Zhang Huangchenghao,Yan Bing,Tang Haoyu,et al.Clinical diagnosis and treatment of 13 children with ectopic testis[J].Journal of Clinical Pediatric Surgery,2022,21(11):1090-1094.[doi:10.3760/cma.j.cn101785-202009028-017]
儿童异位睾丸13例诊疗体会
- Title:
- Clinical diagnosis and treatment of 13 children with ectopic testis
- Keywords:
- Testicular Diseases; Perineum; Penis; Anti-Mullerian Hormone; Surgical Procedures; Operative
- 摘要:
- 目的 探讨异位睾丸患儿的诊断和治疗，提高临床医生对该疾病的认识。方法 回顾性分析2014年9月至2019年7月昆明市儿童医院泌尿外科收治的13例异位睾丸患儿临床资料，从病变类型、病因、临床诊断与治疗方法及预后等方面总结诊治经验。结果 13例异位睾丸患儿年龄6~84个月，中位年龄19个月；染色体检查结果均为男性。睾丸横过异位4例，其中2例为腹膜后横过异位，1例为经腹腔对侧腹股沟横过异位，1例为经对侧腹股沟下降至对侧阴囊。睾丸同侧异位9例，左侧5例，右侧4例，异位于腹股沟皮下浅筋膜囊内5例、会阴部皮下组织2例、大腿内侧根部2例。对同侧非横过异位睾丸行开放性异位睾丸探查术；对横过异位睾丸行腹腔镜探查术，术中证实苗勒氏管残留1例。13例患儿术中均探及异位睾丸，并无张力固定于阴囊内。术后随访6个月至2年，术后6个月、12个月患侧睾丸体积分别为（239.5±73.2） mm3、（239.0±79.5） mm3，均较术前的（145.8±51.7） mm3明显增大（P<0.05）；而术后6个月与术后12个月相比，B超显示患侧睾丸体积无明显变化（t=0.331，P=0.749）。13例中除1例因外伤后致睾丸萎缩外，其余无一例出现睾丸萎缩。结论 异位睾丸的诊治个体差异大，手术是异位睾丸的标准治疗方法。横过异位睾丸可在腹腔镜下明确诊断，需根据具体情况选择合适的手术方式。术后6个月是评估异位睾丸手术治疗效果的重要时间点。
- Abstract:
- Objective To summarize the clinical experiences of diagnosing and treating ectopic testis (ET) and enhance its clinician awareness.Methods From September 2014 to July 2019, clinical data were retrospectively reviewed for 13 ET children.Management experiences were summarized from the aspects of type, etiology, clinical diagnosis, treatment and prognosis.Results The median age was 19(6-84) months.Transverse ET was located in perineal area (n=2), scrotal septum (n=1) and subcutaneous inguinal canal (n=1).The involved side was left (n=5) and right (n=4).The lesion was located in subcutaneous superficial fascia capsule (n=5), perineum subcutaneous tissue (n=2) and thigh root (n=2).Open testicular exploration was performed for non-transverse ET and laparoscopic exploration for transverse ET.During a postoperative follow-up period of 6 months to 2 years.Testicular volume of affected side at 6 months post-operation was (239.5±73.2) mm3.The postoperative testicular volume at affected side at month 12 was significantly larger than that pre-operation[(239.0±79.5) vs. (145.8±51.7) mm3, P<0.05].However, ultrasonic results at Month 6/12 post-operation showed no significant change in testicular volume at affected side (t=0.331, P=0.749).Except for 1 case of testicular atrophy after trauma, none had testicular atrophy.Conclusion The specific management protocols of ET vary greatly among individuals and surgery remains a standard treatment.Transectopic testis may be definitively diagnosed laparoscopically and appropriate surgical approach is based upon specific situations.Month 6 post-operation is an important timepoint for evaluating surgical efficacy of ET.
