硫氧还蛋白对大鼠睾丸缺血再灌注损伤保护作用的研究

目的 探讨硫氧还蛋白对大鼠睾丸缺血再灌注损伤的保护作用.方法 选取雄性SD大鼠60只,随机分为4组:假手术对照组(A组);睾丸扭转/复位组(B组);睾丸扭转/复位+腹腔内注射生理盐水组(C组);睾丸扭转/复位+腹腔内注射硫氧还蛋白组(D组).无菌条件下制作左侧睾丸扭转模型,扭转持续4h,复位4h后取睾丸标本(D组在复位前15 min腹腔内注射硫氧还蛋白).对标本进行病理组织学检查;检测睾丸组织中超氧化物歧化酶(SOD)和丙二醛(MDA)的含量.结果 睾丸扭转/复位后可见生精小管退变,间质出现水肿及出血,腹腔注射硫氧还蛋白使睾丸扭转/复位诱发的组织学改变明显改善.B组及C组睾丸损伤评分(8.3±0.96;8±0.87)明显高于A组(0.78±0.36)(P＜0.01),而腹腔注射硫氧还蛋白可以使睾丸损伤分值(3.1±0.42)显著降低(P＜0.05).B组及C组MDA含量(4.39±0.21;4.42±0.17)升高,SOD活性(269±27.1;271±21.3)降低,与对照组(MDA:1.61±0.18;SOD:317±22.3)相比,差别具有显著性意义(P＜0.01).而腹腔注射硫氧还蛋白能有效降低MDA含量(2.03±0.03)并升高SOD活性(315±24.2)(P＜0.01).结论 本实验为硫氧还蛋白作为治疗睾丸扭转继发损害的有效物质提供了组织学及生化依据.为临床预防和治疗睾丸缺血再灌注损伤提供了理论依据.     

褪黑激素对大鼠睾丸扭转缺血和再灌注损伤的保护作用

目的 探讨褪黑激素对大鼠睾丸扭转的治疗作用.方法 选取青春期雄性SD大鼠48只,随机分为3组:空白对照组(A组);扭转复位组(B组);扭转复位+褪黑激素组(C组).B组和C组大鼠建立睾丸扭转复位模型,对照组不扭转.扭转4h后复位睾丸,复位前15 min B组腹腔注射生理盐水1 ml:C组腹腔注射褪黑激素1ml(17 mg/kg).复位后4h处死所有动物取睾丸待测.以原位缺口末端标记法(TUNEL)检测生精细胞凋亡指数;化学比色法测定睾丸组织内总抗氧化能力(T-AOC).结果 B组T-A0C( 20.31±2.55)U/mg比A组(33.62±3.29) U/mg明显降低,差异有统计学意义(P＜0.01).而C组T-AOC(30.05±2.08)U/mg较B组明显升高(P＜0.05).B组凋亡指数(42.2±3.21)％明显高于A组(5 7±0.67)％(P＜0.01),而C组凋亡指数(12.2±1.34)％较B组显著下降(P＜0.05).结论 褪黑激素具有明显对抗睾丸扭转复位后的氧化损伤,对因睾丸扭转导致的缺血再灌注损伤具有保护作用.     

TSEG-2基因在小鼠睾丸扭转复位模型中的表达特征

目的 探讨睾丸特异表达基因2(testis specific expressed gene 2,TSEG-2)在小鼠睾丸扭转复位模型中的表达特征.方法 昆明小鼠36只,随机分组为对照组(6只)、假手术组(6只)、单侧睾丸扭转复位实验组(24只).实验组分为2组,每组12只,左侧睾丸扭转720°维持2 h,分别于复位后1、7 d取扭转侧睾丸.采用HE染色、原位末端标记技术(TUNEL)观察睾丸组织形态改变;黄嘌呤氧化酶法、硫代巴比妥酸比色法测定超氧化物歧化酶(SOD)、丙二醛(MDA)活性;原位杂交法观测TSEG-2在睾丸生精细胞内的表达定位;实时定量PCR法检测TSEG-2基因在睾丸组织中的表达水平.结果 对照组和假手术组生精上皮排列规则,扭转复位后1、7 d的睾丸组织内生精上皮结构松散,出现生精细胞凋亡,Johnsen's评分分别降低23.4%、64.1%(P<0.01),SOD活性降低11.6%、22.2%(P<0.05),MDA活性升高69.6%、93.2%(P<0.01).TSEG-2基因表达定位于小鼠睾丸生精小管的精原细胞和精母细胞.与对照组比较,扭转复位1、7 d后睾丸组织内TSEG-2表达水平分别上调2.2倍、6.6倍(P<0.01).结论 成功建立小鼠睾丸扭转复位模型,TSEG-2表达上调可能与抗氧化酶活性下降、生精细胞凋亡有关.     

