睾丸横过异位8例临床分析

目的探讨睾丸横过异位(TTE)的临床特点、诊断方法和治疗效果。方法回顾性分析2004年5月至2018年11月新乡市中心医院泌尿外一科、郑州大学第一附属医院小儿外科收治的8例TTE患儿的临床资料, 分析总结其临床特点、诊断方法、手术治疗效果及随访结果等。结果 8例TTE患儿, 年龄1岁5个月至5岁。左侧6例, 右侧2例。均因阴囊空虚就诊。合并苗勒管永存综合征(PMDS)3例, 合并尿道下裂1例。5例术前明确诊断, 其中超声诊断4例, 磁共振成像诊断1例。2例患儿行腹腔镜探查, 其中1例行腹腔镜下阴囊内固定术, 另1例因精索发育差而中转为开放手术(行跨阴囊纵隔睾丸固定术)。行开放手术探查的6例患儿中, 1例因精索黏连紧密行双睾丸同侧阴囊固定术, 另5例行跨阴囊纵隔睾丸固定术。3例PMDS患儿术中均切除苗勒管残留物。所有患儿术后未发生伤口感染和血肿, 1例行跨阴囊纵隔睾丸固定术患儿术后11个月发生睾丸附睾炎, 并波及对侧, 予抗炎治疗后好转。术后随访3个月至4年, 患儿超声检查均提示双侧睾丸大小及血供正常, 均未发生睾丸萎缩。结论对于单侧隐睾合并对侧腹股沟肿物患儿应考虑TTE的可能, 超声检...     

隐睾伴扭转的诊治体会

隐睾是小儿泌尿外科常见的先天性疾病,睾丸扭转是外科急症,隐睾可伴有睾丸扭转,但少见,如误诊、延误治疗,可导致睾丸缺血坏死。我院自1998年1月到2003年5月共收治6例隐睾伴扭转患儿,报道总结如下。1 临床资料1.1 一般情况 6例患儿平均年龄2.9岁(4月～8岁)。左侧3例,右侧3例,6例均无明显剧烈活动、外伤史。发病     

新生儿睾丸扭转临床回顾与分析

目的 探讨新生儿睾丸扭转的治疗措施选择.方法 回顾性分析11例新生儿睾丸扭转的诊治资料.分析评估内容包括临床表现、体格检查、辅助检查、治疗方法的选择以及术后随访情况等.结果 11例新生儿睾丸扭转,左侧6例,右侧5例;顺产8例,剖宫产3例;足月产10例,早产1例.产前睾丸扭转5例;产后睾丸扭转6例.产前睾丸扭转5例均行患侧睾丸切除,1例行对侧睾丸预防性固定术.所有产后睾丸扭转均行患侧睾丸切除+对侧睾丸预防性固定术.术后病理检查提示睾丸组织大部分出血伴坏死,其中5例产前睾丸扭转病例中4例病理检查提示睾丸组织有钙化灶.术后随访对侧睾丸未见明显异常.结论 对产前睾丸扭转,需切除患侧睾丸并同时行对侧睾丸固定.对双侧产前睾丸扭转,建议手术探查行睾丸扭转矫正术后保留睾丸.对产后睾丸扭转则需尽早安排手术探查并行预防性睾丸固定.     

小儿左侧腹腔内隐睾畸胎瘤1例并文献复习

目的:探讨小儿腹腔内隐睾合并睾丸肿瘤的诊治方法。方法:回顾性分析2018年10月福建医科大学附属泉州第一医院小儿外科收治的1例1岁5个月腹腔内隐睾畸胎瘤男性患儿的临床资料,患儿经腹腔镜探查发现左侧腹腔内隐睾畸胎瘤并左侧隐睾扭转、坏死,予以行左侧隐睾及肿瘤完整切除。同时检索万方数据库、中国知网、维普数据库、中国生物医学文...     

