腹股沟疝合并隐睾的手术治疗

M. Malikov, F. Khamidov, F. B. Bokiev, O. Khudoydodov, I. Khomidov, N. A. Makhmadkulova
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In addition to clinical investigation, ultrasonography (US), Doppler ultrasonography (DU) and, to a limited extent, computed tomography (CT) were used preoperatively and in the long-term postoperative period. Dynamical changes in the threedimensional testicular measurements, testicular volumes and the time-averaged maximum velocity (TAMAX, cm/s) in the testicular arteries were evaluated. Results: In the immediate postoperative period, seroma formation and suppuration of wounds were not noted. However, in 3 (13.6%) cases, transient swelling of the scrotum was observed. According to ultrasound data, 6 months after single-stage operations, there was a statistically significant increase in all parameters of the operated testicle compared to the initial values, including three-dimensional testicular measurements and volume (p<0.05) in all age groups. 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引用次数: 1

摘要

目的:评价腹股沟疝合并隐睾的一期手术治疗效果。方法:2005 ~ 2020年,22例3 ~ 28岁的腹股沟疝合并隐睾患者行手术治疗。所有手术均使用器械进行,通过增强的可视化和放大提供手术精度。右侧疝合并隐睾12例(54.5%),左侧疝8例(36.4%)。此外,2例(9.1%)患者出现双侧疝和隐睾。除临床调查外,术前和术后长期均采用超声(US)、多普勒超声(DU)和有限程度的计算机断层扫描(CT)。评估睾丸三维测量、睾丸体积和睾丸动脉时间平均最大速度(TAMAX, cm/s)的动态变化。结果:术后即刻创面无血肿形成及化脓现象。然而,在3例(13.6%)病例中,观察到短暂性阴囊肿胀。超声资料显示,单期手术后6个月,各年龄组手术睾丸的各项参数,包括睾丸三维测量和体积,均较初始值有统计学意义(p<0.05)。此外,术后6个月,除3-5岁儿童睾丸厚度外,各年龄组手术降睾丸和健康睾丸的大小基本相等。同时,根据DU数据,病变一侧睾丸动脉TAMAX也有统计学意义的升高(p<0.001)。结论:在腹股沟疝和隐睾手术中使用器械,通过增强的视觉和放大提供手术精度,是金标准治疗。因为它可以防止对关键解剖结构的医源性损伤,允许最大限度地调动保留睾丸的血管蒂,并有助于在不太紧张的情况下安全放下后者。选择合适的疝口重建方法,同时预防复发,也有助于避免压迫精索元素,从而提高生育功能。关键词:腹股沟疝,隐睾,腹股沟疝合并隐睾。
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SURGICAL TREATMENT OF INGUINAL HERNIA COMBINED WITH CRYPTORCHIDISM
Objective: To evaluate outcomes of single-stage surgery performed for inguinal hernia combined with cryptorchidism. Methods: Between 2005 and 2020, 22 patients aged 3 to 28 years underwent surgery for inguinal hernias combined with cryptorchidism. All surgeries were performed using instrumentation, affording surgical precision through enhanced visualisation and magnification. The combination of the hernia with cryptorchidism was noted in 12 (54.5%) and 8 (36.4%) patients on the right and left sides, respectively. In addition, bilateral localisation of hernia and cryptorchidism was observed in 2 (9.1%) patients. In addition to clinical investigation, ultrasonography (US), Doppler ultrasonography (DU) and, to a limited extent, computed tomography (CT) were used preoperatively and in the long-term postoperative period. Dynamical changes in the threedimensional testicular measurements, testicular volumes and the time-averaged maximum velocity (TAMAX, cm/s) in the testicular arteries were evaluated. Results: In the immediate postoperative period, seroma formation and suppuration of wounds were not noted. However, in 3 (13.6%) cases, transient swelling of the scrotum was observed. According to ultrasound data, 6 months after single-stage operations, there was a statistically significant increase in all parameters of the operated testicle compared to the initial values, including three-dimensional testicular measurements and volume (p<0.05) in all age groups. In addition, 6 months after the operation, the sizes of surgically brought down and healthy testicles in all age groups became equal, except for the thickness of the testis in children aged 3-5 years. At the same time, according to DU data, there was also a statistically significant increase in TAMAX in the testicular artery on the side of the lesion (p<0.001). Conclusion: The use of instrumentation, affording surgical precision through enhanced visualisation and magnification when performing surgery for inguinal hernia and cryptorchidism, is the gold standard treatment. Because it prevents iatrogenic damage to critical anatomical structures, allows maximum mobilisation of the vascular pedicle of the retained testicle and contributes to the safe bringing down of the latter without much tension. The selection of an appropriate hernial orifice reconstruction method, along with the recurrence prevention, also helps to avoid compression of the elements of the spermatic cord and thus improve the fertile function. Keywords: Inguinal hernia, cryptorchidism, a combination of inguinal hernia and cryptorchidism.
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