青春期营养性肥胖大鼠睾丸生精细胞周期的变化

目的探讨青春期营养性肥胖大鼠的睾丸生精细胞周期的变化。方法80只新生的雄性清洁级SD大鼠随机分为两组,对照组(n=32只)喂普通饲料,肥胖组(n=48只)喂高脂饲料,分别于喂养后的第3、4、5、6周末观察喂养后体重,计算Lee’s指数,流式细胞分析术检测睾丸生精细胞周期的改变。结果与对照组比较,肥胖组大鼠第3周开始体重有显著性增加(P<0.05),6周内体重持续上升,至第6周末肥胖组大鼠体重超过对照组达26.6%(P<0.01),Lee’s指数随着大鼠肥胖程度的增加而逐渐增高;大鼠G0/G1期细胞在高脂饲料喂养第3周末增多(P<0.05)、肥胖组S期细胞显著下降(P<0.01),此时处于G2/M期细胞的百分数明显增多(P<0.05)。结论青春期时的肥胖可以引起睾丸生精细胞S期细胞百分数逐渐减少,出现G2期细胞阻滞,细胞有丝分裂延迟。     

大鼠睾丸扭转复位后附睾唾液酸含量变化及意义

目的 :探讨大鼠睾丸扭转 2h和 4h复位后 2 4h附睾唾液酸含量的变化和意义。　方法 :用 2 4只雄性SD大鼠建立左侧睾丸扭转复位模型 ,分为对照组、扭转 2h组和 4h组 ,每组 8只。 5 甲基苯二酚法检测扭转侧附睾唾液酸的含量。　结果 :睾丸扭转 2h复位后 2 4h扭转侧附睾唾液酸含量 [(2 3.385± 9.2 2 0 )mg/mgprot]改变不明显 ;睾丸扭转 4h复位后 2 4h附睾唾液酸含量 [(13.72 5± 7.80 1)mg/mgprot]下降明显 (P <0 .0 5 )。　结论 :睾丸扭转 2h复位后 2 4h附睾分泌唾液酸功能不受影响 ,扭转 4h复位后 2 4h附睾分泌唾液酸功能下降 ;附睾耐受缺血再灌注损伤的时间可能较长。     

IDEAL序列在营养性肥胖男童睾丸脂肪含量评估中的应用

目的 探究IDEAL序列的同相或反相位成像技术在营养性肥胖男童睾丸脂肪含量评估中的价值.方法 共有43人进入研究,包括营养性肥胖的男童30例,年龄7～15岁,平均年龄11.4岁,体质量正常的男童13例,年龄7～16岁,平均年龄11.8岁.再分别按年龄分为10岁及以下组和10岁以上组.所有研究对象测量身高、体质量,计算体质景指数(BMI).用IDEAL序列进行同相或反相位成像,计算睾丸的脂肪信号强度(FSF).结果 肥胖男童的睾丸脂肪信号强度大于体质量正常男童.结论 MRI IDEAL序列的应用作为一种无创性的影像学检查方法,对临床肥胖男童的睾丸脂肪浸润评估提供了客观的依据.     

睾丸间质细胞瘤患者睾丸中锌稳态变化的情况及意义

睾丸间质细胞瘤(testicular interstitial cell tumor)是一种少见的睾丸间质细胞肿瘤,它起源于睾丸间质细胞即Leydig细胞.锌是机体的必需微量元素,是细胞内许多重要蛋白质的辅基.     

儿童睾丸横跨异位的临床诊治分析及文献复习

异位睾丸畸形是指睾丸在发育下降过程中,受多种因素如睾丸引带发育异常、机械性梗阻、雄激素分泌异常等因素影响而异位附着于腹前壁皮下、耻骨部、股部以及对侧腹股沟、阴囊等部位[1],其中睾丸横跨异位(transverse testicular ectopia,TTE)是异位睾丸的特殊类型,临床罕见.现将我院近5年间收治的9例T...     

52例儿童睾丸肿瘤的临床特点分析

目的:探讨儿童睾丸肿瘤的临床特点、诊治方法及预后.方法:回顾性分析我院2015年6月—2018年12月收治的52例儿童睾丸肿瘤患者的临床资料,年龄2个月～13岁,平均4.3岁.发病时间1 d～3年,平均2个月,术前阴囊彩色多普勒超声检查示睾丸肿瘤直径0.5～7 cm,平均1.5 cm.腹盆腔CT或MRI检查均未见异常....     

