四川省德阳农村7～15岁儿童性发育调查研究

作者调查了1063例农村儿童性发育,结果表明:女性性发育以乳房发育开始,高峰年龄为11岁,继之是阴毛和腋毛发育,月经初期年龄为13岁。男性性发育以睾丸增大开始,继之为阴毛、腋毛和面毛发育,首次遗精年龄以15岁最多。作者进一步研究了它们之间的关系。     

UNDESCENDED TESTIS: A STUDY OF 50 CASES

Fifty consecutive cases of undescended testis treated at a service hospital over a period of 3 years from January 1993 to December 1995 were studied. Only 2 patients (4%) were below the age of 2 years and 25 (50%) were past the age of 15 years. Two cases presented with seminoma in intraobdominal testis. Ultrasonography was found unreliable in localizing the impalpable testis. Subdartos pouch orchiopexy (Winsburry-White) was the definitive procedure adopted in 21 out of the 25 orchiopexies performed and the results were good. Orchidectomy seems the best option of treatment in post-pubertal patients with unilateral symptomatic maldescent.KEY WORDS: Cryptorchism, Testis, Orchiopexy, Orchidectomy, Testis undescended     

小儿未降睾丸的磁共振表现及其评价（附36例报告）

目的评价小儿未降睾丸的MRI表现及其临床价值。方法对36例年龄在1—14岁临床发现阴囊空虚病人行MRI检查，33例单侧阴囊空虚，3例双侧阴囊空虚，34例经手术证实，2例因MR未检出未降睾丸而未行手术探查。回顾分析其MR表现并与手术结果对照。结果MRI正确显示未降睾丸34例（37枚），检出率94．4％（34／36），并经手术证实，34例中31例为单侧，3例为双侧，其中2例为异位睾丸，8例合并斜疝。结论无创性、无辐射性、多方位成像的MRI能揭示小儿未降睾丸的解剖及组织学特征，图像清晰直观，最佳的成像平面为横断位及冠状位。有利于对并发症提供一定依据。     

Management of the impalpable testis: a six year review together with a national experience

The management of undescended testes remains variable, and the use of laparoscopy for localisation is controversial. This study reviews the need for laparoscopy and also assesses the current practice among a cohort of surgeons.A retrospective review of all patients undergoing orchidopexy was performed, together with a postal survey of all members of the Welsh Surgical Society. Of the 139 orchidopexies performed, the testis was deemed impalpable in 39 (28%) cases. All patients were treated with groin exploration, and only in two (5%) patients was the testis not located. From the survey, replies were received from 90 (81%) surgeons, of whom 65 (72%) were still performing orchidopexy. Forty eight (74%) surgeons performed orchidopexy between the age of 2 and 3, and only 32 (36%) performed preoperative investigations. The follow up period was variable with the majority of patients seen at six weeks. Laparoscopy for the impalpable testis is not initially warranted. An inguinal exploration is regarded as the definitive investigation. This has the advantage of providing the diagnosis and treatment in the majority of cases.     

睾丸固定术中解剖发现

报告５６例１至１０岁隐睾症患儿睾丸固定术中解剖发现，仅２例（３．７％）双侧睾症。术中发现２只睾丸萎缩。３７．９％的睾丸位于Ｂｒｏｗｎｅ氏囊内。５４只睾丸（９３．１％）伴鞘状突束闭。２７只睾丸（４６．５％）有睾丸引带固定在异常部位。８只睾丸（１３．７％）有腹股沟管闭锁或狭窄。８只睾丸（１３．７％）伴有附睾畸形。这些发现揭示睾丸下降至阴囊的通道不畅和睾丸沿固定在异常部位的睾丸引带下降而发生隐睾。     

The retractile testis

One hundred boys who had a retractile testis on one side were followed up for five years. The position of the retractile testis became higher (in some, it left the scrotum) in 42 boys and the development of this testis was adversely affected in 49. Because of this, regular review of boys with retractile testes should be continued as long as retraction persists.     

小儿隐睾89例诊治临床分析

目的:探讨小儿隐睾的合理诊治方法,以减少并发症的发生。方法:89例小儿隐睾症,对其中16例<2岁和3例B超发现睾丸体积过小的3例患儿进行人绒毛膜促性腺激素(HCG)治疗,每次1500U肌肉注射,每周2次,总剂量15000U。对经HCG治疗失败以及年龄>2岁的患儿采用手术治疗。结果:9例患儿HCG治疗1个疗程后睾丸降至阴囊;7例经HCG治疗睾丸未降至阴囊,但睾丸比注射前增大。经手术治疗的患儿中76例1次手术完成,3例分2次手术,睾丸缺如1例;3例睾丸过小的患者尽管睾丸未降到阴囊,但是睾丸比注射前明显增大;本组中未发现癌变,无睾丸坏死及睾丸切除,无睾丸回缩等并发症。结论:尽早采取合理的治疗方法是有效治疗小儿隐睾、减少并发症的关键。     

