287例隐睾诊治分析

目的:总结隐睾及其并发症的诊治经验,提高对隐睾合理治疗年龄的认识。方法:回顾性分析287例362侧隐睾患者诊治资料。就诊时年龄1~45岁,左侧77例,右侧135例,双侧75例,结果:手术治疗362侧,其上行一期下降固定术347例,疑为萎缩或恶变而行手术切除送病理12例,探查缺如3侧。腹外型238侧,腹内型115侧。238例腹外型隐睾B超检查符合率81.9%,体检符合率60.1%。结论:2岁以内最佳手术时机的隐睾患者诊治率明显偏低,应引起重视。B超对隐睾的定位诊断符合率较高。     

超声诊断后天性隐睾扭转1例

<正>创伤性睾丸移位又称后天性隐睾,由于未及时复位引起的扭转临床罕见,超声是首选的影像学诊断方法,可为临床诊断提供及时可靠的依据。我院2013年12月收治1例,现报告如下。1资料与方法患者,17岁,因无明显诱因下出现左侧腹股沟区疼痛,可触及压痛性包块30 h,于2013年12月5     

隐睾65例分析

目的分析隐睾患者术前治疗、手术时机及方式选择。方法回顾性分析65例隐睾患者资料。年龄1.5～41岁,20岁6例,5岁34例,5～10岁25例。右侧40例,左侧15例,双侧10例。隐睾位于腹股沟管上段2例,位于腹股沟管中段34例,位于腹股沟管外环口部及耻骨结节部29例。结果 23例术前行非正规内分泌治疗,且治疗时间晚。42例术前未行正规内分泌治疗,1例体检及彩色多普勒检查未发现隐睾位置及大小自动出院,余住院后均行手术治疗。隐睾下降肉膜外固定术62例,71侧;2例I期未下降到阴囊内,3～6月行Ⅱ期手术成功;睾丸切除2例。结论隐睾患者早期行内分泌治疗率低,对隐睾治疗时机无明确认识,致手术时间晚,影响发育,恶变率升高。     

成人腹腔型隐睾并肠梗阻五例临床分析

本文总结分析我院 1 985年 1月～ 2 0 0 2年 5月收治的成人腹腔型隐睾致肠梗阻共 5例 ,报道如下。临床资料1 .一般资料 :本组 5例 ,年龄 2 6～ 6 3岁 ,平均4 4.5岁。以腹痛、腹部肿块、呕吐、肛门停止排气排便入院。其中右侧 3例 ,左侧 1例 ,双侧 1例。患者阴毛男性分布 ,阴茎发育正常。提供隐睾病史而发现阴囊空虚者 4例 ,遗漏阴囊检查者 1例。行常规X片、B型超声检查 ,部分行肿瘤标志物 (HCG、AFP)、钡灌肠、腹部、盆腔CT、MRI检查 ,没有 1例术前被确诊肠梗阻的原因为腹腔型隐睾 ,而被误诊为肠套叠 2例 ,肠粘连 1例 ,急性阑尾炎 1例…     

隐睾继发睾丸癌的临床分析

目的分析隐睾继发睾丸癌的临床诊治特点。方法回顾性分析10例隐睾继发睾丸癌患者资料。年龄32～55岁，平均40岁。其中腹股沟隐睾4例，腹腔隐睾6例。左侧2例、右侧5例、双侧3例。临床分期ⅠA3例、ⅠB5例、ⅡD2例。其中3例已行腹股沟隐睾复位固定术(双侧1例)，手术年龄8～9岁，复位固定与发现睾丸癌间隔24～35年，平均29年。结果4例腹股沟隐睾睾丸癌行肿瘤根治性切除。6例腹腔隐睾肿瘤中，肿瘤根治性切除2例、根治性切除加腹膜后淋巴结清扫2例，2例因肿瘤严重粘连行姑息切除。病理诊断精原细胞瘤9例，精原细胞瘤合并胚胎癌1例。10例均行术后放疗，其中合并胚胎癌者及姑息性肿瘤切除术者同时予以化疗。6例随访6个月～14年，平均5．2年，未见复发及远处转移征象。结论隐睾发生肿瘤的机会高于正常睾丸，隐睾应及时治疗并终生随访。隐睾睾丸肿瘤的病理类型多为精原细胞瘤，手术切除加术后放疗疗效较好。     

