背景:高度隐睾的治疗可能具有挑战性,经常有令人沮丧的结果。我们报告了使用保留精索血管的原始两阶段睾丸固定术治疗精索血管非常短的隐睾的25年经验。
方法:我们回顾了通过我们的原始手术方法在小儿外科树研究所治疗的精索血管非常短的隐睾患儿的临床图表。该程序的第一阶段从腹股沟切口和标准的睾丸固定术开始,并在腹膜后进行深度动员,以拉直完全保留的精索血管。在术中意识到这种最大的腹膜后动员不能确保睾丸的阴囊位置令人满意后,精索包裹在成形为导管的聚四氟乙烯(PTFE)薄片中。睾丸固定在阴囊的底部,由于张力而保持内陷。[Fig.A-操作方案]。第一阶段也可以在腹腔镜检查中进行,与PTFE导管的视频辅助定位[图。B-分别用黑色和白色箭头标记血管和血管的腹腔镜视图]。第二个手术阶段安排在6-12个月后移除PTFE导管。
结果:一组100名受隐睾和极短精索血管影响的儿童(9个双侧,86腹内,23“在内环上偷窥”)总共109例睾丸接受了两阶段手术。从第一阶段到第二阶段,观察到每个睾丸向阴囊逐渐降低。在第二阶段,去除PTFE片材后,保留的脊髓在腹股沟管中松动,所有的睾丸都位于阴囊中:68个睾丸被发现正确定位,不需要进一步的护理,而41人仍处于阴囊高位。然而,后者很容易从阴囊底部脱离,并重新固定在一个更令人满意的位置。在1-9年的随访中,所有睾丸中只有一个(99%)处于正确的阴囊位置,睾丸体积稳定或增加[图。C],而1个睾丸消失了。随访期间无并发症发生。
结论:这项为期25年的长期审查表明,我们最初的手术技术保证了高成功率,既没有明显的禁忌症,也没有缺点,对于患有精索血管短到无法通过标准睾丸固定术治疗的未降睾丸的患者。
BACKGROUND: Treatment of high cryptorchidism can be challenging, often with frustrating results. We report 25 years of experience in the treatment of the cryptorchidism with very short spermatic vessels using an original two-stage
orchiopexy that preserves the spermatic vessels.
METHODS: We reviewed the clinical charts of children affected by cryptorchidism with very short spermatic vessels treated through our original surgical approach in tree Institutes of Pediatric Surgery. The first stage of the procedure started with an inguinal incision and a standard
orchiopexy with a deep mobilization in the retroperitoneum to straighten the spermatic vessels that are entirely preserved. After realizing intraoperatively that such maximal retroperitoneal mobilization cannot ensure a satisfactory scrotal position of the testis, the spermatic cord is wrapped in a thin sheet of polytetrafluoroethylene (PTFE) shaped as a conduit. The testis is fixed to the bottom of the scrotum which remains invaginated due to the tension. [Fig. A - scheme of the operation]. This first stage can also be performed in laparoscopy, with a video-assisted positioning of the PTFE conduit [Fig. B - laparoscopic view with vessels and vas respectively marked by black and white arrows]. The second surgical stage is scheduled after 6-12 months to remove the PTFE conduit.
RESULTS: A group of 100 children affected by cryptorchidism and very short spermatic vessels (9 bilateral, 86 intra-abdominal, 23 \"peeping\" at the internal ring) for a total of 109 testes underwent surgery with a two-stage procedure. From the first to the second stage, a progressive lowering of each testis towards the scrotum was observed. During the second stage, after removal of the PTFE sheet, the preserved cord was loose in the inguinal canal and all the testes were located in the scrotum: 68 testes were found correctly located with no further care needed, while 41 were still in a high scrotal position. However, the latter were easily detached from the scrotal bottom and re-fixed in a more satisfactory location. At 1-9 years follow-up all the testes but one (99%) were in the correct scrotal position with stable or increased testicular volume [Fig. C], while 1 testis vanished. No complications were observed all along the follow-up.
CONCLUSIONS: This long term 25-year review indicates that our original surgical technique guarantees a high rate of success with neither evident contraindications nor drawbacks for patients affected by undescended testes with spermatic vessels so short to be untreatable through a standard
orchiopexy.