非触知精巣に対する腹腔鏡検査の経験

Abstract

非触知精巣28例32精巣に対し腹腔鏡検査を施行し, その有用性について検討した。1)腹腔鏡検査結果では消失精巣が7例, 腹腔内精巣が5例, 鼠径管内精巣が20例であった。2)消失精巣を除いた25精巣に対し腹腔鏡検査に引き続き手術を施行したが, それぞれ腹腔内精巣3例には精巣固定術, 2例には摘除術, 鼠径管内精巣は各10例ずつ精巣固定術, 摘除術が行われた。3)腹腔鏡検査では全例で安全かつ確実な部位診断が可能で, 必要に応じてそのままの麻酔で治療も行え, 術後の回復状況にも支障をきたさなかったことから, 非触知精巣に対し有用な検査法であると考えられた。

We evaluated the results and advantages of laparoscopic examination in 28 patients with 32 nonpalpable testes. Between April 1991 and May 2006, 28 patients, 12 months to 12 years old, with 32 nonpalpable testes underwent diagnostic laparoscopy under general anesthesia before surgical management of the testes. If the blind end of the vas deferens and/or spermatic vessels was observed, the diagnosis of vanishing testis was made, and no further examination or treatment was performed. If intra-abdominal testis was observed, laparoscopic orchiectomy or open orchiopexy was performed. If the internal spermatic vessels and vas deferens entered into the internal inguinal ring, the diagnosis of intra-canalicular testis was made so that the inguinal canal was opened for surgical interventions. Of the 32 nonpalpable testes 10 were on the right side and 22 were on the left side (4 patients had bilateral undescended testes). There were 7 (21.8%) vanishing, 5 (15.6%) intra-abdominal and 20 (62.5%) intra-canalicular testes. There were no complications related to laparoscopy. Laparoscopy can be safely performed to assess the location of the non-palpable testes. Another advantage of the laparoscopic examination is that orchiopexy or orchiectomy can be immediately performed after the examination to avoid a second surgery.