参考文献/References:
[1] 赵善超, 郑少斌, 谭万龙, 等.睾丸横过异位的诊断和治疗(附一例报告并文献复习)[J].南方医科大学学报, 2009, 29(7):1489-1490.DOI:10.3321/j.issn:1673-4254.2009.07.070. Zhao SC, Zheng SB, Tan WL, et al.Diagnosis and treatment of transverse testicular ectopia:a case report and literature review[J].J South Med Univ, 2009, 29(7):1489-1490.DOI:10.3321/j.issn:1673-4254.2009.07.070.
[2] 张黄成昊, 严兵, 张昆, 等.睾丸横过异位1例[J].临床泌尿外科杂志, 2019, 34(6):497, 500.DOI:10.13201/j.issn.1001-1420.2019.06.021. Zhang HCH, Yan B, Zhang K, et al.One case of testicular heterotopia[J].J Clin Urol, 2019, 34(6):497, 500.DOI:10.13201/j.issn.1001-1420.2019.06.021.
[3] 胡强, 徐汇义, 仇学文, 等.异位睾丸七例报告[J].中华泌尿外科杂志, 2002, 23(2):106-107.DOI:10.3760/j:issn:1000-6702.2002.02.013. Hu Q, Xu HY, Qiu XW, et al.Ectopic testes:a report of 7 cases[J].Chin J Urol, 2002, 23(2):106-107.DOI:10.3760/j:issn:1000-6702.2002.02.013.
[4] Robinson HB.A clinical lecture on misplaced testes and their surgical treatment[J].Br Med J, 1899, 1(2006):1385-1386.DOI:10.1136/bmj.1.2006.1385.
[5] 中华医学会小儿外科学分会泌尿学组.青少年精索静脉曲张诊治中国小儿泌尿外科专家共识[J].中华小儿外科杂志, 2020, 41(9):777-783.DOI:10.3760/cma.j.cn421158-20191017-00598. Group of Urological Surgery, Branch of Pediatric Surgery, Chinese Medical Association.Chinese Pediatric Urological Surgical Expert Consensus on Managing Adolescent Varicocele[J].Chin J Pediatr Surg, 2020, 41(9):777-783.DOI:10.3760/cma.j.cn421158-20191017-00598.
[6] Christman MS, Zderic SA, Kolon TF.Comparison of testicular volume differential calculations in adolescents with varicoceles[J].J Pediatr Urol, 2014, 10(2):396-398.DOI:10.1016/j.jpurol.2013.12.007.
[7] Barthold JS.Abnormalities of the testis and scrotum and their surgical management[M]//Wein AJ, Kavoussi LR, Novick AC, et al.Campbell-Walsh Urology.Philadelphia:Saunders, 2012:3557-3596.e13.
[8] 王宁, 萨音白刚, 刘宏, 等.异位睾丸19例诊治分析[J].临床小儿外科杂志, 2017, 16(2):178-181.DOI:10.3969/j.issn.1671-6353.2017.02.017. Wang N, Sayin BG, Liu H, et al.Clinical diagnosis and treatment of ectopic testicle[J].J Clin Ped Sur, 2017, 16(2):178-181.DOI:10.3969/j.issn.1671-6353.2017.02.017.
[9] Hutcheson JC, Snyder HM 3rd, Zu?iga ZV, et al.Ectopic and undescended testes:2 variants of a single congenital anomaly?[J].J Urol, 2000, 163(3):961-963.DOI:10.1016/S0022-5347(05)67864-0.
[10] 曾洪飚, 王祖耀.睾丸横过异位1例[J].临床小儿外科杂志, 2004, 3(3):171.DOI:10.3969/j.issn.1671-6353.2004.03.030. Zeng HB, Wang ZY.One case of ectopic across testis[J].J Clinl Ped Sur, 2004, 3(3):171.DOI:10.3969/j.issn.1671-6353.2004.03.030.
