Lindgren B W, Darby E C, Faiella L, Brock W A, Reda E F, Levitt S B, Franco I
Division of Pediatric Urology, Long Island Jewish Medical Center, Schneider Children's Hospital, New Hyde Park, New York, USA.
J Urol. 1998 Jun;159(6):2132-5. doi: 10.1016/S0022-5347(01)63294-4.
Multiple approaches exist for the management of the nonpalpable testis. With the use of diagnostic laparoscopy widely accepted in the setting of the nonpalpable testis we have found laparoscopic orchiopexy to be an efficient and logical extension. To evaluate its use we report our experience with laparoscopic orchiopexy to treat 44 nonpalpable testes in 36 patients.
We retrospectively reviewed the medical records of all patients who underwent laparoscopic orchiopexy for a 2 1/2-year period. Modifications of the surgical technique are described.
The left testis was affected in 18 boys, the right in 9 and both in 9. At laparoscopy 8 testes were at the internal ring or were peeping and the remainder were intra-abdominal. One patient underwent a unilateral 1-stage Fowler-Stephens orchiopexy, and 3 unilateral and 1 bilateral 2-stage Fowler-Stephens orchiopexy. Two patients underwent laparoscopically assisted orchiectomy. The remaining 31 patients underwent laparoscopic orchiopexy without division of the spermatic vessels. At followup (mean 6 months) all testes are without atrophy, and 39 of 42 (93%) are in an acceptable scrotal position. There are 3 testes (7%) high in the scrotum.
Laparoscopic orchiopexy is a logical extension of diagnostic laparoscopy for the evaluation and treatment of the nonpalpable testis. The low incidence of complications and 93% success rate underscore the feasibility of this procedure. It is our procedure of choice for the treatment of nonpalpable testis.
对于不可触及睾丸的处理存在多种方法。随着诊断性腹腔镜检查在不可触及睾丸的处理中被广泛接受，我们发现腹腔镜睾丸固定术是一种有效且合理的延伸。为评估其应用，我们报告了36例患者中44个不可触及睾丸行腹腔镜睾丸固定术的经验。
我们回顾性分析了所有在2年半时间内行腹腔镜睾丸固定术患者的病历。描述了手术技术的改进。
18例男孩左侧睾丸受累，9例右侧受累，9例双侧受累。腹腔镜检查时，8个睾丸位于内环处或探出头，其余位于腹腔内。1例患者行单侧一期福勒-斯蒂芬斯睾丸固定术，3例单侧和1例双侧二期福勒-斯蒂芬斯睾丸固定术。2例患者行腹腔镜辅助睾丸切除术。其余31例患者行腹腔镜睾丸固定术，未切断精索血管。随访（平均6个月）时，所有睾丸均无萎缩，42个睾丸中有39个（93%）位于可接受的阴囊位置。有3个睾丸（7%）位于阴囊高位。
腹腔镜睾丸固定术是诊断性腹腔镜检查在不可触及睾丸评估和治疗方面的合理延伸。并发症发生率低和成功率达93%突出了该手术的可行性。它是我们治疗不可触及睾丸的首选手术方法。
