Clinical Analysis Of 243 Cases Of Cryptorchidism With Inguinal Palpable Testis In Children

Objective:To explore the clinical efficacy of laparoscopic,scrotal incision and traditional inguinal incision in the treatment of cryptorchidism with inguinal palpable testis in children,and to provide a reference for the selection of appropriate surgical methods.Methods:A retrospective analysis of the clinical data of 243 children with cryptorchidism whose testis could be reached by inguinal groin in Department of Pediatric Surgery,Second Affiliated Hospital of Harbin Medical University,from January 2015 to December 2017 was retrospectively analyzed.Collecting general conditions,perioperative conditions,and postoperative complications of the children among inguinal incision surgery,laparoscopic surgery,and scrotal incision surgery.Distribution of cryptorchidism before operation,operative time,intraoperative bleeding volume,postoperative orthostatic activity time,postoperative hospital stay,abdominal incision length,incision bleeding,wound infection,scrotal hematoma,ipsilateral testicular retraction and so on were compared to analyze the clinical features.The data results were processed using SPSS 22.0 software.The measurement data was expressed as the median interquartile range,and the count data was expressed as the composition ratio or rate.The measurement data were compared using the rank sum test.The count data were compared using the sputum test or Fisher's exact probability method.P<0.05 indicated that the difference was statistically significant.Results:1.Of the 243 patients with cryptorchidism,92?37.9%?underwent inguinal incision operation,126?51.8%?in laparoscopic surgery,and 25?10.3%?in scrotal incision.2.The median age of the children was 3?1,7?years.Preoperative cryptorchidism was distributed in 191 cases?78.6%?on one side and 52 cases?21.4%?on both sides.3.The operative time of groin incision group(P50=40.0min,P25=35.0min,P₇₅=45.0min),laparoscopic group(P₅₀=45.0mim,P₂₅=40.0min,P₇₅=50.0min)and scrotal incision group(P₅₀=30.0mim,P₂₅=30.0min,P₇₅=40.0min)were significantly different?P<0.001?.The amount of intraoperative bleeding in groin incision group(P₅₀=10.0ml,P₂₅=10.0ml,P₇₅=15.0ml)was more than laparoscopic group(P₅₀=5.0ml,P₂₅=5.0ml,P₇₅=5.0ml)and scrotal incision group(P₅₀=5.0ml,P₂₅=5.0ml,P₇₅=5.0ml)?P<0.001?.There were significant differences between the inguinal incision group(P₅₀=3.0d,P₂₅=3.0d,P₇₅=4.0d),the laparoscopy group(P₅₀=1.0d,P₂₅=1.0d,P₇₅=2.0d)and the scrotal incision group(P₅₀=1.0d,P₂₅=1.0d,P₇₅=1.0d)in postoperative orthostatic activity time?P<0.001?,and there was a significant difference between the laparoscopic group and the scrotal incision group?P<0.001?.The postoperative hospitalization time of groin incision group(P₅₀=7.0d,P₂₅=6.0d,P₇₅=7.0d),laparoscopic group(P₅₀=5.0d,P₂₅=4.0d,P₇₅=5.0d)and scrotal incision group(P₅₀=3.0d,P₂₅=3.0d,P₇₅=3.0d)was significantly different?P<0.001?.There were significant differences in the length of abdominal incision in endoscopic group(P₅₀=3.0cm,P₂₅=3.0cm,P₇₅=5.8cm),laparoscopic group(P₅₀=1.5cm,P₂₅=1.5cm,P₇₅=1.5cm),and scrotal incision group(P₅₀=0.5cm,P₂₅=0.5cm,P₇₅=0.5cm)?P<0.001?.4.Postoperative complications included incision infection?4.9%?,scrotal hematoma?4.1%?,ipsilateral testicular retraction?3.3%?,incision hemorrhage?2.1%?,testicular atrophy?0.0%?,and inguinal hernia or sheath Fluid?0.0%?.The incidence of postoperative complications in groin incision group?29.3%?was significantly higher than laparoscopic group?2.4%?and scrotal incision group?12.0%??P<0.001?.There was no significant difference in the incidence of postoperative complications between the inguinal incision group?29.3%?and the scrotal incision group?12.0%??P>0.05?.There was also no significant difference in the incidence of postoperative complications in laparoscopic group?2.4%?and the scrotal incision group?12.0%??P>0.05?.The three groups were followed up for 6�12 months.The groin incision group has 7 cases?7.6%?testicular retraction,no testicular atrophy in the laparoscopic group,and the scrotal incision group has 1 case?4.0%?testicular retraction.All three groups had no testis after operation.There were no testicular atrophy,inguinal hernia or hydrocele in the three groups.Conclusions:1.The distribution of cryptorchidism with inguinal palpable testis is more than one side on one side.2.The proportion of children who underwent laparoscopic surgery was the highest among the three procedures.3.Scrotal incision surgery has short operation time,less intraoperative bleeding,early post-operative activities,short hospital stay,and short abdominal incision length in the perioperative period.4.The incidence of wound infection was the highest in postoperative complications,followed by scrotal hematoma among the three procedures;Laparoscopic surgery has the lowest incidence of complications.