Orchiopexy

Testicular fixation is the main method for the treatment of cryptorchidism, that is, after finding the testicles, loosening the spermatic cord, expanding the scrotum and fixing the testicles in the scrotum. About 75% of patients with bilateral cryptorchidism and 50% of unilateral cryptorchidism were treated with testicular fixation at different ages before puberty. The number of sperm after surgery was lower than that of normal people. Treating diseases: cryptorchidism Indication 1, the testicles did not fall into the scrotum, cryptorchidism patients over one year old. 2, combined with cryptorchidism of the inguinal hernia. 3. Ectopic testicles. 4, adult cryptorchidism, if the unilateral cryptorchid testis has been highly atrophied, in order to prevent testicular malignant transformation, testicular resection should be performed, otherwise testicular fixation should be performed. 5. The sheath is not closed. 6, the traumatic testicular dislocation, after the manual reset was unsuccessful. The testicular extracapsular sac of the inguinal oblique incision has been widely used at home and abroad. The cryptorchidism with short spermatic vessels can be divided into two phases to ensure the blood supply of the testicles, but there is also a second accidental injury. The possibility of vascularization, the Foweel Stephen procedure can be applied to the high cryptorchidism of the long vas deferens. Recently, the improved method of this procedure is recommended. Foweer Stephen staged surgery, that is, the initial enjoyment only cuts the spermatic vascular pedicle at high position, and does not perform testicular fixation. In the second phase, after the establishment of the collateral circulation, the testis is fixed in the scrotum, reducing the chance of testicular atrophy. Contraindications Fowler The contraindications to stephens surgery have the following four aspects: (1) The vas deferens are too short. (2) Testicular development is poor. (3) Partial vascular atresia. (4) The testis is not connected to the epididymis. Preoperative preparation Shave the pubic hair 1 day before surgery to clean the perineal skin. In order to identify bilateral cryptorchidism and non-testis in the abdominal cavity, a chorionic gonadotropin test should be performed. The method was to measure the basal testosterone concentration on the first day, and then stimulated with -hCG for 3 days. On the fourth day, the plasma testosterone level did not increase by more than 20 ng/100 ml, indicating that there were no testes on both sides. Surgical procedure (a) Standard testicular fixation The currently used surgical methods are based on the surgical methods of Bevan and Torek. The main surgical procedure is to take the inguinal incision along the groin, stratify the skin, subcutaneous shallow, deep fascia, open the external oblique muscle aponeurosis and protect the inferior and inguinal inguinal nerves, find cryptorchidism and white sac. , separate the sac to the inner ring and ligature, free spermatic cord and testis. The scrotum is bluntly separated under the deep fascia through the abdominal incision, and a transverse incision is made in the upper part of the scrotum and subcutaneously separated to form a subcutaneous pocket to accommodate the testes. A suture was made in the lower part of the testis with a silk thread, and was pulled out from the upper incision of the scrotum with a vascular clamp. Place the testicles in the subcutaneous pocket of the scrotum, thread the thread out at the bottom of the scrotum and ligature it on a button. The inguinal and scrotal incisions were sutured in layers, and the testicular sutures at the bottom of the scrotum were removed two weeks later. If the cryptorchidism is located above the inner ring or the inner ring, the incision should be extended obliquely upwards to free the spermatic vessels upwards, reaching the lower part of the kidney. At the same time, the inguinal inner ring can be opened, and the external oblique muscle, the internal oblique muscle and the transverse transverse tendon can be cut off. Membrane to facilitate free spermatic cord. The cryptorchidism must be fixed in the scrotum to ensure that there is no tension at all to fully guarantee the blood supply of the testes. Prentiss proposed that after the spermatic cord is fully dissociated, the spermatic cord can be straight down and a new inner ring can be made. The scrotum can be directly entered into the scrotum by the front of the pubic bone, which can shorten the stroke of the spermatic cord by 2 to 3 cm. If cryptorchidism is not found during surgery, the abdominal cavity should be opened for further exploration. (two) stage testicular fixation Staging testicular fixation is a surgical procedure applied to cryptorchidism patients with high or intra-abdominal testicles and short spermatic vessels. A total of more than 200 cases have been reported by 10 authors such as Suyder, and the success rate of treatment ranges from 70 to 100%. The specific method is to make a skin incision along the inguinal region, and after finding the testicle, suture a needle on the testicular ligament, and then fix it on the inguinal ligament or the upper part of the scrotum, paying attention to keeping the tension of the spermatic cord should not be too large. 