隐睾恶变7例报告

隐睾症是男性生殖系统最常见的先天性畸形之一。我科于1977～1997年收治隐睾症201例，其中7例（9枚）睾丸恶变，现报告如下。1资料与方法1．1一般资料本组7例，年龄24～45岁，平均34．5岁，病程2个月～10年，平均5年。双侧恶变2例，单侧5例；右侧恶变3枚，左侧6枚，其中腹股为管型2枚，腹腔内型7枚。术前已婚5例，已育3例。双侧隐睾者均无生育。7例均表现为逐渐增大的局部肿块伴胀痛（5例下腹部，2例区股沟部），1例会并尿道下裂，1例会并左下肢明显浮肿；4例检测甲服蛋白均为阴性。术前5例拟诊为隐睾恶变，2例以腹部包块收住院，行剖腹探查…     

腹腔镜高位隐睾下降固定术治疗高位隐睾患儿的临床效果

目的探讨腹腔镜高位隐睾下降固定术治疗高位隐睾患儿的临床效果。方法收集2017-12—2019-04间郑州大学第三附属医院收治的50例高位隐睾患儿,均予以腹腔镜高位隐睾下降固定术治疗,并对其临床资料进行回顾性分析。结果 50例患儿术中均顺利寻及睾丸且成功实施下降固定术,无中转开腹病例。手术时间为(40.20±4.30)min,术中出血量为(28.60±9.90)mL。切口均I期愈合。术中及术后未发生肠管及其他脏器损伤等并发症。住院时间为(6.70±1.40)d。术后随访6～10个月,经复查显示,下降固定的睾丸位置良好,未出现睾丸回缩或萎缩病例。结论腹腔镜高位隐睾下降固定术治疗高位隐睾患儿,创伤小,康复时间短,并发症风险低,疗效理想。     

隐睾恶变10例报告

报告隐睾恶变１０例１１枚，其中腹腔内隐睾恶变６枚，腹股沟管及外环隐睾恶变３枚，腹内环隐睾下固定后恶变１枚，一侧隐睾时侧睾丸恶变１次，指出成年后的隐睾切除和下降固定存在较大的癌变威胁，需长期的Ｂ超随访观察，至少每年检查１次。     

腹腔镜诊断和治疗高位隐睾的探讨

目的 探讨腹腔镜在高位隐睾诊断和治疗中的价值。方法 腹腔镜下对19例21侧睾丸进行腹腔探查、睾丸下降固定术。结果 11例睾丸位于肾下极，8例位于内环上方。15例睾丸固定于阴囊底部，4例睾丸固定于腹腔内，Ⅱ期手术。1例睾丸缺如，1例睾丸发育不良进行睾丸切除术。术后3例患侧阴囊气肿，1例患侧阴囊血肿。19例术后伤口恢复良好。随访15例，时间3月—10月，平均6月，患儿无不适。结论 腹腔镜诊断和治疗高位隐睾，创伤小，出血少，术后恢复快，小切口无严重并发症。     

腹腔镜诊治未触及睾丸的隐睾42例

目的 探讨腹腔镜在未触及睾丸的隐睾患儿中的诊断及治疗作用。方法 对42例未触及睾丸的隐睾患儿腹腔镜检查，根据睾丸的位置及发育情况，分别行睾丸一期固定术，分期Fowler-Stephens手术或切除术，结果 腹腔内睾丸28例（28/42，66.7%），其中4例行分期Fowler-Stephens手术，1例行分期睾丸固定术，余23例行一期睾丸固定术，睾丸发育不良4例（4/42，9.5%）,经腹腔沟区探查行切除术；睾丸缺如7例（7/42，16.7%）；腹股沟管内睾丸3例（3/42，7.1%），行常规睾丸固定术。术后随访6-60个月，平均38个月，患侧睾丸位置和发育基本正常。结论 腹腔镜能够准确诊断未触及睾丸的隐睾，并可做相应的治疗。     