Long-term follow-up study on surgical treatment of cryptorchism in children

This article reports 1010 cases of cryptorchism managed by surgical treatment during the recent 30 years. The age range of the patients was from 4 months to 14 years. This series includes 342 left side, 456 right side and 212 bilateral lesions. Orchiopexy was performed on 1145 testes with three different forms of fixation excluding 33 cases of absent testis and 44 cases of testicular agenesis. Four hundred and fifty-five cases (527 testes) were available for follow-up study. Four hundred and seventeen testes (79.1%) descended into the scrotum, while 237 testes (45%) manifested atrophy. The results showed that orchiopexy into sub-dartos pouch and surgical treatment during 1 to 2 years of age can give the best results. In this article is discussed the age for surgical treatment, procedure of testicular fixation, surgical treatment of cryptorchism with impalpable testes, prevention of testicular atrophy etc.     

Management of the undescended testis

Surgical correction of the undescended testis is frequently postponed beyond the optimal time, namely, 6 years of age.

An accurate diagnosis of undescended testis may be made during the first year of life. Complications and mistakes arising from misdiagnosis of undescended testis and retracted testis may, therefore, be prevented by recording findings.

The purpose of this article is to present the arguments in favour of early diagnosis and operative treatment of undescended testis, and to correct possible misconceptions.

     

精索内静脉造影定位不能触及的隐睾(附12例报告)

本文报告精索内静脉造影定位不能触及的隐睾症12例。10例造影获得成功,其中右侧3例,左侧7例。造影及手术对照结果提示:①精索内静脉及蔓状丛显影表明有睾丸存在。②出现盲端静脉表明无睾丸存在。③长段精索内静脉显影无典型蔓状丛表明有睾丸存在。     

儿童周期性呕吐综合征的诊断与治疗（附41例报告）

目的探讨儿童周期性呕吐综合征的临床特征、诊断、预防性治疗及疗效。方法对1995年3月-2006年3月我院确诊的周期性呕吐综合征30例的临床特征、治疗与预后的临床资料进行回顾性分析,分析普萘洛尔和阿米替林对预防性治疗周期性呕吐综合征的临床疗效。结果本组患儿发病年龄新生儿-14岁,男20例,女21例,初次症状发作的平均年龄为（4．9±3．3）岁（新生儿-14岁）;70％在清晨或午夜发病,临床表现为反复发作性呕吐;采用普萘洛尔或阿米替林的有效率分别达91％和55％。结论对典型的反复呕吐发作的周期性呕吐综合征患儿无需有创检查就可确诊,普萘洛尔对CVS的治疗效果优于阿米替林。     

Torsion of the testis

Torsion of the testis demands early diagnosis and urgent operative treatment. This study of all patients with torsion of the testis who were admitted to The Prince of Wales Children's Hospital, The Prince of Wales Hospital and The Prince Henry Hospital, Sydney, between 1965 and 1987, reinforces the need for urgent diagnosis and treatment and evaluates the diagnostic value of the sign of the contralateral horizontal testis. One hundred and thirty-one patients were studied; the majority was in the adolescent age-group. If operation were delayed beyond 24 hours without spontaneous relief of the symptoms or manipulative detorsion being performed, then at follow-up 5.5% of testes were normal; however, if operation were performed within 24 hours of the onset of symptoms, 90% of testes were normal at follow-up. In all cases in which it was sought, the sign of the contralateral horizontal testis was found, which confirms the bilaterality of the condition and that a high investment of the tunica vaginalis predisposes to torsion of the testis.     

睾丸扭转35例临床分析

目的探讨睾丸扭转的诊治方法。方法回顾性分析35例睾丸扭转病例的临床资料。患者年龄14～29岁,发病至确诊时间7h～45d。入院前误诊为急性睾丸附睾炎抗炎治疗23例,误诊时间3～45d,误诊为急性阑尾炎行阑尾切除术1例。结果所有患者均行彩色多普勒超声检查,33例确诊。4例试行手法复位均失败。手术探查示精索鞘膜内型扭转34例,鞘膜外形扭转1例;扭转度数360°～720°。2例行患睾复位和固定术,其余患者均切除患睾。所有患者同时行健侧睾丸固定术。结论对于非外伤性阴囊急症,尤其对青壮年患者,临床医生要考虑到睾丸扭转的可能,有条件者应立刻行CDFI等辅助检查以帮助诊断和鉴别,高度怀疑睾丸扭转者应早期果断行手术探查以最大限度地提高睾丸的挽救率。     

Torsion of undescended testis in an infant: case for early orchiopexy

Torsion of the testis is a true surgical emergency in paediatric age group. Prompt recognition of the condition and immediate surgical intervention is the only hope for testicular salvage. The condition becomes all the more important when this occurs in an undescended testis as the diagnosis is often delayed, and therefore the treatment too. A six-month old infant presented with the torsion of an undescended testis. Even prompt exploration could not avoid the necrosis and orchidectomy was done. Therefore to avoid this almost unsalvageable condition the orchiopexy must be considered at an earlier age.     