睾丸附件扭转33例

目的 分析小儿睾丸附件扭转的临床特点和治疗方法.方法 回顾性分析本院1999年8月-2007年8月收治的33例小儿(3.2～14.0岁)睾丸附件扭转临床治疗.20例于治疗前行彩色多普勒超声(CDFI)检查,记录检查结果.33例分为手术组23例和保守治疗组10例,记录手术组术中所见睾丸附件情况及切除福建的病理检查结果,比较二组患儿平均住院时间、平均阴囊红肿消退时间.结果 睾丸附件扭转以阴囊肿痛为主要表现,CDFI检查表现为睾丸上极附近无血流回声团.手术组和保守治疗组均取得满意疗效.手术组阴囊红肿消除时间为(5.0±1.0)d,保守组为(9.1±5.2)d;住院时间分别为(5.2±2.3)d和(8.9±6.6)d,二组比较,均有显著性差异(t=2.26, 3.12 P<0.05).对病程长、症状轻的病例,在阴囊红肿消退时间和住院时间等方面手术组均优于保守组,术后B超显示睾丸附件可恢复正常.结论 CDFI检查哈在小儿睾丸附件扭转的诊断中具有重要意义,早期手术治疗睾丸附件扭转有利于睾丸及附睾炎性反应得吸收.     

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.     

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。     

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.     

睾丸扭转患儿平均血小板体积与睾丸活性的相关性北大核心CSCD

目的研究睾丸扭转患儿血液学参数与睾丸活性的相关性,探讨术前预测扭转睾丸活性或睾丸萎缩的指标。方法回顾性分析2006年1月至2020年1月于首都医科大学附属北京儿童医院泌尿外科行急诊手术治疗的173例睾丸扭转患儿的临床资料,根据手术方式分为睾丸复位固定术组83例,睾丸切除术组90例,采用独立样本t检验、χ^(2)检验、Mann-Whitney U检验法对比2组患儿的发病时长、精索扭转度数和血液学参数等指标,对睾丸切除的危险因素行多因素Logistic回归分析。随访睾丸复位固定术组的83例患儿,术后6个月复查双侧阴囊彩超患儿共30例,分为睾丸萎缩组13例(43.3%),睾丸非萎缩组17例,采用独立样本t检验、Mann-Whitney U检验法比较2组的各项参数,对发病时长为>6-<51 h患儿中差异有统计学意义的指标行受试者工作特征曲线(ROC)分析。结果发病时长(9.3 h比51.0 h)(Z=-8.293,P<0.001)、精索扭转度数(360.0°比540.0°)(Z=-5.267,P<0.001)、平均血小板体积(MPV)(9.8 fL比10.1 fL)(Z=-2.018,P=0.044)和年龄(147.5个月比143.0个月)(Z=-2.165,P=0.030)在睾丸复位固定术组和睾丸切除术组间的差异均有统计学意义。多因素分析提示,发病时长(OR=1.033,P<0.001)、精索扭转度数(OR=1.004,P<0.001)和MPV(OR=1.662,P=0.044)与睾丸丢失均呈正相关。分析发病时长为>6-<51 h的患儿的发病时长、精索扭转度数和MPV的ROC曲线,三者的曲线下面积(AUC)分别为0.753、0.755、0.629。在睾丸萎缩组和睾丸非萎缩组的对比中,组间仅MPV的差异有统计学意义[(10.2±0.5)fL比(9.8±0.5)fL](t=2.426,P=0.022)。ROC曲线分析提示,MPV预测睾丸萎缩的截断值为9.9 fL,敏感性为83.3%,特异性为70.6%,AUC为0.752。结论发病时长、精索扭转度数和MPV可作为术中睾丸活性的预测指标,有助于临床医师术前早期预测和判断睾丸扭转所致的睾丸坏死。此外,43.3%保留了扭转睾丸的患儿在睾丸复位固定术后最终发生了睾丸萎缩,而MPV可能是扭转睾丸保留后发生萎缩的预测指标。     