经脐单部位腹腔镜治疗小儿隐睾42例

目的 探讨经脐单部位腹腔镜治疗小儿隐睾的临床价值。方法 回顾性分析2012年1月至2013年10月,新疆维吾尔自治区人民医院对42例（49侧）隐睾患儿采取经脐单部位切口腹腔镜技术治疗隐睾,完成手术操作。结果 42例患儿手术均获成功,手术时间30—50min,平均40．2min;住院时间4～5d,平均4．5d。无中转开腹及改变手术方式病例。术后随访时间1～6个月,其中2例单侧睾丸萎缩;没有回缩及切口感染发生。结论 经脐单部位腹腔镜治疗小儿隐睾安全有效技术可行,值得推广。     

Diagnostic imaging in cryptorchidism: utility, indications, and effectiveness

Background

Cryptorchidism (undescended testis) is the most common genitourinary anomaly in male infants.

Methods

We reviewed the available literature on the diagnostic performance of ultrasound, computed tomography, and magnetic resonance imaging (MRI) in localizing undescended testes.

Results

Ultrasound is the most heavily used imaging modality to evaluate undescended testes. Ultrasound has variable ability to detect palpable testes and has an estimated sensitivity and specificity of 45% and 78%, respectively, to accurately localize nonpalpable testes. Given the poor ability to localize nonpalpable testes, ultrasound has no role in the routine evaluation of boys with cryptorchidism. Magnetic resonance imaging has greater sensitivity and specificity but is expensive, not universally available, and often requires sedation for effective studies of pediatric patients. Diagnostic laparoscopy has nearly 100% sensitivity and specificity for localizing nonpalpable testes and allows for concurrent surgical correction.

Conclusions

Although diagnostic imaging does not have a role in the routine evaluation of boys with cryptorchidism, there are clinical scenarios in which imaging is necessary. Children with ambiguous genitalia or hypospadias and undescended testes should have ultrasound evaluation to detect the presence of müllerian structures.     

腹腔内隐睾恶变3例报告

目的 探讨腹腔内隐睾恶变为巨大精原细胞瘤的临床特点.方法 回顾性分析2007年6月至2011年1月我院收治的3例腹腔内隐睾恶变为巨大精原细胞瘤患者的临床资料及诊治方法,并复习相关文献.结果 3例患者的平均年龄为32.3岁,均表现为隐睾、腹痛及盆腔内肿块.3例最终均行手术治疗,术后病理类型均为精原细胞瘤.术后1个月开始给予放疗或化疗.随访0.5至5年,例1术后5年,健在,性功能正常,未生育;例2术后4.5年,健在;例3术后0.5年,健存.结论 腹腔精原细胞瘤大多继发于隐睾,隐睾患者腹盆腔有增大的肿块应高度怀疑隐睾恶变,手术切除加放化疗较理想.隐睾患者需早期诊断、治疗及长期随访.     

Management of cryptorchidism and gastroschisis

Background

Cryptorchidism is commonly associated with gastroschisis. Management of the undescended testes varies with regard to technique and timing of orchidopexy. To evaluate the appropriate timing of and procedure for orchidopexy in patients with gastroschisis, we reviewed our experience.

Methods

Male neonates admitted between January 1999 and September 2010 with gastroschisis were reviewed. This retrospective study was conducted after institutional review board approval. Testis location at birth was recorded, and outcomes for those with undescended testes were analyzed.

Results

Sixty-two males with gastroschisis were identified, and 24 had cryptorchidism (38.7%) affecting 31 testes. All babies had an initial watch-and-wait approach without any attempt at orchidopexy during gastroschisis closure. Those with extraabdominal testes at birth had the testicle repositioned in the abdomen before gastroschisis closure. Mean follow-up was 27.3 months. At follow-up, 54.8% of the testes relocated without intervention and 38.7% required orchidopexy. Laparoscopy was used in 5 patients to perform the orchidopexy. A total of 3 testes required orchiectomy secondary to atrophy, one of which had previously undergone an orchidopexy. Two of the orchiectomies were performed laparoscopically.

