Bugel H, Pfister C, Liard-Zmuda A, Bachy B, Mitrofanoff P
Clinique Chirurgicale Infantile, Hôpital Charles Nicolle, Rouen, France.
Prog Urol. 1998 Feb;8(1):78-82.
Laparoscopy now constitutes the reference technique for the diagnosis and treatment of cryptorchid testes. We report our experience over the last three years (1993-1996).
48 strictly impalable testes were investigated in 46 boys between the ages of 11 months and 14.5 years (mean age: 40 months). The intraperitoneal investigation assessed both deep inguinal regions looking for gonads, vas deferens and pedicles. Intra-abdominal gonads were ligated and their pedicle was sectioned laparoscopically allowing transinguinal descent 6 months later according to the Fowler-Stephens technique.
We found 21 cases of typical antenatal torsion, including one bilateral case (pedicle and vas deferens present, but gonad absent), one case of total unilateral agenesis and 3 cases of incomplete agenesis (only the vas deferens was detected) and performed three resections of the gonadal rest for histological examination. The first-stage of cryptorchid testis descent was performed in 20 cases, by laparoscopy in 19 cases (1 failure of insufflation). Definitive descent was possible in 13 cases, with early onset of atrophy in only one case.
Laparoscopy is therefore a simple technique, allowing a definitive diagnosis and two-stage descent without increasing the risk of testicular atrophy.
腹腔镜检查现已成为隐睾诊断和治疗的参考技术。我们报告过去三年（1993 - 1996年）的经验。
对46名年龄在11个月至14.5岁（平均年龄：40个月）的男孩的48个完全无法触及的睾丸进行了检查。经腹腔检查评估双侧腹股沟深部区域，寻找性腺、输精管和精索。对腹腔内性腺进行结扎，并在腹腔镜下切断其精索，6个月后根据福勒 - 斯蒂芬斯技术经腹股沟使其下降。
我们发现21例典型的产前扭转，包括1例双侧病例（精索和输精管存在，但性腺缺失），1例单侧完全发育不全，3例不完全发育不全（仅检测到输精管），并对3例性腺残体进行了切除以进行组织学检查。20例进行了隐睾下降的第一阶段手术，19例通过腹腔镜进行（1例气腹失败）。13例实现了最终下降，仅1例早期出现萎缩。
因此，腹腔镜检查是一种简单的技术，可实现明确诊断和两阶段下降，且不增加睾丸萎缩的风险。