Prepubertal testicular tumours in Kashmir--a histopathological report of 15 cases

A total of 15 cases of prepubertal testicular tumours were reported by the department of pathology, Government Medical College, Srinagar, Kashmir over a period of 15 years, from January 1984 to December 1998. The cases included yolk sac tumour (10 cases; 67%), teratoma [(mature) 2 cases (13%)], rhabdomyosarcoma [(paratesticular) 2 cases (13%)] and NHL-Burkitt's lymphoma [one case (7%)]. The youngest patient was 10 months old and the oldest was of 14 years age. Ten cases (67%) occurred at or below the age of 4 years. The youngest patient had yolk sac tumour and oldest had rhabdomyosarcoma. In 2 cases both the testes were involved with one of these two cases having bilateral undescended testes.     

高位隐睾应用“长袢输精管”睾丸固定术12例报告

对于高位隐睾不能Ⅰ期手术降入阴囊者采用了“长袢输精管”固定术,共治疗12例17侧隐睾,16侧效果满意。随访中对睾丸部位、大小、弹性作了估价。认为手术成功的关键在于高位切断精索、保留输精管血管及睾丸引带侧支。     

精索固定加绒毛膜促性腺激素治疗双侧隐睾

本文介绍28例双侧隐睾采用精索固定加绒毛膜促性腺激素(HCG)治疗的病例,经术后1～3年随访观察,疗效满意。作者认为精索固定治疗隐睾改变了过去在睾丸复位至阴囊后用丝线缝合牵引固定的传统术式,使双侧隐睾可一期完成手术。在手术前后用HCG作为辅助治疗对于促进辜丸、阴茎和阴囊的发育效果显著,对于减少高位隐睾固定的难度也有一定帮助。     

The nutritional status of Tanzanian children: A cross-sectional anthropometric community survey report

Anthropomorphic measurements have been found to be most useful in the assessment of nutritional and health status. Scattered cross-sectional community anthropomorphic measurements of rural preschool children from 8 regions of Tanzania were carried out in 1976 and 1977. This report involves 4766 preschool children and 341 school children who had their anthropomorphic measurements analyzed. The results showed that 2.4% of the preschool children had severe Protein Energy Malnutrition (PEM), whereas 42.6% suffered from mild to severe PEM. There were more underweight children among preschool girls than among the boys in all age groups, except in those aged 0-6 months. School girls, however, had fewer underweight children among them than school boys. This is a finding not reported in 4 other studies in Tanzania involving some 2000 preschool children, in the past. There is a cumulative stunting becoming maximum at the 18-30 month age group. The mean average "stunting" prevalence was 46.5% while the mean average "wasting" prevalence was 8.3%. There is a need to find out the reason why PEM prevalence among preschool children has not changed since about 15 years ago, while it is common knowledge that primary health care facilities have doubled or even quadrupled in quantity during the same period. It is rather expedient to find out if there is preferential treatment of preschool boys by parents.     

睾丸扭转的诊断与治疗

目的：探讨睾丸扭转的早期诊断和治疗,以提高患者的睾丸成活率。方法：对18例睾丸扭转患者的临床资料进行回顾性分析,18例患者行彩色多普勒超声检查和手术探查,其中8例患者行睾丸切除术,10例行睾丸复位固定术,所有病例均行对侧睾丸探查固定术。结果：18例中初诊确诊为睾丸扭转者11例,误诊为急性睾丸附睾炎7例,彩超诊断符合率为100％;18例患者均痊愈,发病〈12h6例均保留睾丸,术后睾丸均成活;发病12～24h5例,保留睾丸4例,1例睾丸坏死行切除术;发病〉24h7例均为睾丸坏死而行睾丸切除术。随访1～5年,10例保留睾丸的患者中,6例患者彩超显示睾丸形态和血流正常;3例出现患侧睾丸轻微萎缩,但对侧睾丸血流正常;1例患者患侧睾丸明显萎缩。8例切除睾丸患者彩超显示对侧睾丸血流正常。结论：彩超是睾丸扭转首选检查方法,早期诊断、及时手术探查是提高患者睾丸成活率的关键。睾丸扭转12h以内均应行睾九复位固定术,12～24h应尽量保留睾丸,超过24h应切除睾丸。