腹腔镜诊治不能触及睾丸的隐睾患儿127例

目的 总结和分析腹腔镜在诊治未触及睾丸的隐睾中的应用.方法 2000年1月-2006年12月应用腹腔镜对127例未触及睾丸的隐睾患儿进行诊治.手术时平均年龄55个月.全麻或加单次硬膜外麻醉下建立气腹,腹腔镜探察.术中发现腹腔内睾丸,行分期Fowler-Stephen手术或睾丸固定术;如精索在腹内为盲端或虽出内环但发育极差,诊断为睾丸缺如,无需进一步探查;如精索发育较好出内环,行腹股沟探查,发现睾丸存在则行睾丸固定术.对分期行Fowler-Stephen手术患儿术后随访睾丸大小和位置.结果 隐睾患儿127例中, 62例 (48.8%)直接诊断为睾丸缺如;24例 (18.9%) 经腹股沟探查后,11例睾丸缺如,13例直接行睾丸固定术;41例(32.3%)诊为腹腔内睾丸,26例行分期Fowler-Stephen手术,包括11例双侧,8例右侧,7例左侧,余15例患儿行睾丸固定术.127例中单侧病例104例(81.9%),其中左侧75例,右侧29例.左侧睾丸缺如57例,占左侧总例数的76%.右侧睾丸缺如12例,约占右侧的41%.双侧病例共23例(18.1%),左右均行分期Fowler-Stephen手术共11例,22只睾丸.双侧睾丸均缺如3例.127例患儿中9只睾丸发育极差,病理均未见曲细精管结构.行分期Fowler-Stephen手术患儿18例得到随访,睾丸大小较术前无缩小,1例术后睾丸上缩.结论 应用腹腔镜可准确诊断未触及睾丸的隐睾,对于腹内靠近内环口的睾丸可行腹腔镜或传统睾丸固定术,对于高位腹内睾丸可行分期Fowler-Stephen手术.     

双侧高位隐睾腹腔镜下一期下降固定22例

目的探讨双侧高位隐睾腹腔镜下一期睾丸下降固定术的临床疗效。方法回顾性分析22例双侧高位隐睾患儿的临床资料,平均年龄3．9（1．1～11．7）岁,均于腹腔镜下行一期睾丸下降同定术。结果22例中,除3侧睾丸缺如外,其余41侧均顺利完成一期睾丸下降同定,其中26侧行一期Fowler—Stephens手术。术后随访6～40个月,平均随访22个月,下降的睾丸无回缩、无萎缩。结论双侧高位隐睾行腹腔镜下一期睾丸下降固定术是可行的。     

隐睾患儿Hoxa10基因突变的检测及其临床意义

一般资料 :2 0 0 0年 11月至 2 0 0 1年 11月我科收治的隐睾患儿 2 0例为观察组 ,年龄 9个月至 12岁 ,隐睾 6例 ,单侧14例。 2 0例隐睾患儿未发现合并其他先天性畸形。 18例行睾丸松解固定术 ,2例行精索遗迹切除术。术中见睾丸位于外环口 11例 ,腹股沟管 5例 ,内环口 2例 ,另有 2例术中仅见精索遗迹。对照组 10例 ,系同期我科收治的骨折患儿 ,年龄 10个月至 12岁。方法 :(1)提取外周血白细胞DNA组 ,PCR扩增目的基因。Hoxa10基因第 1外显子上游引物为GTCTAGGTCC CGGGGCGCACGGCTA ,下游引物为AGGC TAGCGCGGGCGGGAGATCG…     

小儿睾丸扭转的诊治体会

目的 探讨小儿睾丸扭转的诊断和治疗。方法 回顾性分析获随访的8例小儿睾丸扭转病例。结果 发病24h内就诊并及时手术治疗者睾丸发育正常。超过24h后诊治者4例中有3例睾丸轻微萎缩。结论 小儿睾丸扭转须早诊断，及时治疗，才能提高睾丸的生存质量。     

儿童获得性隐睾8例临床分析

目的探讨儿童获得性隐睾的临床特点, 总结其诊断及治疗经验。方法回顾性分析杭州美中宜和妇儿医院2020年5月至2021年7月收治的获得性隐睾患儿8例, 年龄为(6.9±2.3)岁;均为单侧患病。收集患儿的一般临床资料, 包括年龄、合并症、既往睾丸检查等资料。本组病例诊断获得性隐睾后均采用手术治疗, 术中观察患侧睾丸的解剖学特点, 术前及术后利用超声测量睾丸的三维直径, 计算睾丸体积、睾丸萎缩指数, 采用t检验比较分析手术前后患侧与健侧睾丸的体积差异。结果本组患儿均合并重度尿道下裂, 在尿道下裂术后临床随诊中发现获得性隐睾, 其中2例为会阴型尿道下裂, 6例为阴茎阴囊型尿道下裂, 1例伴有46, XX性逆转综合征。本组患儿均有尿道下裂术后随访记录和儿童泌尿外科医师的睾丸体检记录, 其中6例曾为正常睾丸, 2例曾为回缩性睾丸。2例对侧睾丸曾因诊断先天性隐睾行睾丸下降固定术。本组患儿术前患侧睾丸体积(0.38±0.19)ml, 健侧睾丸体积(0.65±0.29)ml, 患侧睾丸体积较健侧均有不同程度减小(P<0.05), 睾丸萎缩指数为(41.4±16.6)%。8例患儿诊断后均行睾丸下降...     

