Hayashi Y, Mogami T, Sasaki S, Maruyama T, Tatsura H, Tsugaya M, Kohri K
Department of Urology, Nagoya City University Medical School, Japan.
Int J Urol. 1996 Jul;3(4):274-7. doi: 10.1111/j.1442-2042.1996.tb00533.x.
About 20% of all undescended testes are nonpalpable. Although surgical exploration was previously the method of choice for management, laparoscopy from the inferior edge of the umbilicus has been established as a useful method of examining a testis that is nonpalpable. However, conventional subumbilical laparoscopy is unnecessary when the testis or its remnant is located below the internal inguinal ring. We evaluated the efficacy of transinguinal laparoscopy after inguinal exploration performed for nonpalpable testis.
Twelve children with 14 nonpalpable testes (2 children had bilateral nonpalpable testes) were considered for a novel method of laparoscopy. We performed laparoscopy through the internal inguinal ring after opening the inguinal canal.
Inguinal exploration revealed the testis or its remnant in 5 patients, and thus prevented unnecessary laparoscopy in these individuals. Transinguinal laparoscopy identified the anatomy in 7 patients. Four of the latter were found to have blind-ending vas deferens and spermatic vessels, while in 3 patients, the testes were located in the peritoneal cavity.
Transinguinal laparoscopy may become the accepted method for managing nonpalpable testes, as inguinal exploration can eliminate the need for laparoscopy in some cases, and the visualization achieved with transinguinal laparoscopy is just as good as that with conventional laparoscopy.
所有隐睾病例中约20%的睾丸无法触及。虽然手术探查以前是治疗的首选方法，但从脐下缘进行腹腔镜检查已被确立为检查无法触及睾丸的一种有用方法。然而，当睾丸或其残余组织位于腹股沟内环下方时，传统的脐下腹腔镜检查就没有必要了。我们评估了对无法触及的睾丸进行腹股沟探查后经腹股沟腹腔镜检查的疗效。
12例患有14个无法触及睾丸的儿童（2例为双侧无法触及睾丸）被纳入一种新的腹腔镜检查方法。我们在打开腹股沟管后通过腹股沟内环进行腹腔镜检查。
腹股沟探查在5例患者中发现了睾丸或其残余组织，从而避免了这些患者进行不必要的腹腔镜检查。经腹股沟腹腔镜检查明确了7例患者的解剖结构。其中4例发现输精管和精索血管盲端，3例患者的睾丸位于腹腔内。
经腹股沟腹腔镜检查可能会成为治疗无法触及睾丸的公认方法，因为腹股沟探查在某些情况下可避免进行腹腔镜检查，且经腹股沟腹腔镜检查所获得的视野与传统腹腔镜检查一样好。
