隐睾不同手术方式的比较研究

发布时间：2018-01-15 06:27

  本文关键词：隐睾不同手术方式的比较研究　出处：《重庆医科大学》2013年硕士论文　论文类型：学位论文

  更多相关文章： 隐睾 微创手术方式 睾丸固定术

【摘要】：目的分析隐睾患者不同手术方式的疗效，探讨隐睾最适宜的微创治疗方式。 方法回顾性分析2003年9月至2011年5月间在重庆医科大学附属儿童医院泌尿外科首次接受手术治疗的1720例（1933侧）隐睾患者，年龄0.5-17.5岁（中位年龄3.3岁）。术前麻醉状态下可扪及隐睾1365例（1536侧），未扪及隐睾355例（397侧）。分别采用经腹腔镜、经腹股沟、经阴囊三种手术方式治疗，比较相同位置类型隐睾不同手术方式的睾丸降入阴囊率、术后睾丸萎缩或回缩并发症发生率，以及不同手术方式的围手术期并发症。 结果355例（397侧）术前麻醉状态下未扪及隐睾，分别经腹腔镜（144侧）和经腹股沟（253侧）两种手术方式探查，探及睾丸率分别为84.0%（121/144）和88.1%（223/253），无明显统计学差异（P0.05）。排除睾丸缺如或萎缩、横过异位睾丸以及腹腔镜下行Fowler-Stephens手术隐睾，共1661例（1869侧）隐睾纳入手术方式疗效分析。其中，1014例（1153侧）腹股沟型隐睾分别采用经腹腔镜（197侧）和经腹股沟（956侧）手术方式，术中睾丸降入阴囊率分别为100%（197/197）和99.4%（950/956），术后随访率分别为93.9%（185/197）和90.9%（869/956），睾丸萎缩率分别为0和0.2%（2/869），均无睾丸回缩，两种手术方式之间均无明显统计学差异（P0.05）。351例（383侧）外环口型隐睾分别采用经腹腔镜（10侧）、经腹股沟（307侧）、经阴囊（66侧）手术方式，三种手术方式的睾丸降入阴囊率均为100%、术后随访率分别为100%（10/10）、94.1%（289/307）和97.0%（64/66），均无睾丸萎缩或回缩，三种手术方式疗效一致。296例（333侧）腹腔型隐睾分别采用经腹腔镜（110侧）和经腹股沟（223侧）两种手术方式，睾丸降入阴囊率分别为90%（99/110）和88.3%(197/223)，术后随访率分别为91.8%（101/110）和92.4%（206/223），睾丸萎缩率分别为1.0%（1/101）、1.5%（3/206），睾丸回缩率分别为1.0%(1/101)、1.9%(4/206)，两种手术方式之间均无明显统计学差异（P0.05）。经腹股沟（1486侧）、经腹腹腔镜（317侧）两种术式的围手术期并发症发生率分别为0.5%（7/1486）和0.9%（3/317），无明显统计学差异（P0.05）。经阴囊（66侧）术式无围手术期并发症发生。 结论首次接受手术治疗的隐睾中，术前在麻醉状态下能将睾丸推至外环口及以下的隐睾，首选经阴囊切口睾丸下降固定术；腹腔型、腹股沟型隐睾，对于有成熟腹腔镜下手术经验者，，可以优先采用经腹腔镜探查及睾丸下降固定，此两种术式具有微创优势。
[Abstract]:Objective to analyze the effect of different surgical methods on cryptorchidism and to explore the most suitable minimally invasive treatment for cryptorchidism.
Methods: a retrospective analysis of 1720 cases from September 2003 to May 2011 in the Department of Urology, children's Hospital Affiliated to Medical University Of Chongqing for the first time to accept surgical treatment of patients with cryptorchidism (1933 sides), aged 0.5-17.5 years (median age 3.3 years). The preoperative anesthesia palpable cryptorchidism in 1365 cases (1536 sides), without palpable cryptorchidism in 355 cases (397 sides). Were treated by laparoscopy, transinguinal, with three kinds of surgical treatment of scrotum, compared to the same type of position of different surgical methods of cryptorchidism testis descended into the scrotum rate, postoperative testicular atrophy or retraction of the incidence of complications, and different surgical methods of perioperative complications.
Results 355 cases (397 sides) of preoperative anesthesia and without palpable cryptorchidism condition, respectively (144 sides) and laparoscopic inguinal (253 sides) exploration of two kinds of surgical exploration, and testicular rates were 84% (121/144) and 88.1% (223/253), no statistically significant difference (P0.05). Exclude the absence of testis or atrophy of ectopic testis and crossing the laparoscopic Fowler-Stephens surgery operation, a total of 1661 cases (1869 sides) into the analysis of operative methods in the treatment of cryptorchidism. Among them, 1014 cases (1153 sides) were treated by laparoscopic inguinal cryptorchidism (197 sides) and transinguinal (956 sides) surgical approach, intraoperative testes descended into the scrotum respectively. 100% (197/197) and 99.4% (950/956), the follow-up rate was 93.9% (185/197) and 90.9% (869/956), testicular atrophy rates were 0 and 0.2% (2/869), there were no testicular retraction, there were no statistically significant differences between the two kinds of operation (P0.05).351 cases (383 side the outer ring mouth hidden) 鐫惧垎鍒�閲囩敤缁忚吂鑵旈�

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