单侧隐睾症患者睾丸大小及位置的术前超声评估

目的运用超声检查探讨单侧隐睾症患者年龄及睾丸所在部位与睾丸体积之间的关系。方法采用彩色多普勒超声检查双侧睾丸位置,测量睾丸各径线,计算睾丸体积。按年龄和睾丸所在位置分组。采用方差分析睾丸体积、年龄及睾丸所在位置的关系。结果608例年龄6个月至13岁经超声检查及手术证实的单侧隐睾患儿中,左侧306例,右侧302例。51例隐睾位于腹腔内,557例位于腹腔外。单侧隐睾患儿未下降睾丸位于腹腔内组与位于腹腔外组患侧睾丸体积比较无明显差异（P=0．658）;6个月至13岁各年龄组患儿患侧睾丸体积均明显较对侧睾丸体积小（P〈0．001）;单侧隐睾患儿双侧睾丸体积在1-11岁之间比较,差异无统计学意义（P〉0．05）。结论隐睾症对小于1岁的婴儿睾丸体积发育已造成影响,宜在1岁以前尽早手术。1-11岁双侧睾丸体积均未见明显变化,睾丸发育处于相对静止期。     

睾丸扭转的诊断及治疗

目的 提高睾丸扭转的诊治水平。方法 回顾性分析总结16例睾丸扭转的临床资料。结果 16例均经彩色多谱勒血流成像(Color Doppler ultrasonics flow image，CDFI)确诊为睾丸扭转，2例经手法复位，5例经手术复位固定，9例行睾丸切除加对侧睾丸固定。11例获0．5～4．5年随访，手法复位者1例再次发生扭转，经手术复位治愈。结论 CDFI是诊断急性睾丸扭转的可靠方法，早期诊断、及时手术探查是提高睾丸存活率的关键，术中应同时固定对侧睾丸。     

Outcomes of Second Look Exploration in Testicular Torsion of Children

Background:

Testicular torsion (TT), or twisting of the testicle resulting in a strangulation of the blood supply, occurs in men whose tissue surrounding the testicle is not well attached to the scrotum. It is important to emphasize that testicular torsion is a medical emergency.

Objectives:

The aim of this study is to evaluate the second look exploration and outcomes in TT.

Patients and Methods:

Seventy boys out of 124 patients underwent early exploration and 48 hours later second look exploration due to TT. All patients were checked with preoperative color-doppler ultrasonography (CDU) and intraoperative bleeding test. Data included age at admission, side of pathology, relation of TT with season of year, duration of preoperative history, degree of testicular torsion, CDU findings, and degree of bleeding; results of second look exploration, follow-up, and outcomes were analyzed.

Results:

Totally 70 patients were included in this study within five years, of which mean age was 28.6 ± 32.9 months (range 1 to 144), 48% of our patients had nausea and vomiting. Preoperative CDU showed absent/weak flow in 50 (71%) cases. Winter showed most frequently (44%) referred cases of testicular torsion. Orchidopexy was performed in 44 (63%) and orchidectomy in 26 (37%) cases after second look exploration. Mean follow-up duration was 3.1 ± 1.4 years. 4 (9%) cases in orchidopexy group developed testicular atrophy during follow-up, all four cases had a history of longer than 12 hours and grade II testicular bleeding test intra-operatively. Other orchidopexy patients salvaged. 26 patients, who were in grade III, underwent orchidectomy in second look exploration.

Conclusions:

TT requires emergency attention. The ischemia time of the testis is traditionally after 6 hours, and imaging or other diagnostic modality should not be a cause of delay. Early surgical exploration is modality of choice, and second look exploration after 48 hours can be more effective and salvageable in these patients.     

小儿睾丸附件扭转的彩色多普勒超声诊断意义

目的探讨彩色多普勒超声检查在诊断小儿睾丸附件扭转中的意义。方法回顾性分析我院1999年2月～2005年11月收治的小儿睾丸附件扭转病例的临床资料及超声检查结果。结果在所有病人中,发现蓝斑征9例(8.6%),痛性结节23例(21.9%),74例超声检查资料完整的病例中,超声检查在睾丸上极发现无血流回声结节67例,均经手术证实。结论彩色多普勒超声检查若发现睾丸上极附近无血流回声团,则提示睾丸附件扭转。超声检查在小儿睾丸附件扭转的诊断中具有重要的意义。     

