高位隐睾治疗新进展

小儿隐睾是泌尿外科常见的一种先天畸形，异位的睾丸可位于肾脏下极至腹股沟管下端之间的任何部位，但绝大多数位于腹股沟管内。通常我们把睾丸位于腹股沟管内环以上的隐睾症称为高位隐睾。高位隐睾约占先天性隐睾的15％，由于其复杂的解剖学因素，临床上处理起来比较棘手。近年来，随着泌尿外科相关技术的发展，这一状况正逐渐得到改善。现将目前临床上对高位隐睾的治疗进展综述如下。     

未触及睾丸隐睾症的诊治进展

隐睾症是男性最常见的性发育障碍疾病,可见于3.5%的新生儿。尽管约一半的新生儿隐睾可自发下降,但是部分男性睾丸在儿童后期还会不断上升,维持隐睾状态。隐睾患者中有15%～20%的未降睾丸不能触及,称之为未触及睾丸或不可触及睾丸(NPT)的隐睾症。NPT中60%为无活力睾丸(NVT),包括睾丸残迹、睾丸结节、睾丸缺如和阴囊内萎缩睾丸等,剩下的40%为形态大致正常的腹腔内睾丸(IAT)和腹腔外睾丸(EAT)。目前临床上对NPT隐睾的处理仍存在较大争议。本文将从病因、术前检查评估、手术方式选择、新兴技术和临床尚存争议等方面对NPT隐睾作一综述。     

隐睾症的HCG治疗

隐睾症的ＨＣＧ治疗隐睾症是常见的睾丸先天性异常。在新生男婴中约有３％的足月男婴和３０％的早产男婴发生隐睾，其中大多数人可以在出生后数年自行下降至阴囊内，少数患者可延迟到青春期性激素增加时才下降。成年人隐睾发生率约０．３～０．７％。由于隐睾有影响生育和...     

二点固定法治疗小儿隐睾症

隐睾症为常见的先天性睾丸位置异常性疾病.临床发现隐睾病人的阴囊常伴有发育不良,睾丸固定后偶有回缩现象.从1990年3月起,我们对196例小儿隐睾症病人在Surraco法的基础上,再将精索固定在同侧耻骨结节表面筋膜上,术后效果满意,报告如下.     

高频彩超诊断隐睾症的价值

目的:探讨高频彩超诊断隐睾症的临床价值.方法:总结35例经彩起诊断隐睾症的声象图和多普勒血流特点并与手术后病理结果进行分析.结果:彩超诊断35例隐睾症的病例中,经手术病理证实的声像图呈低回声33例,稍强回声2例,其中隐睾位于腹股沟管21例,腹膜后4例,阴囊上端5例,盆腔3例.结论高频彩超用于隐睾的探测有一定的价值,是隐睾术前定位及良性、恶性鉴别首选的影像学检查方法.     

隐睾患儿血清FSH、LH、T水平及其临床意义

目的研究隐睾患儿血中促卵泡激素(FSH)、促黄体激素(LID和睾酮(T)激素水平变化,探讨其临床意义及在隐睾症发病中的作用。方法应用化学发光免疫技术检测42例隐睾症和23例斜疝(对照组)患儿血清FSH、LH、T水平。结果单侧隐睾症组和斜疝组之间血清FSH、LH和T水平无显著性差异(P＞0．05)；(2)双侧隐睾组血清FSH水平高于斜疝组,差别有统计学意义(P＜0．05)；单侧隐睾症组血清FSH高于斜疝组,低于双侧隐睾症组,差别无统计学意义(P＞0．05)。结论(1)血清中性激素LH和T水平的变化在隐睾发生中并不起主要作用；(2)血清FSH水平的升高可能反映睾丸功能损害严重程度。     

隐睾症诊断与处理的安全共识

正隐睾症(cryptorchidism)是最常见的先天性男性泌尿系统畸形之一,指睾丸未在正常的阴囊位置中。在足月男性新生儿中发病率为1%～4%,在早产男婴中发病率为1%～45%,大多数隐睾为单侧,双侧的概率约为15%~([1-3])。隐睾症也称为睾丸未降(undescended testis),临床诊断中最重要的鉴别点在于是可触及的隐睾(palpable cryptorchid testes)还是不可触及的隐睾(nonpalpable testes)~([4])。需要特别指     

