儿童睾丸横过异位17例临床分析  

Clinical analyses of transverse testicular ectopia in children:a report of 17 cases

作　　者：周广伦[1] 孙雪蕊 郭慧杰[1] 尹鉴淳[1] 孙俊杰 李守林[1] Zhou Guanglun;Sun Xuerui;Guo Huijie;Yin Jianchun;Sun Junjie;Li Shoulin(Department of Urology,Municipal Children's Hospital,Shenzhen 518034,China)

机构地区：[1]深圳市儿童医院泌尿外科,深圳518034

出　　处：《中华小儿外科杂志》2022年第9期822-826,共5页Chinese Journal of Pediatric Surgery

基　　金：深圳市医疗卫生三名工程项目(SZSM201612013);深圳市医学重点学科(SZXK035);深圳市卫生计生系统科研项目(SZXJ2018045)。

摘　　要：目的探讨小儿睾丸横过异位(transverse testicular ectopia,TTE)的临床特点和治疗疗效。方法收集2009年9月至2020年6月深圳市儿童医院泌尿外科收治的17例TTE患儿的临床资料,患儿手术时年龄范围为8~28个月,中位年龄为13个月。总结分析其临床表现、检查结果、手术治疗及随访等资料。术后随访5~135个月,随访内容包括睾丸位置,超声检查睾丸血供及泌尿生殖系统有无肿物等。结果本研究患儿右侧TTE有10例,左侧TTE有7例。16例临床表现为单侧阴囊空虚和对侧腹股沟可复性包块,术前超声检查均怀疑为TTE;另1例表现为双侧阴囊空虚,超声检查未发现双侧睾丸。14例患儿行腹腔镜探查、经腹股沟切口阴囊中隔睾丸固定术,3例行腹腔镜下高位分离精索、经两侧腹股沟管睾丸下降固定术;术中发现16例患儿对侧鞘状突未闭。超声检查提示睾丸旁残留米勒管结构1例,后经腹腔镜探查证实并发现残留米勒管结构6例。术后无伤口感染和血肿。随访发现所有患儿双侧睾丸均处于阴囊内,无睾丸萎缩,超声提示睾丸血运正常且未发现肿物。结论对于单侧隐睾合并对侧腹股沟斜疝的患儿应怀疑TTE的可能,超声检查TTE的敏感性高。腹腔镜技术能有效诊断和治疗TTE,有助于发现残留米勒管结构等异常。Objective To explore the clinical characteristics and therapeutic outcomes of transverse testicular ectopia(TTE)in children.Methods From September 2009 to June 2020,clinical data were reviewed for 17 TTE children with a median age of 13(8-28)months.Clinical manifestations,examination results,surgical approaches and follow-up findings were analyzed.The patients were followed up for 5-135 months.The follow-up included testicular location,testicular blood supply and urogenital tumor by ultrasonography.Results The involved side was right(n=10)and left(n=7).There were unilateral scrotal emptiness and contralateral reducible inguinal masses(n=16).TTE was suspected on preoperative ultrasonography.In one case,there was bilateral scrotal emptiness and bilateral testes were absent on ultrasonography.Laparoscopic exploration and scrotal septal orchiopexy via an inguinal incision(n=14)and laparoscopic high separation of spermatic cord and orchiopexy via bilateral inguinal canals(n=3)were performed.Patent processus vaginalis at contralateral side was detected intraoperatively(n=16).Residual para-testicular Müllerian duct structure was detected by ultrasonography(n=1)and laparoscopic exploration(n=6).There was no postoperative onset of wound infection or hematoma.During follow-ups,all testes were in scrotum without testicular atrophy,and ultrasonography revealed normal testicular blood supply and there was no mass.Conclusions The possibility of TTE should be suspected in children with unilateral cryptorchidism plus contralateral indirect inguinal hernia.Ultrasonography offers a high sensitivity for TTE.Laparoscopic technique may effectively diagnose and treat TTE and aid in detecting residual Müllerian duct structure.

关 键 词：睾丸 异位 米勒管 诊断 腹腔镜检查 

分 类 号：R726.9[医药卫生—儿科]