Conclusion

The watch-and-wait approach for cryptorchidism in gastroschisis is safe and appropriate, with a high rate of spontaneous migration during the first year of life and greater than 90% testes viable at follow-up. Laparoscopy is a safe and feasible option for management of undescended testes that remain intraabdominal at follow-up.     

Congenital spigelian hernias and cryptorchidism

Purpose

Spigelian hernias in childhood are rare. Only 24 infants in the English literature have been identified to have spigelian hernias, and 12 of these have been associated with cryptorchidism. Spigelian hernias are more commonly seen in the adult population and are considered to be acquired because they are typically associated with trauma or other etiologies of increased intraabdominal pressure. In the infant however, the etiology remains unclear, but a congenital defect in abdominal wall development is suspected.

Methods

We discuss the presentation and treatment of 4 additional patients with spigelian hernias (2 siblings included) associated with cryptorchidism.

Results

The hernias occurred within the well-described spigelian hernia belt in the semilunar line at the level of the semicircular fold of Douglas. Of the 6 repaired spigelian hernias, 5 were closed primarily with absorbable suture similar to previously reported cases; the sixth hernia required a patch closure because of its large size. All cryptorchid testes (7) were repaired in single-stage orchiopexies.

Conclusions

Spigelian hernias are rare entities in infants. We present 4 new cases of spigelian hernias associated with cryptorchidism and, with previously reported cases, discuss the probability of a congenital origin of these hernias in infants.     

先天性隐睾症术式改良及疗效分析

目的 研究先天性隐睾症术式改良的临床疗效.方法 选取本院在2009年3月～2014年3月间收治的42例先天性隐睾症患者的临床资料,随机将患者平分为两组,每组各21例病例.对照组行肉膜囊睾丸固定术治疗,观察组采用腹横纹切口保留睾丸引带阴囊皮下睾丸固定术治疗,比较两组患者术后的治疗优良率.结果 观察组有13例患者治疗情况为优,7例患者恢复良好,总优良率为95.2％;对照组有7例患者治疗情况为优,8例患者恢复良好,总优良率为71.4％.观察组治疗优良率明显优于对照组,对比差异显著,具有统计学意义(P＜0.05).结论 采用腹横纹切口保留睾丸引带阴囊皮下睾丸固定术有利于减少对患者身体的损伤,切口瘢痕较小,同时不会增加并发症的发生,具备较高的安全性与可靠性,有利于促进患者疾病的好转,值得临床推广应用.     

57例急性结石性胆囊炎的外科手术治疗

目的总结急性结石性胆囊炎的外科手术治疗经验。方法回顾性分析57例急性结石性胆囊炎患者的临床资料。结果全组57例急性结石性胆囊炎患者均有急性腹痛、恶心、呕吐,并伴有不同程度的右上腹压痛及反跳痛。伴黄疸32例,合并其他内科疾病22例。入院后所有患者均采取禁食、胃肠减压、纠正酸碱平衡紊乱、选用敏感抗生素及对症治疗等措施。57例急性结石性胆囊炎患者中36例症状缓解后选择近期择期手术治疗,21例患者症状无改善后行急诊手术。本组痊愈出院57例,术后出现并发症8例,均为急诊手术患者。结论对于急性结石性胆囊炎患者的治疗,应对外科手术治疗保持积极的心态,充分做好围手术期的准备,选择合适的手术时机和手术方式,最大程度降低并发症的发生。     

结直肠癌术后早期肠内营养的临床观察 (附20例报告)

目的:研究结直肠癌术后早期肠内营养的临床疗效及安全性、可行性.方法:将20例结直肠癌患者在术后24 h给予能全力肠内营养,整个过程将持续10 d.肠内制剂的投入通过鼻肠管或空肠造瘘管.结果:术后第7天均转入正氮平衡,白蛋白术前(34.1±3.5)g/L,术后第7天(33.8±3.8)g/L,前白蛋白术前(0.23±0.02)g/L,术后第7天(0.25±0.03)g/L;肝功能转氨酶,胆红素无明显变化;肠蠕动恢复时间(2.3±0.5)d,无并发症.结论:①结直肠癌术后早期(24h内)提供肠内营养是安全有效的.②促进肠功能恢复快,对肝功能影响小.③避免了胃肠外营养相关的并发症.