[11] 罗建斌, 王德娟, 方友强, 等.睾丸横过异位的诊断和治疗:附1例报告并文献复习[J].中华腔镜泌尿外科杂志(电子版), 2011, 5(3):231-235.DOI:10.3877/cma.j.issn.1674-3253.2011.03.016. Luo JB, Wang DJ, Fang YQ, et al.Transverse testicular ectopia:one case report with a literature review[J].Chin J Endourol (Electronic Ed), 2011, 5(3):231-235.DOI:10.3877/cma.j.issn.1674-3253.2011.03.016.
[12] Loeff DS, Rosenthal IM, Weigensberg MJ, et al.Current surgical approach to patients with persistent mullerian duct structures[J].J Pediatr Surg, 1991, 26(4):504.DOI:10.1016/0022-3468(91)91018-T.
[13] Gauderer MWL, Grisoni ER, Stellato TA, et al.Transverse testicular ectopia[J].J Pediatr Surg, 1982, 17(1):43-47.DOI:10.1016/S0022-3468(82)80323-0.
[14] 王冰洁, 周君梅, 李玲玲, 等.人类高低位隐睾睾丸引带内肌肉组分的探究[J].临床小儿外科杂志, 2019, 18(6):523-526, 528.DOI:10.3969/j.issn.1671-6353.2019.06.017. Wang BJ, Zhou JM, Li LL, et al.Muscle components of gubernaculum testis from high/low cryptorchidic children[J].J Clin Ped Sur, 2019, 18(6):523-526, 528.DOI:10.3969/j.issn.1671-6353.2019.06.017.
[15] Malik MA, Iqbal Z, Chaudri KM, et al.Crossed testicular ectopia[J].Urology, 2018, 71(5):984.E5-E6.DOI:10.1016/j.urology.2007.11.088.
[16] 杨庆堂, 姚干, 梁健升, 等.两种手术方式治疗儿童隐睾的比较研究[J].临床小儿外科杂志, 2018, 17(11):862-865.DOI:10.3969/j.issn.1671-6353.2018.11.014. Yang QT, Yao G, Liang JS, et al.Clinical efficacies of different surgical approaches for cryptorchidism in children[J].J Clin Ped Sur, 2018, 17(11):862-865.DOI:10.3969/j.issn.1671-6353.2018.11.014.
[17] 李索林, 张潍平, 李龙, 等.隐睾症腹腔镜手术操作指南(2017版)[J].临床小儿外科杂志, 2017, 16(6):523-532.DOI:10.3969/j.issn.1671-6353.2017.06.002. Li SL, Zhang WP, Li L, et al.Guideline for laparoscopy for cryptorchidism (2017 Edition)[J].J Clin Ped Sur, 2017, 16(6):523-532.DOI:10.3969/j.issn.1671-6353.2017.06.002.
[18] Alamsahebpour A, Blachman-Braun R, Gupta A, et al.Laparoscopy and transseptal orchiopexy in the management of transverse testicular ectopia[J].Curr Urol Rep, 2015, 16(7):48.DOI:10.1007/s11934-015-0515-9.
[19] Kamble RS, Gupta RK, Gupta AR, et al.Laparoscopic management of transverse testicular ectopia with persistent Mullerian duct syndrome[J].J Minim Access Surg, 2015, 11(3):213-215.DOI:10.4103/0972-9941.152093.
[20] Bowen DK, Matulewicz RS, Gong EM.Preservation of Müllerian structures with laparoscopic management of intra-abdominal testes in persistent Müllerian duct syndrome[J].J Pediatr Urol, 2016, 12(1):65-66.DOI:10.1016/j.jpurol.2015.08.024.
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备注/Memo
收稿日期:2020-09-15。
基金项目:云南省教育厅科学研究基金（2020J0228）；云南省科技厅昆医联合专项-面上项目（202001AY070001—271）；昆明市卫生科技人才"十百千"培养项目（2020—SW（后备）—112）；昆明市西山区科技计划项目（2020—西科字23号）；云南省儿童健康与疾病临床医学研究中心开放研究基金（2022—ETYY—YJ—03）
通讯作者:严兵,Email:yanbing@etyy.cn