西地那非对大鼠单侧睾丸扭转后对侧睾丸的影响及作用研究

目的 探讨大鼠单侧睾丸扭转后对侧睾丸的损伤以及西地那非（万艾可）的保护机理.方法 将72只健康雄性SD大鼠,随机分为假手术组、安慰剂组、西地那非组.3组分别在假手术/左侧睾丸扭转复位术后4 h、24 h、2周时,各组各处死8只大鼠.分别观察右侧睾丸组织病理学变化、测定右侧睾丸组织中MDA、NO/NOS含量.结果 术后4 h,各组间组织病理学变化、MDA、NOS含量无明显差异,睾丸组织未见损伤,但NO在两地那非组较假手术组、安慰剂组明显增加（P〈0.05）.术后24 h,假手术组右侧睾丸组织损伤最小,西地那非组较严重,安慰剂组最为严重;与假手术组比,其余两组MDA、NO/NOS含量明显升高（P〈0.05）;西地那非组NO/NOS含量与安慰剂组相比明显下降（P〈0.05）;术后2周时,睾丸组织损伤有不同程度恢复,但仍以安慰剂组最为严重;与假手术组比,其余两组MDA、NO/NOS含量仍然升高（P〈0.05）;西地那非组NO/NOS含量与安慰剂组相比明显下降（P〈0.05）.结论 大鼠单侧睾丸扭转复位后,对侧睾丸组织术后4 h时.睾丸组织未见损伤.12 h后睾丸组织明显损伤,并且持续至2周后.早期应用适量西地那非（万艾可）可促局部NO增加,扩血管作用加强,拮抗交感神经缩血管作用,进而保护对侧睾丸.     

Scrotal Exploration for Testicular Torsion and Testicular Appendage Torsion: Emergency and Reality

Background:

Scrotal exploration is considered the procedure of choice for acute scrotum.

Objectives:

We evaluated the importance of early diagnosis and testicular salvage on the therapeutic outcomes of patients with pediatric testicular torsion (TT) and testicular appendage torsion (TAT) in our geographic area.

Patients and Methods:

We performed a retrospective database analysis of patients who underwent emergency surgery for TT or TAT between January 1996 and June 2009. Patient history, physical examination findings, laboratory test results, color Doppler sonography (CDS) results, and surgical findings were reviewed.

Results:

A total of 65 cases were included in our analysis. Forty-two cases were followed up for at least 3 months. Testicular tenderness was identified as the major clinical manifestation of TT, while only a few patients with TAT presented with swelling. CDS was an important diagnostic modality. The orchiectomy rate was 71% in the TT group.

Conclusions:

Cases of acute scrotum require attention in our area. Early diagnosis and scrotal exploration could salvage the testis or preserve normal function without the need for surgery.     

微型腹腔镜下睾丸下降固定术40例

目的 探讨微型腹腔镜下睾丸下降固定术在儿童隐睾中的应用.方法 2010年6月至2011年6月,我们对40例隐睾患儿施行微型腹腔镜睾丸下降固定术.术中行单侧睾丸下降固定术33例,双侧5例,一期Fowler-Stephens手术4例.术中见睾丸萎缩2例,除2例睾丸萎缩病例外,其余病例均行患侧疝囊高位结扎术,对侧疝囊高位结扎术7例.结果 40例患儿均顺利完成手术,无中转开放手术.单侧手术时间30~45 min,平均38 min,双侧手术时间54~78 min,平均64 min.随访12～24个月,平均18个月,无睾丸回缩、睾丸萎缩、腹股沟疝等并发症.结论 微型腹腔镜下睾丸下降固定术治疗儿童隐睾创伤小,睾丸下降完全,安全有效,并发症少,可作临床推广应用.     

Oophoropexy in children with ovarian torsion.

AIM: Children who have suffered from ovarian torsion may be at increased risk for a repeat event, and after unilateral ovarian loss, the contralateral ovary is at risk for future torsion. Oophoropexy has not been emphasized enough in the literature. We present our experiences with oophoropexy in children. METHODS: The medical records of 10 patients with ovarian torsion, who underwent oophorectomy and contralateral oophoropexy between April 1992 and April 2003, were reviewed retrospectively. The ovary was connected to the peritoneum of the posterior abdominal wall avoiding a disturbance of the tubo-ovarian anatomic relationship. RESULTS: The ages of patients ranged from 5 days to 14 years, with a mean age of 7.7 years. The period from onset of symptoms to hospital admission was ranged from 2 hours to 11 months. Only 1 ovary was salvaged after detorsion and bilateral oophoropexy was performed. In the other patients, the torsion caused necrosis, and oophorectomy or salpingo-oophorectomy and contralateral oophoropexy were carried out. Ovarian torsion occurred in 4 previously normal ovaries, in 5 cystic ovaries, and in 1 ovary containing a mature cystic teratoma. Two out of 10 patients had thrombus formation within the vessels of the twisted ovaries. An embolic phenomenon did not develop in any of the cases. At follow-up, all pubertal girls had normal menstrual periods. CONCLUSIONS: Failure to protect ovaries from subsequent torsions can result in castration, and we performed oophoropexy in both retained detorsed and contralateral ovaries without any postoperative complication. We performed medial oophoropexy to avoid tubo-ovarian disturbance. Oophoropexy is an easy and reversible procedure, and should be done in all cases of ovarian torsion.     

