King L R
Division of Urology, The University of New Mexico School of Medicine, Health Sciences Center, Albuquerque, USA.
J Urol. 1998 Dec;160(6 Pt 2):2457-60. doi: 10.1097/00005392-199812020-00018.
This review was performed to assess the effect of protecting the collateral circulation between spermatic and vasal vessels by leaving a strip of peritoneum attached to the lower spermatic cord in patients in whom the spermatic vessels needed to be divided to bring the testis into good scrotal position.
Between 1983 and 1994, 22 boys were encountered in whom 1 testis was always normal in size and position, and the other was intra-abdominal and would not be in normal scrotal position after complete cord straightening. A strip of peritoneum had been left attached to the spermatic cord before full mobilization. After high division of the spermatic vessels the testes were brought in the mid scrotum during the same operation.
All testes remained in scrotal position except 1 which retracted and was subsequently removed. None became atrophic.
Division of the spermatic vessels, the Fowler-Stephens maneuver, can safely be performed during an initial operation as long as its possible need is anticipated, and the collateral circulation between the vasal vessels and spermatics is not disrupted. Secondary orchiopexy for inadequate cord length is now rarely required. This type of open orchiopexy for high impalpable testis is safe, is easy to learn, has no increased morbidity and is generally less expensive than a laparoscopic approach.
本综述旨在评估对于那些为了将睾丸置于阴囊良好位置而需要切断精索血管的患者，通过保留一条附着于精索下段的腹膜来保护精索血管与输精管之间侧支循环的效果。
1983年至1994年间，共遇到22名男孩，其中1个睾丸的大小和位置始终正常，另一个睾丸位于腹腔内，在完全伸直精索后也无法处于正常阴囊位置。在充分游离之前，已保留一条腹膜附着于精索。在高位切断精索血管后，于同一次手术中将睾丸置于阴囊中部。
除1个睾丸回缩并随后被切除外，所有睾丸均保留在阴囊位置。无一发生萎缩。
只要预计可能需要，在初次手术时就可以安全地进行精索血管切断术（福勒-斯蒂芬斯手术），并且不会破坏输精管与精索之间的侧支循环。现在很少需要因精索长度不足而进行二期睾丸固定术。这种针对高位不可触及睾丸的开放式睾丸固定术是安全的，易于学习，发病率没有增加，而且总体上比腹腔镜手术费用更低。
