Papparella Alfonso, Umano Giuseppina Rosaria, Romano Mercedes, Delehaye Giulia, Cascone Salvatore, Trotta Letizia, Noviello Carmine
Pediatric Surgery Unit, Department of Women Children General and Specialist Surgery, Campania University "Luigi Vanvitelli", Naples, Italy.
Minim Invasive Surg. 2022 Sep 30;2022:1564830. doi: 10.1155/2022/1564830. eCollection 2022.
Since laparoscopy has been proposed in the management of the nonpalpable testis (NPT), this technique has been widely diffused among pediatric surgeons and urologists, but its application is still debated. We conducted a retrospective review to highlight how diagnostic and surgical indications for laparoscopy are selective and should be targeted to individual patients. From 2015 to 2019, 135 patients with NPT were admitted to our surgical division. Of these, 35 were palpable on clinical examination under anesthesia and 95 underwent laparoscopy. The main laparoscopic findings considered were: intra-abdominal testis (IAT), cord structures that are blind-ending, completely absent, or entering the abdominal ring. The patients' mean age was 22 months. In 48 cases, an IAT was found, and 42 of these underwent primary orchidopexy while 6 had the Fowler-Stephens (FS) laparoscopic procedure. Of the first group one patient experienced a testicular atrophy while two a reascent of the testis. In the FS orchidopexy group, one patient had testicular atrophy. Cord structures entering the internal inguinal ring were observed in 35 children, and all were surgically open explored. In 3 cases of these, a hypotrophic testis was revealed and an open orchidopexy was executed. In the remaining the histological examination revealed viable testicular cells in four patients and fibrosis, calcifications, and hemosiderin deposits in the others. Eleven patients presented with intrabdominal blind-ending vessels and one a testicular agenesia. A careful clinical examination is important to select patients to submit to laparoscopy. Diagnostic laparoscopy, and therefore, the anatomical observation of the testis and cord structures are strictly related to develop a treatment plan. In IAT, many surgical strategies can be applied with good results. Laparoscopy offers a concrete benefit to the patient.
自从腹腔镜检查被应用于不可触及睾丸（NPT）的治疗以来，这项技术已在儿科外科医生和泌尿外科医生中广泛传播，但其应用仍存在争议。我们进行了一项回顾性研究，以强调腹腔镜检查的诊断和手术指征是如何具有选择性的，并且应该针对个体患者。2015年至2019年，135例NPT患者入住我们的外科科室。其中，35例在麻醉下临床检查时可触及，95例行腹腔镜检查。主要的腹腔镜检查发现包括：腹腔内睾丸（IAT）、盲端、完全缺失或进入腹环的精索结构。患者的平均年龄为22个月。在48例中发现了IAT，其中42例行一期睾丸固定术，6例行Fowler-Stephens（FS）腹腔镜手术。在第一组中，1例患者出现睾丸萎缩，2例睾丸回缩。在FS睾丸固定术组中，1例患者出现睾丸萎缩。观察到35例儿童的精索结构进入腹股沟内环，均进行了手术探查。其中3例发现睾丸发育不良，行开放睾丸固定术。其余患者中，组织学检查显示4例患者有存活的睾丸细胞，其他患者有纤维化、钙化和含铁血黄素沉积。11例患者出现腹腔内盲端血管，1例患者睾丸缺如。仔细的临床检查对于选择接受腹腔镜检查的患者很重要。诊断性腹腔镜检查，因此对睾丸和精索结构的解剖观察与制定治疗计划密切相关。在IAT中，可以应用多种手术策略并取得良好效果。腹腔镜检查对患者有切实的益处。