8 - 16 months later, surgery was performed, the spermatic cord was released, and the testes were fixed in the scrotum. Corkey used a silicone membrane to wrap the testicles and spermatic cords during the first operation, reducing adhesions and allowing the second procedure to proceed smoothly. (3) Fowle stephens testicular fixation In some patients with high intra-abdominal cryptorchidism, the vas deferens is long and curved in the inguinal canal. For this cryptorchidism, Fowler and ste-phens proposed a treatment for cutting the spermatic vessels and moving the testes down. . Harrjson~ studied the blood condition of the testicular rhyme, which was derived from the inner blood vessels of the spermatic cord and the outer blood vessels of the spermatic cord (the cremaster muscle vessels). Fowler and stephePs studied the blood supply and collateral circulation of the spermatic vessels and testes, and used intraoperative testicular angiography to determine an anastomosis between the spermatic cord and the vas deferens. In a recent study, Pascual and Railer pointed out that the blood flow of the testes was measured by 133xenon, and the blood flow of the testis was ligated in the spermatic cord. The testicular blood flow was reduced by 80% 1 hour after ligation, but After 30 days, testicular blood flow returned to the level before ligation (from collateral circulation) r histological examination confirmed 6 testicular tissues of white rats; 4 lesions of seminiferous tubules were less than 25%, and 1 seminiferous tubule damage was greater than 75 %, the other 1 has only point damage. Their research supports Fowle-stepens surgery. The specific method of surgery is to remove the cryptorchidism and the vas deferens and the accompanying blood vessels after surgery, and clamp the spermatic vessels from the cryptorchidism more than 5 cm, and cut a 3 cm incision in the testicle from the membrane for five minutes. If the incision continues to bleed, it indicates that the Fowle-stephens operation is feasible, that is, the spermatic vessels are cut off, the cryptorchidism is free, the vas deferens and accompanying blood vessels are preserved, and the cryptorchidism is placed in the scrotum. If the testicular surface is incision. There is no bleeding, then a testicular autograft is required. During surgery, attention should be paid to the retention of the vas deferens and the associated posterior peritoneal side. In a recent report, F~ogan noted that 38 patients with 38 cryptorchidism achieved 89% sputum power with this procedure. Giblowr reported treatment of 17 cases of intra-abdominal cryptorchidism, and 5 cases (30%) had testicular atrophy after surgery. The cause of atrophy was mainly due to excessive separation during surgery and removal of the posterior peritoneum around the vas deferens. Ransley proposed a staged Fowler-stephen~s surgical treatment method, in which the spermatic vessels are ligated in the first step of the operation, and the testicular collateral circulation is increased. After 6 months, the second step of free cryptorchidism is transferred to the scrotum. The success rate of this operation. (iv) Testicular autograft (microsurgical technique) Only a few people with high intra-abdominal cryptorchidism are eligible for Fowler-stephens surgery, and a significant number of patients require testicular autografts. From the results of the transplant reported by Giuliajn et al, the testicular biopsy and serological examination of the patients have normal male hormone secretion, some patients have spermatogenic changes, and many cases have achieved good results. The specific method of operation is to match the internal spermatic artery and vein with the deep inferior epigastric artery and the end of the vein, and place it in the scrotum of the ball. Because testicular tissue is highly tolerant to ischemia and does not require cryo-perfusion during surgery, patients do not need to use any anticoagulant therapy after surgery. This procedure requires high surgical skills and microscopy. Surgical techniques. complication 1, testicular retraction testicular incompleteness is due to insufficient peritoneal detachment. The testicular retraction is mostly due to the incomplete completion of the spermatic cord in the operation, and the testicle is barely pulled into the scrotum, which is not treated by corresponding traction. If the testicles are retracted above the outer ring, testicular fixation should be performed again after 3 months. 2, testicular ischemia and testicular atrophy testicular atrophy and preoperative testicular size. Mostly caused by intraoperative damage to the spermatic blood vessels, spermatic cord torsion and excessive traction testicular strength. If you use a magnifying glass or surgical microscope and fine instruments during surgery, you can avoid this complication by careful operation. 3, vas deferens often occur in cases that do not touch the testes. Microsurgical vasectomy should be performed immediately or in adulthood. 4, bleeding and infection scrotum progressive increase suggestive of active bleeding, should be surgical exploration. In addition, the presence of too many sheath membranes can occur in the long-term hydrocele, when the fluid is small, it can be left untreated, and surgery is necessary when there is more fluid.

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