不同日龄隐睾复位大鼠睾丸组织结构观察

目的 观察不同13龄隐睾复位大鼠睾丸组织结构的变化.方法 72只21 d雄性SD大鼠随机分为单侧隐睾组、双侧隐睾组、假手术对照组各24只.建立单、双侧隐睾动物模型.2周后行隐睾大鼠睾丸下降固定术,于日龄40、60 d处死取睾丸,采用苏木素.伊红染色光镜下观察各组大鼠精曲小管生育力指数(TFI)和平均精曲小管直径(MTD);生物素-dUTP/酶标亲和素法(TUNEL法)检测睾丸生殖细胞凋亡情况.结果 隐睾侧睾丸MTD、TFI显著低于阴囊内睾丸,而隐睾生殖细胞凋亡指数(AI)明显增高于阴囊内睾丸(P＜0.05);单侧隐睾组阴囊内睾丸TFI低于相应日龄的假手术对照组,但无统计学意义(P＞0.05).40 d时单侧隐睾组隐睾侧睾丸生殖细胞AI较双侧隐睾组低(P＜0.05),日龄60 d,各组隐睾侧睾丸AI较40 d时明显降低(P＜0.05),但单侧隐睾和双侧隐睾AI比较无统计学差异(P＞0.05).结论 实验隐睾复位大鼠睾丸AI升高,同时单侧隐睾鼠对侧睾丸组织存在不同程度的损害.随着复位时间的延长,隐睾组织的病理损害有恢复的趋势.     

生脉注射液对青春前期大鼠睾丸扭转/复位缺血再灌注的保护作用

目的观察青春前期大鼠睾丸单侧扭转复位后对双侧睾丸氧自由基的远期影响,探讨生脉注射液对其的保护作用。方法 5周龄健康SD雄性大鼠24只,随机分为实验组(生脉注射液组)、对照组(9 g.L-1盐水组)和假手术组,每组8只。实验组和对照组建立左侧睾丸扭转复位模型,假手术组游离睾丸,不予扭转。于术后7周取各组大鼠双侧睾丸,分别测定大鼠睾丸组织内超氧化物歧化酶(SOD)、一氧化氮合酶(NOS)活性和丙二醛(MDA)水平。结果与对照组比较,实验组和假手术组大鼠双侧睾丸中SOD活性升高,NOS活性和MDA水平下降(Pa<0.05)。与假手术组比较,实验组大鼠双侧睾丸组织中SOD活性下降,NOS活性和MDA水平升高(Pa<0.05)。结论生脉注射液可提高大鼠睾丸组织中的SOD活性,提高机体抗氧化能力,清除氧自由基,抑制脂质过氧化反应,减轻MDA对细胞膜的损伤,对睾丸缺血再灌注损伤具有一定的保护作用。     

