Ekwunife Okechukwu Hyginus, Modekwe Victor Ifeanyichukwu, Ugwu Jideofor Okechukwu, Ugwunne Chuka Abunike
Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria.
Niger J Surg. 2017 Jul-Dec;23(2):115-118. doi: 10.4103/njs.NJS_59_16.
Nonpalpable undescended testes (NPT) constitute 20%-30% of undescended testes, and its management has been a challenge both in diagnosis and treatment. Worldwide, laparoscopy is the current gold standard of management. In Nigeria, the management of NPT has largely been by open surgery with consequent high morbidity. In Nigeria, the trend is changing from a largely open management with its attendant high morbidity, to laparoscopic management which is the current worldwide gold standard of care.
This study aims to classify the laparoscopic features of NPT and determine the outcome of managed cases in our center.
Prospective data were collected from consecutive patients who had laparoscopy for NPT at the Paediatric Surgical Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from June 2014 to July 2016.
A total of 15 patients with 23 testes were treated. There were eight patients with bilateral NPT; four had left and the remaining three right NPT. The age ranged from 1.2 to 29 years with a median of 5 years. Eleven out of the 22 internal inguinal rings were open. The position of the testes was canalicular (2), peeping (2), low abdominal (6), high abdominal (6), blind-ended vas (1), absent vas and vessels (5). No further intervention was needed for the six agenetic/atrophic testes. Standard open orchiopexy was done for the two canalicular testes. Eight testes were brought down by one stage laparoscopic orchiopexy while four were brought down by staged laparoscopic Fowler-Stephens procedure. Laparoscopic orchiectomy was done in two patients (a grossly dysmorphic testes [nubbin] and a high abdominal testis in a 29-year-old). Orchiopexy was successful in 11 out of 15 fixed testes. Of the unsuccessful ones, three testes were atrophic (volume less than what it was initially) while two were high scrotal (one testes has both complications). There was no conversion to open abdominal surgery. All patients were discharged within 24 h of surgery.
Laparoscopy provides for a better management of NPT by combining diagnosis and intervention in the same sitting with a good success rate and minimal postoperative morbidity.
不可触及的隐睾（NPT）占隐睾病例的20%-30%，其管理在诊断和治疗方面一直是一项挑战。在全球范围内，腹腔镜检查是目前的管理金标准。在尼日利亚，NPT的管理主要采用开放手术，因此发病率较高。在尼日利亚，趋势正从主要采用开放手术及其伴随的高发病率，转变为采用腹腔镜管理，而腹腔镜管理是目前全球护理的金标准。
本研究旨在对NPT的腹腔镜特征进行分类，并确定我们中心治疗病例的结果。
前瞻性数据收集自2014年6月至2016年7月在尼日利亚纽维市纳姆迪·阿齐克韦大学教学医院小儿外科接受NPT腹腔镜检查的连续患者。
共治疗15例患者，23个睾丸。8例为双侧NPT；4例左侧NPT，其余3例右侧NPT。年龄范围为1.2至29岁，中位数为5岁。22个腹股沟内环中有11个开放。睾丸位置为小管状（2个）、窥视状（2个）、下腹低位（6个）、上腹高位（6个）、盲端输精管（1个）、无输精管和血管（5个）。6个发育不全/萎缩的睾丸无需进一步干预。对2个小管状睾丸进行了标准的开放睾丸固定术。8个睾丸通过一期腹腔镜睾丸固定术下降，4个睾丸通过分期腹腔镜Fowler-Stephens手术下降。2例患者进行了腹腔镜睾丸切除术（1个严重畸形的睾丸[小结节]和1例29岁患者的上腹高位睾丸）。15个固定睾丸中有11个睾丸固定术成功。未成功的病例中，3个睾丸萎缩（体积小于初始体积），2个睾丸位于阴囊高位（1个睾丸有两种并发症）。未转为开放腹部手术。所有患者均在术后24小时内出院。
腹腔镜检查通过在同一次手术中结合诊断和干预，为NPT提供了更好的管理，成功率高，术后发病率低。
