478例小儿低位隐睾治疗方式选择及疗效分析

摘要

Objective:To further explore the clinical characteristics and treatment about the children with low cryptorchidism. Methods:A retrospective analysis of clinical data which are about the low cryptorchidism children for the ifrst time in our hospital treated 478 cases of urology (573 side) from October 2008 to October 2014. Respectively endocrine therapy (group A) and surgical treatment (group B) according to age, and compared the rate of testis failing into scrotum, the incidence of testicular atrophy or retraction and the circumstances of perioperative complications after the use of different treatment modalities. Results:Group A of 158 cases (198 sides), the total success rate of testis descent into the scrotum were 38.4%(76/198), in which the success rate of group A1 (0.5 to 1.0 year old) were 53.6%(52/97), group A2 (1.0 to 2.0 years old) were 23.8%(24/101), the difference was statistically signiifcant (P<0.01), and testicular atrophy did not appear during follow-up period, the incidence of testicular retraction were 3.8%(2/52) and 8.3%(2/24), the difference was statistically signiifcant (P<0.05). Group B of 320 cases (375 sides) used three surgical approaches, group B1 (inguinal method) were 175 cases (198 sides), B2 group (transscrotal orchidopexy method) were 87 cases (99 sides), B3 group (laparoscopic method) were 58 cases (78 sides), the success rate of testis descent into the scrotum were all 100%, testicular atrophy did not appear during follow-up period, the incidence of testicular retraction were 1.5%(3/198), 2.0%(2/99) and 0%(0/78), which indicated no statistically significant differences between them. The incidence of perioperative complications were 2.5%(5/198), 1.0%(1/99) and 1.3%(1/78), also showed no statistically signiifcant differences. Conclusion:For the children younger than 1 year old with low cryptorchidism undertaking primary treatment, endocrine therapy should be the preferred treatment;older than 1 year of age, transscrotal orchidopexy should be preferred.%目的：进一步探讨小儿低位隐睾的临床特点和治疗方式。方法：回顾性分析2008年10月至2014年10月间首次在我院泌尿外科接受治疗的478例(573侧)低位隐睾患儿的临床资料，根据年龄大小分别采用内分泌治疗(A组)和手术治疗(B组)，比较小儿低位隐睾在运用不同治疗方式后睾丸降入阴囊的成功率、睾丸萎缩或回缩的发生率及围手术期并发症的情况。结果：A组158例(198侧)睾丸降入阴囊的总成功率为38.4%(76/198)，其中A1组(0.5~1.0岁)成功率为53.6%(52/97)，A2组(1.0~2.0岁)成功率为23.8%(24/101)，差异有统计学意义(P<0.01)，随访期内未出现睾丸萎缩，睾丸回缩发生率分别为3.8%(2/52)和8.3%(2/24)，差异有统计学意义(P<0.05)。B组320例(375侧)采用三种术式，其中B1组(经腹股沟法)175例(198侧)、B2组(经阴囊法)87例(99侧)、B3组(经腹腔镜法)58例(78侧)睾丸降人阴囊的成功率均为100%，术后随访期内睾丸均未发生萎缩，睾丸回缩发生率分别为1.5%(3/198)、2.0%(2/99)、0%(0/78)，差异无统计学意义(P>0.05)；围手术期并发症发生率分别为2.5%(5/198)、1.0%(1/99)、1.3%(1/78)，差异无统计学意义(P>0.05)。结论：首次接受治疗且年龄小于1岁的低位隐睾患儿，应首选试用内分泌治疗；年龄大于1岁低位隐睾患儿，应首选经阴囊隐睾下降固定术。