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发育医学电子杂志  2022, Vol. 10 Issue (3): 215-219    DOI: 10.3969/j.issn.2095-5340.2022.03.009
  结构畸形   临床经验交流 |
单孔腹腔镜下经阴囊入路睾丸引降固定术治疗腹股沟型隐睾合并斜疝后内环口形态观察
刘雪来 王文博 李龙 李索林
1. 首都儿科研究所附属儿童医院 外科,北京 100020;2. 河北医科大学第二医院 小儿外科,河北 石家庄 050000
Morphology observation of inner ring orifice after laparoscopic assisted transcrotal orchidopexy for treatment of inguinal cryptorchidism combined with indirect inguinal hernia
Liu Xuelai, Wang Wenbo, Li Long,et al
1. Department of Surgery, Capital Institute of PediatricsAffiliated Children Hospital, Beijing 100020, China; 2. Department of Pediatric Surgery, the Second Hospitalof Hebei Medical University, Hebei, Shijiazhuang 050000, China
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摘要 【摘要】 目的  观察传统三孔腹腔镜和单孔腹腔镜监视下经阴囊入路睾丸引降固定术(laparoscopic
assisted transcrotal orchidopexy,LATO)实施睾丸引降固定之后内环口的形态学特征,为LATO 手术术中
是否需要同时行单孔腹腔镜腹膜外结扎术( laparoscopic percutaneous extraperitoneal closure, LPEC)提
供形态学参考。 方法 选取2015 年5~12 月实施传统三孔腹腔镜睾丸引降固定术治疗的24 例腹股沟型隐睾合并斜疝患儿作为传统腹腔镜组,选取2016 年11 月至2017 年4 月实施LATO+LPEC 治疗的22 例腹股沟型隐睾合并斜疝患儿作为LATO 组。留取两组术中影像学资料,并进行观察和比较两组内环口的形态。 结果 传统腹腔镜组术后内环口处腹膜后形成裂伤平面,腹膜因收缩而出现不同大小的裂隙,腹膜细小血管破裂而导致微小出血,术中内环口组织随时间自行止血,血痂渗漏至内环口周围腹膜外间隙;LATO 手术组引降固定后内环口处腹膜依旧光滑完整,内环口处腹膜和腹膜外间隙内未见出血。两组睾丸引降固定所致的牵拉作用使精索向内侧移行和压迫内环口。两组术中实施引降固定之后,内环口形态改变但内环口依旧存在。 结论 与传统三孔腹腔镜法实施睾丸引降固定术相比,LATO 术后内环口不具备受损鞘突腹膜修复、内环口腹膜化和瘢痕组织增生填塞内环口的形态学基础,因此内环口依旧处于开放,具备发展为具有临床症状的疝或鞘膜积液的形态学条件,其牵拉精索组织造成的阻挡对预防疝或鞘膜积液的形成作用仍需深入研究。
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关键词:  单孔腹腔镜监视下经阴囊入路睾丸引降固定术  腹股沟型隐睾;  腹股沟斜疝  内环口  形态    
Abstract: 【Abstract】 Objective To observe morphology of inner ring orifice after conventional three-port
laparoscope orchidopexy and laparoscopic assisted transcrotal orchidopexy (LATO) for treatment of inguinal cryptorchidism combined with indirect inguinal hernia. Method Twenty-four children with inguinal cryptorchidism combined with indirect inguinal hernia underwent conventional three–port laparoscope orchidopexy procedures between May and December 2015 were selected as conventional laparoscope group, and LATO + laparoscopic percutaneous extraperitoneal closure (LPEC) procedures in 22 children with palpable inguinal canalicular cryptorchidism combined with indirect inguinal hernia from November 2016 to April 2017 were selected as LATO group. Vedios were preserved for observation and comparison of inner ring orifice between the two groups. Result In conventional laparoscope group, circular laceration could be noted around inner ring orifice, retroperitoneal wound and slight hemorrhage caused by small vessel rupture could be seen due to peritoneal contraction. Furthermore, spontaneous hemostasis and leakage of extraperitoneal space around inner ring orifice could be found. While for the LATO group, inner ring orifice tissue presented smooth without any destroy around peritoneum, and no hemorrhage could be seen round inner ring orifice and extraperitoneal space. Spermatic cord would migrate interiorly due to pulling during orchidopexy and inner ring orifice was lessened in both procedures group. Morphology changed after orchidopexy but inner ring orifice in both procedures group still exist. Conclusion Compared with conventional three–port laparoscope orchidopexy procedures, LATO procedure does not possess the morphological basis for peritoneal repair, regeneration around inner ring orifice, and potential closure caused by tissue proliferation and remodeling. As the result, the inner ring orifice is still open, and has potential to develop indirect inguinal hernia or hydrocele. Although this, the investigations are still needed to prevent the indirect inguinal hernia or hydrocele caused by the obstruction of spermatic cord.
Key words:  Laparoscopic assisted transcrotal orchidopexy    Inguinal canalicular cryptorchidism    Indirect inguinal hernia    Inner ring orifice    Morphology
收稿日期:  2020-12-16                     发布日期:  2022-05-31     
基金资助: 北京市自然科学基金(7222015);北京市属医学科研院所公益发展改革试点项目(京医研2019-11)
通讯作者:  刘雪来    E-mail:  liuxuelai_steven@163.com
引用本文:    
刘雪来 王文博 李龙 李索林. 单孔腹腔镜下经阴囊入路睾丸引降固定术治疗腹股沟型隐睾合并斜疝后内环口形态观察[J]. 发育医学电子杂志, 2022, 10(3): 215-219.
Liu Xuelai, Wang Wenbo, Li Long, et al. Morphology observation of inner ring orifice after laparoscopic assisted transcrotal orchidopexy for treatment of inguinal cryptorchidism combined with indirect inguinal hernia. Journal of Developmental Medicine(Electronic Version), 2022, 10(3): 215-219.
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http://www.fyyxzz.com/CN/10.3969/j.issn.2095-5340.2022.03.009  或          http://www.fyyxzz.com/CN/Y2022/V10/I3/215
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