目的:总结腹腔镜下一期FowlerStephens手术治疗小儿腹腔型隐睾的经验。方法:回顾从2003年3月至2009年3月本组用腹腔镜下一期FowlerStephens手术治疗的腹腔型隐睾13例,共20侧,年龄11月～14岁(平均51岁)。结果:13例患儿中双侧腹腔内高位隐睾7例,一侧腹腔内高位隐睾对侧睾丸萎缩4例(1例一侧为索状性腺),单侧腹腔内高位隐睾2例,共20侧腹腔内高位隐睾行了腹腔镜下一期FowlerStephens手术,同时对萎缩睾丸进行了切除。全组病例没有并发症发生,术后随访3月,下降固定的睾丸均血运良好,无睾丸萎缩发生。结论:腹腔镜治疗腹腔型隐睾的优势十分明显,腹腔型睾丸根据术中判断睾丸的游离程度及精索的松弛情况和睾丸位置,可采用一期FowlerStephens手术和精索松解、睾丸下降固定术,腹腔镜下FowlerStephens手术后的睾丸萎缩发生率明显低于开放FowlerStephens手术。
From October 1985 to October 1988, fourty-nine impalpable testis in 39 patients were treated. The ages of the patients ranged from lyear 10 months to 11 years. There were fixed testis into scrotum (in 24 cases), superficial layer of aponeurosis of musculus obliquus externus abdominis (in 4 cases), autotransplantation (in 7 cases), and testectomy (in 11 cases). No testis in 3 cases were conformed in exploration. The author suggestes it necessary to do exploration early in impalpable testis of children to obtain good physiologic function of testis.
目的:探讨医源性隐睾的病因,预防和治疗特点。方法:回顾分析我院治疗的16 例医源性隐睾患儿,其中睾丸鞘膜积液术后7 例,腹股沟斜疝术后8 例,尿道下裂术后1 例。结果:16 例均接受手术治疗,10 例睾丸存在不同程度的萎缩,其中1 例睾丸完全萎缩,行睾丸切除。术后随访12 例,睾丸均在阴囊内,但发育较健侧差。结论:降低医源性隐睾发病率的根本措施是防止其发生,尽量减少不正确的医疗行为,并做到早期发现,早期行手术治疗。
ObjectiveTo evaluate the health economics indexes of day surgery mode and traditional specialist hospitalization mode, and to provide reference for the selection of different hospitalization mode of inguinal-type cryptorchidism in children.MethodsThe patients with unilateral cryptorchidism under 5 years old between January 2017 and January 2018 in Chongqing Children’s Hospital were selected in this study. According to different inpatient surgery modes, the included children were divided into day surgery group (day group) and special in-hospital surgery group (specialty group). The general data of patients, treatment indicators, incidence of complications, postoperative testicular atrophy rate, recurrence, nosocomial infection, hospitalization time, hospitalization cost, satisfaction of patients, and other health effect indicators between the two operation modes were compared. The treatment effect indexes and cost-effect ratio of the two modes were statistically analyzed.ResultsA total of 198 children were included, including 83 in the day group and 115 in the specialty group. The patients in both groups underwent orchiopexy by small inguinal dermatoglyph and scrotal incision. There was no statistically significant difference in the affected side, source area, postoperative complications, or nosocomial infection between the two groups (P>0.05). The patients in the specialty group were older than those in the day group [(27.60±11.04) vs. (20.88±9.48) months old; t=4.586, P<0.001]; the bed occupancy time [(118.60±10.80) vs. (23.95±5.90) h; t=72.353, P<0.001] and operation time [(0.45±0.15) vs. (0.38±0.12) h; t=2.946, P=0.004] in the specialty group were longer than those in the day group. The difference was statistically significant in hospitalization expenses between the two groups (χ2=155.374, P<0.001); 92.8% of the children in the day group spent less than 5 000 yuan, while 95.7% of the children in the specialty group spent more than 5 000 yuan. The American Society of Anesthesiologists scores in the specialty group were higher than those in the day group (χ2=44.870, P<0.001). The treatment effect indexes in the day group and the specialty group were 0.99 and 1.01, respectively, and the cost-effect ratios were 3 850 and 6 657, respectively. The economic benefit of the day group was better.ConclusionsThe cost-effectiveness of day surgery is better than that of specialized inpatient surgery. Therefore, this model can be recommended for children who meet the indications of day surgery.