Elder J S
Department of Urology, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH.
Semin Pediatr Surg. 1993 Aug;2(3):168-73.
In boys with an impalpable testis, the gonad may be intraabdominal, canalicular, atrophic secondary to in utero torsion (vanishing), or absent. Although radiological techniques have been used to localize the testis in such patients, they are not sufficiently accurate to avoid surgical exploration. Laparoscopy provides the most rapid and accurate means of localizing impalpable testes. The technique has been demonstrated to be extremely safe. Between 40% and 75% of these boys have a vanishing testis. In the majority of the remainder of cases, the testis is intraabdominal. In boys with an intraabdominal testis, a standard orchiopexy or a one- or two-stage Fowler-Stephens orchiopexy has been used most commonly. In the two-stage Fowler-Stephens orchiopexy, the initial procedure is accomplished laparoscopically by placing a clip on the testicular vessels; the second stage is performed 6 to 12 months later as an open operation. Alternatively, if the patient is a teenager over 16 years of age or an adult, laparoscopic orchiectomy is preferable. Currently efforts are under way to develop and improve the laparoscopic-assisted orchiopexy.
对于睾丸无法触及的男孩，性腺可能位于腹腔内、腹股沟管内、因宫内扭转而萎缩（消失）或缺失。尽管已采用放射学技术来定位此类患者的睾丸，但它们的准确性不足以避免手术探查。腹腔镜检查是定位无法触及睾丸的最快速、准确的方法。该技术已被证明极其安全。这些男孩中有40%至75%存在睾丸消失的情况。在其余大多数病例中，睾丸位于腹腔内。对于腹腔内睾丸的男孩，最常用的是标准睾丸固定术或一期或二期福勒 - 斯蒂芬斯睾丸固定术。在二期福勒 - 斯蒂芬斯睾丸固定术中，初始手术通过腹腔镜在睾丸血管上放置夹子来完成；第二阶段在6至12个月后作为开放手术进行。或者，如果患者是16岁以上的青少年或成年人，腹腔镜睾丸切除术更为可取。目前正在努力开发和改进腹腔镜辅助睾丸固定术。