隐睾症发病的内分泌分子病因学研究进展

隐睾症系指在胎儿期睾丸未能按照正常发育过程从腰部腹膜后下降,导致一侧或双侧睾丸未能正常下降至同侧阴囊内,又称睾丸下降不全,是小儿最常见的男性生殖系统先天性疾病之一。隐睾症在足月新生儿中的发病率约为2%~4%~([1]),是男性不育和睾丸肿瘤的重要危险因素。睾丸通常从怀孕的第28周开始下降,一般大多数隐睾在出生时或者婴儿早期被发现。临床上隐睾表型各异:腹腔型、腹股沟管型、阴囊高位隐睾、异位隐睾等。性腺在分化之前位于肾周,被背侧和腹侧     

隐睾及少精子症家系1例报告

隐睾症是一种常见病,多发病,但隐睾家系临床较少见,2002年9月我院发现1例,报告如下.     

表皮生长因子与隐睾症关系的临床研究

本文通过临床观察隐睾症儿童术前、术后血清中表皮生长因子（ＥＧＦ）,睾酮（Ｔ）,５α－ＤＨＴ）的浓度变化和隐睾症的关系,以探讨ＣＧＦ在隐睾发病中的作用和二者之间的关系。采用谢射免疫法（ＲＩＡ）对４０例隐睾儿童术前,术后外周期脉血清ＥＧＦ、Ｔ、５α－ＤＨＴ进行了测定,并与２４例正常儿童进行了比较,隐睾症儿童术前组血清ＥＧＦ、Ｔ、５α－ＤＨＴ值明显低于正常儿童,而术后组血清ＥＧＦ、Ｔ、５α－ＤＨＴ明显上     

Analysis of anomalies of the epididymis and processus vaginalis in human fetuses and in patients with cryptorchidism treated and untreated with human chorionic gonadotrophin

OBJECTIVE: To analyse the incidence of epididymal anomalies and the structure of the processus vaginalis (PV) in patients with cryptorchidism treated or not with human chorionic gonadotrophin (hCG), and to compare these findings with human fetuses with testes in the scrotum. PATIENTS, MATERIALS AND METHODS: We assessed 24 fetuses with a gestational age of 23-35 weeks, and 114 cryptorchid patients (mean age 10.3 years). The patients were divided into two groups of those who used hCG (55, 65 testes) and those who did not (59, 75 testes). The sample was divided into six groups of possible anatomical relationships between the testis and the epididymis, according to a previous classification. Two situations were considered to analyse the PV: (a) total obliteration between the internal inguinal ring and the upper pole of the testis; and (b) total patency. RESULTS: Epididymal anomalies were found in 35% of patients with cryptorchidism and in only 4% of normal fetuses. Of the 47 cases of epididymal anomalies in patients with cryptorchidism 23 (49%) were treated with hCG and 24 (51%) were not. The PV was patent in 58% of patients with cryptorchidism and in only 5% of fetuses. Considering the three groups, the epididymal anomalies were more frequent when the PV was patent. CONCLUSIONS: Patency of the PV and the incidence of epididymal anomalies were more frequent in patients with cryptorchidism. The existence of epididymal anomalies did not influence testicular migration in patients treated with hCG.     

Treatment of renal angiomyolipoma: pooled analysis of individual patient data

Epididymal anomalies and patent processus vaginalis are frequently found in boys with cryptorchidism or hydrocele. We conducted this study to evaluate the association between epididymal anomalies and testicular location or patent processus vaginalis in boys with undescended testis or hydrocele. Children undergoing surgery with undescended testis (group A, 136 boys and 162 testes) or communicating hydrocele (group B, 93 boys and 96 testes) were included. Testicular locations and epididymal anomalies were investigated prospectively. An anomalous epididymis was defined as anomalies of epididymal fusion that consisted of loss of continuity between the testis, the epididymis, and the long looping epididymis. The epididymis was considered normal when a normal, firm attachment between the testis, the caput, and the cauda epididymis was present. The mean ages of groups A and B were 24.6 ± 19.7 (range, 8–52 months) and 31.4 ± 20.6 months (range, 10–59 months). The incidence of epididymal anomalies was significantly higher in group A than that in group B (65.4 % vs. 13.5 %, P < 0.001). The incidence of epididymal anomalies in boys with undescended testis was significantly different according to testis location. Epididymal anomalies were observed in 100 %, 91.4 %, and 39.3 % of cases when the testis was located in the abdomen, inguinal canal, and distal to the external inguinal ring, respectively (P < 0.001). We conclude that epididymal anomalies were more frequent in boys with undescended testis than in boys with hydrocele, and that these anomalies were more frequent when undescended testis was at a higher level. These results suggest that testicular location is associated with epididymal anomalies rather than patent processus vaginalis.     

