One-stage Fowler-Stephens Orchiopexy for Intra-abdominal Testes

背景：有經驗之小兒外科醫師可以傳統之睪丸固定術將大部分腹內睪丸置入陰囊內，但是某些相當高位之腹內睪丸則不置入。本篇文章提出以一階段Fowler-Stephens睪丸固定術治療腹內睪丸之結果。方法：於2000至2003年間有六位病患共七個腹內睪丸施行一階段Fowler-Stephens睪丸固定術治療並追蹤睪丸之位置及大小至少一年。技巧重點在於手術中必需保留一片位於精索下半部之腹膜以保護睪丸及輸精管之間的側枝循環。結果：病患年齡從一至五歲（平均三歲）。合併之先天性畸形為一例巨大臍膨出及一例右腎發育不全。診斷方法為四例腹腔鏡一例核磁共振及一例手術探查。有兩位病患曾接受其他醫院之手術探查。所有七個睪丸皆由手術可置入陰囊中，其中五個接受一次手術，兩個經歷兩次手術。除一個較高位睪丸外，位置皆於陰囊中，追蹤一年內未見任何睪丸萎縮之情況。結論：吾人應可嘗試一階段Fowler-Stephens手術方法來處理高位之腹內睪丸。我們的結果相當好，但需更多病患之經驗及更長之追蹤才能下更佳結論。

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並列摘要

Objective: Although most intra-abdominal testes can be delivered to normal scrotal position by the conventional method in the hands of an experienced pediatric surgeon, some very high testes cannot. We evaluate the results of one-stage Fowler-Stephens orchiopexy for intra-abdominal testes. Methods: From 2000 to 2003, 7 intra-abdominal testes in 6 patients treated by one-stage Fowler-Stephens orchiopexy were followed up for at least 1 year. The position and size of testes were checked. Special attention was paid to protect collateral circulation between spermatic and vasal vessels by leaving a strip of peritoneum attached to the lower spermatic cord. Results: The ages of the patients ranged from 1 to 5 years (mean, 3 years). The associated anomalies were giant omphalocele in 1 and right renal agenesis in 1. Diagnosis was made by diagnostic laparoscopy in 4 patients, magnetic resonance image in 1 and high inguinal exploration in 1. Two patients had undergone negative explorations at other hospitals. Five testes were brought into the scrotum by one operation, and the other 2 by a second operation. All six testes were in normal scrotal position, but one in the high scrotum. No atrophy of any testes has so far been noted. Conclusions: One-stage Fowler-Stephens orchiopexy should be tried for intra-abdominal testes. Although our results are very good, more patients and long-term follow-up are desirable for a better evaluation of the result of this operation.

並列關鍵字

cryptorchidism ； Fowler-Stephens orchiopexy ； intra-abdominal testis

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One-stage Fowler-Stephens Orchiopexy for Intra-abdominal Testes

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