腹腔镜睾丸下降固定术后睾丸萎缩的超声评估  

Sonographic evaluation of testicular atrophy after laparoscopic orchidopexy

作　　者：沈一丁[1] 刘世雄[2] 唐达星[1] 吴德华[1] 陶畅[1] 杨华军[1] 

机构地区：[1]浙江大学医学院附属儿童医院泌尿外科,杭州310003 [2]浙江省台州市中心医院

出　　处：《中华小儿外科杂志》2010年第8期594-596,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的 探讨超声检查对腹腔镜睾丸下降固定术后睾丸萎缩的评估价值,尝试建立睾丸萎缩的超声评分方法.方法 分别用腹腔镜行直接睾丸下降固定、Fowler-Stephen Ⅰ或Ⅱ期治疗不可触及隐睾,术后从不同时段对睾丸的体积（无改变、轻微缩小、明显缩小10%以上）、回声（均匀、不均匀）、边界（清晰、模糊、难确定）、实质内微结石（无、散在、弥漫）及血供（清晰、减少、无）等五方面的超声改变来评估睾丸萎缩情况,据此建立相对应超声评估方法,将术后睾丸萎缩进行分级：0级（无萎缩）、Ⅰ级（部分萎缩）、Ⅱ级（完全萎缩）.结果 共施行43例（56侧）手术,超声检查能清晰反映睾丸内在情况,术后3～6个月睾丸的超声表现趋于稳定,睾丸萎缩0级42/56（75.0%）、Ⅰ级12/56（21.4%）、Ⅱ级2/56（3.6%）.结论 超声检查可在术后3～6个月较为客观地评估腹腔镜睾丸下降固定术后睾丸萎缩情况;本文介绍的超声睾丸萎缩评分方法可应用于临床.Objective Testicular atrophy is a common complication after Fowler-Stephens （F-S）orchidopexy. So far no objective method for evaluating testicular atrophy is available. Histomorphological changes of the testes secondary to the ischemia can be accurately identified by the ultrasonography, based on previous animal experiment. The aim of this study is to assess testicular atrophy after orchidopexy clinically. Methods Laparoscopic orchidopexy and laparoscopic Fowler-Stephen staged orchidopexy for impalpable cryptorchidism were reviewed. The patients were followed up with sonography on post-operative day 7 and 20 and, 3, 6 and 12 months post-operatively. The atrophy was assessment was based on the testicular volume（no change, slight reduced, marked reduced ≥ 10%）,border （clear, blurry, uncertain）, echogenicity （homogenous, heterogenous）, microlithiasis （none,scattered, massive） and blood flow （apparent, reduced, almost none）. A 3 grades sonographic classification was used. Grade O represents no atrophy whereas grade Ⅰ represents partial and grade Ⅱ complete atrophy. Results Forty-three patients with 56 testes were operated. Postoperative sonography could identify the changes within the testes. After 3 to 6 months, ultrasound changes were minimal.Grade O accounted for 75% （42/65）, grade Ⅰ21 % （12/56） and Ⅱ 4% （2/56） of all the operations. Of the 35 testes without spermatic cord tension, grade Ⅰ atrophy was found in 14%. Of the 12 testes with tension grade Ⅰ was found in 25% and grade Ⅱ in 8%. Of the 9 testes in F-S group grade Ⅰ and Ⅱ atrophies were detected in 44% and 11 % of testes respectively. The testes with spermatic cord tension orunderwent F-S procedure had a significantly higher atrophic rate when compared with the testes without tension （P＜0.05）. Conclusions Sonographic examination is an objective method for evaluating testicular atrophy after laparoscopic orchidopexy. The 3 grades evaluation system for testicular atrophy can be applied clinically.

关 键 词：隐睾 睾丸 萎缩 

分 类 号：R726.9[医药卫生—儿科]