超声及腹腔镜探查诊断小儿未触及睾丸

目的探讨超声及腹腔镜探查诊断小儿未触及睾丸的价值。方法对35例未触及睾丸患儿行常规超声检查,对超声于腹腔外未探及患侧睾丸者行腹腔镜探查术。分析检查结果,比较睾丸缺如、睾丸残余与单侧隐睾患儿健侧睾丸体积差异。结果 35例未触及睾丸患儿中,超声探及14例(17个)隐睾(13个腹内型和4个腹外型)、3例腹外型睾丸缺如、2例腹外型睾丸残余及2例异位睾丸,总检出率为60.00%(21/35)。对25例患儿行腹腔镜探查,发现17例(19个)腹内型隐睾、6例睾丸缺如(5例腹内型和1例腹外型)、2例腹内型睾丸残余,腹腔镜探查对腹内型未触及睾丸检出率为100%(24/24)。睾丸缺如、睾丸残余患儿健侧睾丸体积大于单侧隐睾患儿健侧睾丸体积(P均0.05)。结论联合应用超声和腹腔镜对诊断小儿未触及睾丸具有重要应用价值。     

Studies on the scrotal testis in unilateral experimental cryptorchidism in rat and guinea pig

The effects of experimental unilateral cryptorchidism on the scrotal testis regarding weight, morphology and secretion of tubular fluid and the sertoli-cell specific androgen binding protein (ABP) were studied. In the intact guinea pig testis and epididymis an androgen binding component similar to rat ABP was found. In juvenile and adult rats cryptorchid for 17 and 21 days, respectively, and in guinea pigs cryptorchid for 11 weeks, the scrotal testis seemed unaffected regarding all parameters studied. With reference to previous findings of lowered fertility in unilateral cryptorchidism in man the possible mechanisms by which unilateral cryptorchidism may influence the scrotal testis are discussed.     

同源盒基因-A10在人体睾丸组织的表达及其临床意义

目的比较同源盒基因-A10(HOXA10)在正常人和隐睾症患者睾丸组织的表达差异。方法收集正常人和隐睾症患者的睾丸组织,采用反转录-多聚酶链式反应(RT-PCR)和免疫组织化学的方法检测HOXA10的表达水平。结果HOXA10在正常人和隐睾症患者的睾丸组织均有表达,与正常组织比较,HOXA10在隐睾症患者睾丸组织的表达显著降低。结论HOXA10的表达减少与隐睾症的发生有密切关系。     

Experimental cryptorchidism in the adult mouse: I. Qualitative and quantitative light microscopic morphology

Morphologic changes in the testes of adult mice after experimentally induced cryptorchidism were studied by light microscopy and stereology. Increasing duration of cryptorchidism resulted in a gradual decrease in the volume of seminiferous tubules per testis, and this was associated with germ cell degeneration. The volumes of Sertoli cell lipid droplets increased, and dilations of the intercellular space between the Sertoli cell junctions was observed in the cryptorchid testis. The luminal volume of the seminiferous tubule was reduced by 50% after 28 days of cryptorchidism. However, the volumes of intertubular tissue and Leydig cells in control and cryptorchid testes were not significantly different. Leydig cell number per testis increased, and the average volume of a Leydig cell decreased gradually with the progression of the cryptorchid state. The volume of the connective tissue cells in the intertubular area increased, but no significant volume change was observed in the volume of intertubular macrophages. After 28 days, the cryptorchid testis contained a significantly increased volume of blood vessels and a reduced volume of lymphatic space per testis. These observations clearly demonstrate that, although the mouse is a species closely related to the rat, the morphologic changes that occur in the Leydig cell population after induction of experimental cryptorchidism in this species is different.     

