Objective: To determine the feasibility and short-term effect of single scrotal-incision orchidopexy (SSIO) without ligation of the processus vaginalis (PV) in the treatment of palpable undescended testis (PUDT).
Methods: This retrospective study included 109 cases of PUDT (125 sides) and 15 cases of impalpable undescended testis (IUDT). The former underwent SSIO without PV ligation (group A, n = 53) or standard inguinal orchidopexy with PV ligation (group B, n = 56) while the latter received laparoscopic exploration (group C). We analyzed the success rate of SSIO in the management of PUDT, postoperative complications, and incidence rates of hernia and hydrocele, and compared the relevant parameters between groups A and B.
Results: The median age of the PUDT patients was 1.4 (0.6－11.0) years. Group A included 24 cases of left PUDT (2 with hydrocele), 20 cases of right PUDT (1 with hydrocele), and 9 cases of bilateral PUDT, the success rate of which was 95.1%. Group B consisted of 27 cases of left PUDT, 22 cases of right PUDT (3 with hernias), and 7 cases of bilateral PUDT. The rate of PV patency in the PUDT patients was 80.8% (101/125). Laparoscopic exploration of the 15 IUDT patients revealed 2 cases of congenital testis absence, 6 cases of testis dysplasia, all treated by surgical removal, 3 cases of staying around the inner ring, descended by inguinal orchidopexy, and the other 4 treated by laparoscopic surgery. The incisions healed well in all cases, with no testicular atrophy, inguinal hernia or hydrocele.
Conclusions: Single scrotal-incision orchidopexy without PV ligation is a safe and feasible procedure for the treatment of palpable undescended testis, which avoids the risk of inguinal hernia or hydrocele.
目的: 通过对可触及型隐睾采用单阴囊切口且离断不结扎鞘状突行睾丸下降固定的手术方法的应用，探讨此方法的可行性及近期效果观察。方法: 通过一项回顾性研究，纳入从2015年1-12月间因隐睾入院手术的病例：可触及型隐睾109例（125侧）（A+B组）；未触及型隐睾15例（C组）。前者采用单阴囊切口+近内环口高位离断鞘状突（未结扎）睾丸下降固定（A组， 53例，61侧）或标准腹股沟阴囊双切口睾丸下降固定（B组， 56例，64侧），后者腹腔镜探查（C组）。分析单阴囊切口睾丸固定术在可触及型隐睾中的治疗成功率、术后近远期并发症、斜疝或鞘膜积液的发生（复发），以及单、双切口（A、B组）治疗可触及型隐睾中相关参数的比较。结果： 可触及型隐睾患儿中位年龄1.4（0.6-11.0）岁。A组：中位年龄1.5（0.6-7.0）岁。睾丸侧别：左24例，2例伴有鞘膜积液；右20例，1例伴有鞘膜积液，2例术中增加腹股沟切口；双侧9例，1例右侧术中增加腹股沟切口。治疗成功率为95.1%（58/61）。B组：中位年龄1.4（0.8-11）岁。睾丸侧别：左27例；右22例，3例伴有腹股沟斜疝；双侧7例，1例术后右侧睾丸回缩。两组中鞘状突未闭合率80.8%（101/125）。未触及型隐睾C组15例全部腹腔镜探查：2例睾丸先天缺如；6例睾丸发育不良且切除；3例在内环口呈“窥视”，改普通双切口术；4例腹腔镜手术固定。切口愈合良好，无睾丸萎缩，无斜疝或鞘膜积液发生（复发）。结论: 单阴囊切口且不结扎鞘状突治疗可触及型隐睾是一种安全的手术方法，且不结扎鞘状突未增加发生斜疝或鞘膜积液的风险。.
Keywords: hydrocele; inguinal hernia; ligation; orchidopexy; processus vaginalis; undescended testis.