隐睾患儿手术治疗后青春期性发育的临床和内分泌观察

目的 :观察隐睾患儿术后青春期性发育的状况。　方法 :随访调查 184例隐睾患儿术后青春期阴毛发育程度、阴茎长度和周径、睾丸体积和血清黄体生成素 (LH)、卵泡刺激素 (FSH)、睾酮 (T)水平。比较不同手术年龄、隐睾位置和手术方式对疗效的影响。　结果 :①双侧隐睾固定术组的阴毛发育程度、阴茎长度和周径、睾丸体积和T明显降低 ;FSH和LH明显升高。②单侧隐睾固定术组的术侧睾丸体积明显小于下降侧、但明显大于未治疗组的隐睾侧 ;单侧隐睾固定术及切除术组的FSH明显高于正常组、但切除术组的FSH又明显高于固定术组。③手术年龄<5岁组的阴毛发育程度、阴茎长度和周径、术侧睾丸体积和T均明显大于≥ 5岁组 ;后者的FSH明显高于前者。④高位型的术侧睾丸体积明显降低 ,FSH明显升高。睾丸体积与FSH呈负相关关系。　结论 :隐睾间质细胞功能损伤程度较轻 ,单侧隐睾术后青春期性征发育可表现为正常 ,早期手术可防止隐睾和对侧正常下降睾丸生精功能的损害。

Sexual Development in Adolescents after Surgical Treatment for Cryptorchidism

Objective: To investigate the sexual development in adolescents after surgical treatment for undescended testes. Methods: One hundred and eighty-four adolescents undergoing surgery for cryptorchidism before the age of 10 years,22 cases received no surgical management for unilateral undescended testes,and 25 normal controls were studied. The pubic stage,the natural length and girth of the penis,the volume of the testis,serum luteinizing hormone (LH),follicle-stimulating hormone (FSH) and testosterone (T) were examined to find out the effect of age,the location of the testis and operative procedures on prognosis. Results: The pubic stage,the length and girth of the penis,the volume of the testis and T decreased,but FSH and LH increased significantly in 18 adolescents who had undergone bilateral orchiopexy. The volume of the unilaterally undescended testis was significantly smaller than that of the normally descended contralateral gonad in 152 adolescents who had undergone unilateral orchiopexy. FSH was significantly higher in the adolescents surgically treated for unilateral cryptorchidism. Those treated by unilateral orchiectomy presented significantly higher levels of FSH than those by unilateral orchiopexy. The pubic stage,the length and girth of the penis,the volume of the testis and T were significantly higher,but FSH lower in the adolescents treated before the age of 5 years than at the age of 5 or older. The decrease in testicular volume was significantly greater in adolescents with intra-abdominal testes. Significant negative correlation was found between FSH and testicular volume. Conclusion: Leydig cell function seems relatively resistant to the hostile environment of the cryptorchidism. Early diagnosis and management of the undescended testis are needed to preserve fertility.