隐睾症是小儿外科疾病中的常见病,多数通过手术能够降至阴囊,而对于高位隐睾来说则手术难度较大,我院自1996年～2004年间采用保留睾丸引带-精索血管低位切断—睾丸下降固定术治疗高位隐睾9例。现分析报告如下。1 临床资料1.1 一般资料本组9例,年龄2岁～11岁,左侧6例,右侧3例。其中有5例于腹股沟管内环口处可触及,未触及的4例通过彩超探及2例,仅有2例术前位置不确定。1.2 手术方法采用硬膜外麻醉或骶管麻醉。取患侧腹横纹或腹股沟斜切口,显露腹股沟管。于内环口附近找到睾丸,若在内环口处未找到睾丸则向上切开腹内斜肌和腹横肌2cm～3cm,进行腹膜外或腹腔内探查。找到睾丸后横断鞘膜突,紧贴鞘膜突后壁分离精索血管和输精管,高位结扎鞘膜突。解剖出精索血管,保留精索血管与输精管间的膜样结构,用无损伤血管钳夹住精索血管,在睾丸白膜上作以3mm 的切口,观察:若5分钟后切口不再出血、睾丸颜色变暗或质地变软,说明睾丸侧支循环不足,则应放弃该术式;若5分钟后切口内仍有新鲜血液流出,睾丸颜色、质地变化不大,说明睾丸侧支循环丰富,则可低位切断、结扎精索血管。然后区别并分离输精管上行段、下行段,完整保留睾丸引带,睾丸可无张力地降入阴囊底部,固定于阴囊肉膜袋内。1.3 结果本组9例病人采用该术式均一次完成睾丸固定,术后定期分3个月、半年、1年、2年随访、最长随访5年,9侧睾丸均在阴囊内,外观正常,无睾丸萎缩。2 讨论 Cryptorchidism is a common disease in pediatric surgical diseases, the majority of surgery can be reduced to the scrotum, while the high cryptorchidism surgery is more difficult, our hospital from 1996 to 2004 with the retention of testicular tape - spermatic vessels Low cut off - testicular descent fixation for the treatment of high cryptorchidism in 9 cases. The analysis report is as follows. 1 Clinical data 1.1 General Information The group of 9 patients, aged 2 to 11 years old, 6 cases of left and right in 3 cases. Among them, 5 cases were accessible at the inguinal canal, 4 cases were untreated by color Doppler ultrasound and 2 cases. Only 2 cases had undetermined preoperative position. 1.2 surgical methods using epidural anesthesia or caudal anesthesia. Take the lateral ventral stripes or groin incision, revealing the inguinal canal. In the vicinity of the inner ring to find the testis, if not found in the inner mouth of the testis was cut up the abdominal oblique and transverse abdominal muscle 2cm ~ 3cm, extraperitoneal or intraperitoneal exploration. Testicular transection found after the testis, close to the posterior wall of the sheath separated spermatic vessels and vas deferens, high ligation sheath. The spermatic vessels were dissected and the membranous structure between the spermatic vessels and the vas deferens was preserved. The spermatic vessels were clamped with a non-invasive vascular forceps, and a 3mm incision was made in the testicular albuginea. Observations: If the incision did not bleed after 5 minutes , Testicular darken or texture becomes soft, indicating lack of testicular collateral circulation, you should give up the operation; if after 5 minutes there is still fresh blood outflow incision, testicular color, texture changes little, indicating rich testicular collateral circulation , You can cut off low, ligation spermatic blood vessels. Differentiation and separation and separation of the upper segment of the vas deferens, the next paragraph, complete retention of testis tape, testicles can be reduced to the bottom of the scrotum without tension, fixed in the scrotal pocket. 1.3 Results The group of 9 patients using the technique were completed testicular fixation, postoperative regular 3-month, 6-year, 1 year, 2-year follow-up, up to 5 years follow-up, 9 testis in the scrotum, the appearance of normal , No testicular atrophy. 2 discussions