组有3例并发症（9.7%），第2组有9例并发症（30%）。两组的萎缩率分别为6.5%（2/31）和16.7%（4/24）。标准腹腔镜手术的平均手术室成本为3686美元，两期FS手术第一期为3604美元，第二期为3909美元，单期FS手术为3785美元。
本系列数据表明，在不结扎睾丸血管的情况下单次手术完成腹腔镜睾丸固定术，即使不比FS手术更好，成功率也与之相当，同时降低了成本并可能减少并发症。单期和两期FS手术的结果相似，但前者成本仅为后者的一半。