腹腔镜一期Fowler-Stephens手术治疗高位隐睾

目的探讨腹腔镜一期Fowler-Stephens手术在高位隐睾中的疗效。方法7例(10侧睾丸)高位隐睾患儿,腹腔镜下确认睾丸情况后,高位离断精索血管,充分游离输精管,保留睾丸引带,将睾丸一期下降固定于阴囊皮下与肉膜囊间隙。结果10侧睾丸均一期下降固定,其中9侧行一期Fowler-Stephens手术,1例双侧隐睾患儿的左睾丸充分游离精索后行一期下降固定。7例术后随访6~24个月,平均14个月,下降的睾丸无回缩、无萎缩。结论腹腔镜一期Fowler-Stephens手术对高位隐睾能达到良好疗效,值得推广。     

Chromosomal anomalies in cryptorchidism and hypospadias.

We have studied peripheral blood samples for chromosomal anomalies in 110 consecutive patients who had cryptorchidism and/or hypospadias. Of the patients 7 (6.4%) were found to have chromosomal anomalies. The incidence of chromosomal anomalies in patients with cryptorchidism only was 4/83 (4.8%), in patients with hypospadias only the incidence was 1/18 (5.6%) and in concomitant cases the incidence was 2/9 (22.2%). Of 69 patients with cryptorchidism and/or hypospadias who did not have any other congenital abnormalities, 3 patients (4.3%) were found to have sex chromosomal anomalies. However, of 41 patients associated with generalized congenital abnormalities including mental and growth retardation, we found 4 patients (9.8%) with autosomal anomalies. We conclude that most children with multiple associated abnormalities other than cryptorchidism and/or hypospadias should have chromosome analysis. Moreover, attention should be paid to sex chromosomal anomalies, even when patients with cryptorchidism and/or hypospadias do not have any associated generalized physical abnormalities.     

Acquired cryptorchidism is frequent in infancy and childhood

Accurate prevalence data for acquired cryptorchidism are currently sparse and systematic prospective studies have not yet been reported. Our aim was to determine the prevalence of testicular ascent in childhood. In a prospective longitudinal population-based child cohort from Copenhagen, Denmark (1997–2007), testicular position was examined according to a standardised protocol in a total of 1072 boys, at birth ( n  = 1051), at 3 months ( n  = 983), 18 months ( n  = 888), 36 months ( n  = 790) and again once between 4½ and 10 years of age ( n  = 509). Ascensus testis was defined as ascent of the testis into a cryptorchid position after normal scrotal position at birth. A congenital cryptorchid testis with spontaneous postnatal descent followed by recurrence of cryptorchidism was named recurrent cryptorchidism. Ascensus testis occurred in 0.2%, 0.6% and 0.6% of boys at 3, 18 and 36 months of age respectively. When including recurrent cryptorchidism the prevalence was 0.2%, 1.2% and 0.8% respectively. Ascensus testis accounts for 58% of all cases of cryptorchidism (congenital and acquired) at 18 months, 71% at 36 months and thereafter 69%. Ascensus testis accounts for more than half of cryptorchid testes seen in childhood and occurs in both previously scrotal and cryptorchid testes. We therefore recommend that all boys should have testis position checked regularly during childhood, at least up to 3 years of age.     

Chromosomal anomalies in cryptorchidism and hypospadias

PURPOSE: We studied the incidence of chromosomal anomalies in patients with cryptorchidism and hypospadias to determine the value of routine karyotyping in this population. MATERIALS AND METHODS: Blood samples from 984 patients with cryptorchidism and/or hypospadias were studied for chromosome analysis. RESULTS: Chromosomal anomalies were detected in 27 of the 916 patients (2.94%) with cryptorchidism and in 7 of the 100 (7%) with hypospadias. There were chromosomal aberrations in 13 of the 706 patients (1.84%) with isolated cryptorchidism (no additional congenital abnormalities) and in 14 of the 210 (6.67%) with cryptorchidism with associated anomalies. We identified normal karyotypes in 26 patients with isolated hypospadias, although 7 of the 74 (9.46%) with hypospadias and additional abnormalities had chromosomal aberrations. CONCLUSIONS: It is important to perform karyotyping in these patients, mainly when they show associated abnormalities other than cryptorchidism or hypospadias. However, cost-benefit analysis must be done in each case.