保留睾丸的肿瘤剜除术治疗儿童良性睾丸肿瘤

目的评价保留睾丸的肿瘤剜除术治疗儿童良性睾丸肿瘤的临床疗效。方法回顾性分析1998年10月到2009年3月收治的29例保留睾丸的肿瘤剜除术患儿临床资料。患儿平均发病年龄为42．6个月（4个月至12岁）,临床表现均为无痛性阴囊肿块,除1例术前AFP升高外,其余术前AFP均在正常范围。结果均行保留睾丸的肿瘤剜除术,术后病理诊断：21例为成熟性畸胎瘤,2例为表皮囊肿,4例为皮样囊肿,1例为囊肿性病变伴肉芽肿形成,1例为未成熟畸胎瘤（后行睾丸切除术）。25例冰冻切片均诊断为良性病变。21例B超下计算肿瘤体积为（1．25±2．05）mL,患侧睾丸体积（含肿瘤）为（4．56±5．07）mL,肿瘤占睾丸体积比例为（54．3±30．11）％（6．04％～100％）。7例最近1次门诊随访术侧平均睾丸体积为（0．78±0．31）mL,与健侧比较无统计学意义。20例平均获随访34个月（4～72个月）,无一例复发,患侧睾丸发育良好。结论保留睾丸的肿瘤剜除术可作为小儿睾丸良性肿瘤的首选治疗方法。     

Spermatic cord torsion after testicular fixation. A different surgical approach and a revision of current techniques.

We present a technique for testicular fixation, based on the development of a new anatomical structure formed exclusively by the visceral and the parietal tunica vaginalis; our pre-clinical experience with this technique performed in guinea pigs and a clinical casuistic of 100 operations in 69 patients (age range: newborns to 25 years, mean 101.43 months) where the principal indications were unilateral torsion, testicular descent and contralateral fixation after orchiectomy. Postoperative follow-up ranged between 4 months and 204 months with a mean of 14.304 months. At their final follow-up, all patients presented normal testicular size, shape, consistency, sensitivity, mobility and intrascrotal position; no patient complained of symptoms related to the operation. The discussion also includes 48 cases of failed testicular fixation which were performed with sutures, vaginal adhesions or dartos-pouch techniques, as reported by 30 different authors. Ages of patients at the primary operation ranged from 3 years to 34 years (mean 14.381 years), at the secondary operation from 10 years to 40 years (mean 19.298 years) and the interval between them ranged from 5 days to 27 years (mean 53.773 months). The causes of the failures, which led us to consider them as unreliable, were absorption of cicatricial tissue, serosal regeneration and loosening of sutures. The sequelae included testicular atrophies, orchiectomies and severely damaged testicles.     

保留睾丸手术治疗儿童睾丸畸胎瘤疗效观察

目的 评价保留睾丸手术治疗原发性儿童睾丸畸胎瘤的疗效.方法 对2001年1月～2007年9月收治29例原发性睾丸畸胎瘤患儿的临床资料进行回顾性分析.结果 29例患儿,均为单侧,平均发病年龄43.9个月(50 d～12岁).所有患儿均表现为患侧阴囊内无痛性肿块,且经术前B超证实.除1例50 d患儿的甲胎蛋白(AFP)超出正常范围外,其余28例的AFP检查结果均在正常范围内.29例患儿中21例(72%)行保留睾丸手术,其余8例因睾丸中无正常睾丸组织而行根治性睾丸切除术.所有病例术中冰冻与术后石蜡切片病理检查结果一致,均为睾丸畸胎瘤,其中成熟型27例,不成熟型2例(均行根治性睾丸切除).29例患儿术后随访至今,平均49.7个月(12～92个月).均未出现肿瘤复发、转移等并发症.21例保留睾丸组织的患儿术后B超随访患侧睾丸无萎缩.结论 原发性儿童睾丸畸胎瘤应首选考虑尽可能保留睾丸组织.治疗方法的选择有赖于术前AFP、B超以及术中对病变的评价、冰冻检查结果.