本文關(guān)鍵詞：隱睪不同手術(shù)方式的比較研究　出處：《重慶醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 隱睪 微創(chuàng)手術(shù)方式 睪丸固定術(shù)

【摘要】：目的分析隱睪患者不同手術(shù)方式的療效，探討隱睪最適宜的微創(chuàng)治療方式。 方法回顧性分析2003年9月至2011年5月間在重慶醫(yī)科大學(xué)附屬兒童醫(yī)院泌尿外科首次接受手術(shù)治療的1720例（1933側(cè)）隱睪患者，年齡0.5-17.5歲（中位年齡3.3歲）。術(shù)前麻醉狀態(tài)下可捫及隱睪1365例（1536側(cè)），未捫及隱睪355例（397側(cè)）。分別采用經(jīng)腹腔鏡、經(jīng)腹股溝、經(jīng)陰囊三種手術(shù)方式治療，比較相同位置類型隱睪不同手術(shù)方式的睪丸降入陰囊率、術(shù)后睪丸萎縮或回縮并發(fā)癥發(fā)生率，以及不同手術(shù)方式的圍手術(shù)期并發(fā)癥。 結(jié)果355例（397側(cè)）術(shù)前麻醉狀態(tài)下未捫及隱睪，分別經(jīng)腹腔鏡（144側(cè)）和經(jīng)腹股溝（253側(cè)）兩種手術(shù)方式探查，探及睪丸率分別為84.0%（121/144）和88.1%（223/253），無(wú)明顯統(tǒng)計(jì)學(xué)差異（P0.05）。排除睪丸缺如或萎縮、橫過(guò)異位睪丸以及腹腔鏡下行Fowler-Stephens手術(shù)隱睪，共1661例（1869側(cè)）隱睪納入手術(shù)方式療效分析。其中，1014例（1153側(cè)）腹股溝型隱睪分別采用經(jīng)腹腔鏡（197側(cè)）和經(jīng)腹股溝（956側(cè)）手術(shù)方式，術(shù)中睪丸降入陰囊率分別為100%（197/197）和99.4%（950/956），術(shù)后隨訪率分別為93.9%（185/197）和90.9%（869/956），睪丸萎縮率分別為0和0.2%（2/869），均無(wú)睪丸回縮，兩種手術(shù)方式之間均無(wú)明顯統(tǒng)計(jì)學(xué)差異（P0.05）。351例（383側(cè)）外環(huán)口型隱睪分別采用經(jīng)腹腔鏡（10側(cè)）、經(jīng)腹股溝（307側(cè)）、經(jīng)陰囊（66側(cè)）手術(shù)方式，三種手術(shù)方式的睪丸降入陰囊率均為100%、術(shù)后隨訪率分別為100%（10/10）、94.1%（289/307）和97.0%（64/66），均無(wú)睪丸萎縮或回縮，三種手術(shù)方式療效一致。296例（333側(cè)）腹腔型隱睪分別采用經(jīng)腹腔鏡（110側(cè)）和經(jīng)腹股溝（223側(cè)）兩種手術(shù)方式，睪丸降入陰囊率分別為90%（99/110）和88.3%(197/223)，術(shù)后隨訪率分別為91.8%（101/110）和92.4%（206/223），睪丸萎縮率分別為1.0%（1/101）、1.5%（3/206），睪丸回縮率分別為1.0%(1/101)、1.9%(4/206)，兩種手術(shù)方式之間均無(wú)明顯統(tǒng)計(jì)學(xué)差異（P0.05）。經(jīng)腹股溝（1486側(cè)）、經(jīng)腹腹腔鏡（317側(cè)）兩種術(shù)式的圍手術(shù)期并發(fā)癥發(fā)生率分別為0.5%（7/1486）和0.9%（3/317），無(wú)明顯統(tǒng)計(jì)學(xué)差異（P0.05）。經(jīng)陰囊（66側(cè)）術(shù)式無(wú)圍手術(shù)期并發(fā)癥發(fā)生。 結(jié)論首次接受手術(shù)治療的隱睪中，術(shù)前在麻醉狀態(tài)下能將睪丸推至外環(huán)口及以下的隱睪，首選經(jīng)陰囊切口睪丸下降固定術(shù)；腹腔型、腹股溝型隱睪，對(duì)于有成熟腹腔鏡下手術(shù)經(jīng)驗(yàn)者，，可以優(yōu)先采用經(jīng)腹腔鏡探查及睪丸下降固定，此兩種術(shù)式具有微創(chuàng)優(yōu)勢(shì)。
[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) 鐫懼垎鍒噰鐢ㄧ粡鑵硅厰闀

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