儿童获得性隐睾8例临床分析  

Clinical analysis of acquired undescended testis in children:a report of 8 cases

作　　者：沈晶 徐珊 朱信强 张保峰 李国翰 Shen Jing;Xu Shan;Zhu Xinqiang;Zhang Baofeng;Li Guohan(Center of Pediatric Surgery,Hangzhou Amcare Women&Children's Hospital,Hangzhou 310012,China)

机构地区：[1]杭州美中宜和妇儿医院小儿外科中心,杭州310012

出　　处：《中华小儿外科杂志》2024年第3期242-246,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨儿童获得性隐睾的临床特点,总结其诊断及治疗经验。方法回顾性分析杭州美中宜和妇儿医院2020年5月至2021年7月收治的获得性隐睾患儿8例,年龄为(6.9±2.3)岁;均为单侧患病。收集患儿的一般临床资料,包括年龄、合并症、既往睾丸检查等资料。本组病例诊断获得性隐睾后均采用手术治疗,术中观察患侧睾丸的解剖学特点,术前及术后利用超声测量睾丸的三维直径,计算睾丸体积、睾丸萎缩指数,采用t检验比较分析手术前后患侧与健侧睾丸的体积差异。结果本组患儿均合并重度尿道下裂,在尿道下裂术后临床随诊中发现获得性隐睾,其中2例为会阴型尿道下裂,6例为阴茎阴囊型尿道下裂,1例伴有46,XX性逆转综合征。本组患儿均有尿道下裂术后随访记录和儿童泌尿外科医师的睾丸体检记录,其中6例曾为正常睾丸,2例曾为回缩性睾丸。2例对侧睾丸曾因诊断先天性隐睾行睾丸下降固定术。本组患儿术前患侧睾丸体积(0.38±0.19)ml,健侧睾丸体积(0.65±0.29)ml,患侧睾丸体积较健侧均有不同程度减小(P<0.05),睾丸萎缩指数为(41.4±16.6)%。8例患儿诊断后均行睾丸下降固定术,术中发现患侧睾丸均位于腹股沟管内,未发现附睾畸形,4例鞘状突未闭合。术后3个月复查B型超声,患侧睾丸体积为(0.57±0.23)ml,较术前明显增大(P<0.05),健侧睾丸体积为(0.66±0.23)ml,与术前差异无统计学意义(P>0.05)。结论近端型尿道下裂以及回缩性睾丸的患儿发生获得性隐睾的风险显著增加,应密切随访睾丸位置至青春期以后。获得性隐睾可能发生睾丸体积减小,并且与先天性隐睾有相似的组织病理学改变,影响生育功能,常规睾丸下降固定术效果明确,诊断后应及时采取手术治疗。Objective To explore the clinical characteristics of acquired undescended testis in children and to summarize the experiences of diagnosis and treatment.Methods From May 2020 to July 2021,retrospective review was performed for 8 operated children of acquired unilateral undescended testis.The diagnostic age was(6.9±2.3)years.The relevant clinical data were analyzed,including age,complications and previous testicular examinations.Anatomical characteristics of affected testis were observed during operation.The three-dimensional(3D)diameters of testicle were measured by ultrasound before and after operation and testicular volume and atrophy index calculated.Results All of them had concurrent severe hypospadias during postoperative follow-ups.The clinical types were perineal(n=2)and penoscrotal(n=6).One child was diagnosed as 46,XX reversal syndrome.Testis was normal(n=6)and retractile(n=2).Two cases of contralateral testicle underwent orchiopexy for congenital undescended testis.Preoperative testicular volume was(0.38±0.19)ml at affected side and(0.65±0.29)ml at healthy side.Testicular volume of affected side declined as compared with healthy side(P<0.05).Testicular atrophy index was(41.4±16.6)%.Orchiopexy was performed after a definite diagnosis.The testes at affected side were located in inguinal canal.No epididymal deformity was detected intraoperatively and 4 cases had open processus vaginalis.At 3 months postoperatively,testicular volume of affected side was(0.57±0.23)ml and it was significantly greater than that pre-operation(P<0.05).Testicular volume of healthy side was(0.66±0.23)ml and there was no significant difference with that at pre-operation(P>0.05).Conclusions Children with severe hypospadias and retractile testis are at a particularly elevated risk for acquired undescended testis.And testicular location should be closely followed until adolescence.Acquired undescended testis may decrease in volume and share similar histopathological features with congenital cryptorchidism.Reproductive function m

关 键 词：隐睾 儿童 睾丸固定术 

分 类 号：R726.9[医药卫生—儿科]