Predictors of testicular viability in testicular torsion

AimTesticular torsion (TT) requires prompt diagnosis and treatment to avoid testicular loss. Most studies have focused on the ideal work up to rule TT out in cases of acute scrotum. We attempted here to define objective criteria to select between orchidopexy and orchidectomy in patients undergoing surgery for TT.Patients and methodsFifteen boys with a median age at presentation of 7.8 (range 6.4–12) years undergoing surgical treatment for TT underwent color-Doppler ultrasound (CDU) preoperatively, and a bleeding test intraoperatively. Duration of preoperative history, degree of torsion, CDU findings and degree of bleeding were analyzed.ResultsSalvageability was independent of the degree of torsion. In patients with a history longer than 10 h, no flow on CDU and no bleeding, after orchidectomy all the testicles were necrotic on pathology. When all these variables were negative, all the testicles did well during follow up. In the group of patients with no agreement among the analyzed variables, the outcome was unpredictable. Five out of six underwent orchidopexy, but in two cases the testicle atrophied (in spite of flow on CDU in one).ConclusionsNo predictive parameters were found for testicular salvageability. Taken as a whole, the parameters studied can be of help in treatment choice. In patients with no agreement among the parameters, orchidopexy seems the appropriate option, but parents should be informed of the risk of testicular atrophy during follow up.     

Scrotoshisis,bilateral extra-corporeal testicular ectopia and testicular torsion

Although anomalies of testicular descent are common, scrotoschisis and extracorporeal testicular ectopia is rare with only 3 reported cases in literature. This is a report of a neonate presenting with scrotoschisis and bilateral extracorporeal testicular ectopia. The right testis underwent torsion before presentation, resulting in gangrene of that testis, requiring orchidectomy. The scrotum was explored and the viable left testis placed in the scrotum and fixed in that position. The left testis has remained normal at 9 months of follow up. The possible embryology and management of this curious anomaly is discussed.     

Segmental testicular infarction

Segmental testicular infarction is described in 11-years-old-child presented with acute left hemiscrotal pain and swelling. Clinical examination suggested left testicular tenderness with no evidence of intratesticular mass and the rest of the scrotal contents were normal. Color doppler study suggested a well circumscribed avascular lesion in the upper pole of left testis and provided a clue to diagnosis. Partial orchidectomy resulted in a satisfactory recovery and provided histopathological confirmation of diagnosis. Authors review their experience with this rare entity and the pertinent literature.     

Neonatal testicular torsion

Twenty-six cases of neonatal torsion of spermatic cord were studied and compared to 171 cases reported in the literature. In a few cases, the torsion was antenatal and this may explain some absent testes. Diagnosis is sometimes difficult to make; symptoms were comparable to those in other disorders: peritoneo-vaginal tunnel, testicular inflammation or testicular tumor. In these cases, surgery can make the exact diagnosis although it cannot save the testis even if it is performed early.     

A non-endocrine cause of testicular enlargement mimicking precocious puberty: testicular microlithiasis

Untimely bilateral testicular enlargement greater than 3 ml is suggestive of precocious puberty, in which an underlying organic disease is more common in boys than in girls. We describe a 7 1/2 year-old boy presenting with testicular enlargement due to testicular microlithiasis. Following hormonal tests, diagnosis was based on ultrasonographic findings. Three years follow-up of the patient revealed normal pubertal progress and no malignant evolution. Testicular microlithiasis is a rare cause of testicular enlargement and pediatricians should take this disease into account in the differential diagnosis of suspected precocious puberty.     

Transverse testicular ectopia

Described herein are six cases of transverse testicular ectopia. All patients who underwent orchidopexy at the one pediatric surgical unit between October 2001 and January 2008 were evaluated. The medical records of all patients diagnosed with transverse testicular ectopia were evaluated retrospectively. Five patients (84%) were admitted with a symptomatic right inguinal hernia and empty scrotum on the left side. Only one child (16%) had left‐sided hernia and right non‐palpable testis (age ranged from 1 month to 3 years). Four patients (66%) were diagnosed in the operating theatre and the last two (33%) on inguinal ultrasound preoperatively. Magnetic resonance imaging was also performed in the last patient. Herniorrhaphy with fixation of the ectopic gonad to the opposite hemiscrotum through a transseptal incision was performed in all patients. Postoperative complications were not observed.     

Crossed testicular ectopia

Crossed testicular ectopia is characterized by the presence of both testes in one hemiscrotum. A 7-month-old boy with this condition is described and the relevant literature reviewed. Although this anomaly has been recognized for over 100 years, its etiology is not yet established. The advent of ultrasonography has allowed early diagnosis and therapy in recent years.