Hu Jianjun,Zhao Yaowang,Chen Yifu,et al.Application of laparoscope-assisted in vitro gonadal biopsy for celiac type gonad disorders of sex development[J].Journal of Clinical Pediatric Surgery,,22():1072-1076.[doi:10.3760/cma.j.cn101785-202304058-013]
Application of laparoscope-assisted in vitro gonadal biopsy for celiac type gonad disorders of sex development
- Abstract:
- Objective To evaluate the clinical applications and techniques of laparoscopically assisted in vitro gonadal biopsy for celiac type gonadal disorders of sex development (DSD).Methods From January 2020 to March 2023,17 cases of celiac gonadal DSD were retrospectively reviewed.Laparoscopically assisted gonadal biopsy was utilized for harvesting gonadal tissue in vitro.Surgical procedures were designed.Social gender,gonadal location,age,height,chromosomal karyotype,gonadal pathology examination,hemorrhagic volume,sex-determined age and therapeutic regimen were recorded.Results There were 10 males and 7 females with a median monthly age of 25(13.5,106).Chromosomal karyotypes were 46,XY (n=6),46,XX (n=1),45,X/46,XY (n=9) and 45,X/47,XYY (n=1).Gonads were bilaterally located in abdominal cavity (n=7),right abdominal cavity & left scrotum (n=4),right abdominal cavity & left groin (n=3),left abdominal cavity & right scrotum (n=2) and left abdominal cavity & right groin (n=1).The gonads were located in the abdominal cavity in 24 cases,in the left scrotum in 4 cases,in the left groin in 3 cases,in the right scrotum in 2 cases and in the right groin in 1 cases.Laparoscopically assisted in vitro gonad biopsy was performed on 24 sides of celiac type gonad and 10 sides of groin/scrotal incision gonad biopsy on extraperitoneal gonad.Gonadal tissue was successfully harvested for pathological examination.Volume of intraoperative hemorrhage was 2(1,2.5) mL.There were no such postoperative complications as hemorrhage,incision infection,incisional hernia or abdominal distension.Pathological results indicated bilateral striated gonads (n=4),bilateral testis (n=2),left testis & right striated gonads (n=7),left striated gonads & right testis (n=3) and left testis & right ovary (n=1).Sex determination was performed in 12 cases,including clitoroplasty (n=4),simple bilateral gonadectomy (n=2) and urethroplasty (n=6).Conclusions Laparoscope-assisted ex vivo gonadal biopsy is convenient,safe,effective and accurate for celiac gonadal DSD.It provides an important clinical tool for selecting sex-determining treatments for children of celiac gonadal DSD.
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Memo
收稿日期:2023-4-22。
基金项目:湖南创新型省份建设专项临床医疗技术创新引导项目(2021SK50525);湖南省儿童泌尿生殖疾病临床医学研究中心(2021SK4017);湖南省卫生健康委课题(202204052510)
通讯作者:赵夭望,Email:yw508@sina.com