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,2023,22(11):1072-1076.[doi:10.3760/cma.j.cn101785-202304058-013]
腹腔镜辅助下体外性腺活检术在腹腔型性腺性发育异常中的应用研究
- Title:
- Application of laparoscope-assisted in vitro gonadal biopsy for celiac type gonad disorders of sex development
- 摘要:
- 目的 探讨腹腔镜辅助下体外性腺活检术在腹腔型性腺性发育异常中的临床应用,并进行技术评价。方法 回顾性分析湖南省儿童医院泌尿外科2020年1月至2023年3月采用腹腔镜辅助下体外性腺活检的腹腔型性腺性发育异常(disorders of sex development,DSD)患儿,收集患儿社会性别、性腺位置、年龄、身高、染色体核型、性腺病检结果、出血量、性别决定及治疗方案等资料并分析。结果 本研究共纳入17例腹腔型性腺DSD(共34侧),年龄25(13.5,106)个月;社会性别男性10例,社会性别女性7例;染色体46,XY 6例,46,XX 1例,45,X/46,XY 9例,45,X/47,XYY 1例。性腺双侧位于腹腔内7例,右侧位于腹腔内、左侧位于阴囊4例,右侧位于腹腔内、左侧位于腹股沟3例,左侧位于腹腔内、右侧位于阴囊2例,左侧位于腹腔内、右侧位于腹股沟1例。性腺位于腹腔24侧,左侧阴囊4侧,左侧腹股沟3侧,右侧阴囊2侧,右侧腹股沟1侧。24侧腹腔型性腺采用腹腔镜辅助下体外性腺活检,10侧腹腔外性腺采取腹股沟/阴囊切口性腺活检,成功获得性腺组织完成病理检查,术中出血量2(1,2.5)mL,术后无一例出血、切口感染、切口疝、腹胀等并发症。病理结果提示:双侧条纹性腺4例,双侧睾丸2例,左侧睾丸、右侧条纹性腺7例,左侧条纹性腺、右侧睾丸3例,左侧睾丸、右侧卵巢1例。行性别决定12例(包括阴蒂整形4例、单纯双侧性腺切除2例、尿道成形6例),未行性别决定5例。结论 腹腔镜辅助下体外性腺活检术应用于腹腔型性腺DSD方便、安全、有效且准确,为腹腔型性腺DSD患儿性别决定方案的选择提供了重要的临床参考依据。
- 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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备注/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