64例儿童睾丸畸胎瘤病例分析

目的:分析儿童睾丸畸胎瘤的诊断与治疗,旨在提高其临床诊治水平。方法:回顾性分析本院1995~2014年收治的64例儿童睾丸畸胎瘤的临床资料。结果:61例以无痛性阴囊包块就诊,查体均有沉重感;3例因阴囊空虚诊断为隐睾时发现。术前46例甲胎蛋白(AFP)明显升高,18例AFP值正常。超声检查提示异常混杂回声区,内有钙化成分或液化坏死。阴囊X片检查28例有点片状、弧形高密度影。40例于我院行睾丸肿瘤剜除术(TSS),1例院外手术,20例行高位瘤睾切除术,3例放弃手术治疗。病理检查成熟畸胎瘤均可见成熟的3个胚层,未成熟畸胎瘤可见原始神经管等未成熟胚层成分。60例手术患儿中11例为不成熟畸胎瘤,49例成熟畸胎瘤。成熟畸胎瘤术后无需化疗,未成熟畸胎瘤术后采用顺铂+依托泊苷+博来霉素(Cisplatin,Etoposide,Bleomycin,PEB)方案化疗。随访2年均未见复发或转移。结论:儿童睾丸畸胎瘤多因无痛性阴囊包块就诊,查体包块有沉重感;AFP多有异常,超声及阴囊平片对诊断有一定帮助。手术方案主要为TSS,术中冰冻能协助术者选择手术范围。成熟畸胎瘤术后无需化疗,未成熟畸胎瘤术后应配合化疗。     

儿童睾丸扭转360°以内10年回顾性分析

目的:睾丸扭转处理不及时可导致睾丸坏死,睾丸扭转的损伤程度与扭转度数和扭转时间均有关系,本研究通过对睾丸扭转360°的患儿的病史特点、体格检查结果、实验室和超声检查进行了分析,以期提高对睾丸扭转360°临床认识并对其预后进行预测。方法:回顾性分析2007年1月至2017年1月华中科技大学同济医学院附属武汉儿童医院被术中证实为睾丸扭转患者。根据纳入及排除标准所有患儿被分为两组,A组(n=26)睾丸扭转度数360°者,B组(n=47)睾丸扭转度数≥360°。通过医院的医疗信息管理系统,整理这些病例的临床资料,对这些患儿的临床特点和治疗进行描述性分析。结果:A组的患儿平均年龄中值为2.4岁,B组为11.2岁,A组的发病年龄显著小于B组(P0.01)。A组发病时间明显长于B组[(80±12)h vs(12±6)h,P0.01];A组睾丸丢失率明显低于B组(12.0%vs 91.1%,P0.01)。结论:儿童睾丸扭转度数360°者以2～3岁发病为主,病程时间长,但术后睾丸存活率高,彩色多普勒检查提示血流信号减少对其有重要诊断价值。     

Measurement error of DXA: interpretation of fat and lean mass changes in obese and non-obese children.

Information on reproducibility of dual-energy X-ray absorptiometry (DXA) measurements is essential because DXA is frequently used by clinicians and researchers to assess body composition changes. We estimated measurement error and absolute and relative smallest detectable differences (SDDs) for fat, lean, and bone mass in children. The SDD is the change necessary to be confident that the change is not a consequence of measurement error. Duplicate whole body DXA (Hologic QDR 4500A, Hologic Inc., Waltham, MA) scans were obtained on 32 obese and 34 non-obese children ages 6-19 yr. Absolute (kg) and relative (coefficient of variation) measurement error and SDD were calculated. Absolute SDDs for fat and lean were higher for obese (1.39 and 1.30 kg, respectively) than for non-obese children (0.42 and 0.47 kg, respectively). The %SDD for fat was lower for obese (3.58%) than non-obese children (5.24%), but for lean the %SDD was higher for obese (2.60%) than non-obese children (1.32%). The SDDs for bone mass were similar for obese and non-obese children. An obese child must lose or gain more absolute fat and lean mass than a non-obese child to be confident that the change is not a reflection of measurement error. Overall, SDD values for fat, lean, and bone mass are low.     

Clinical features of testicular tumors in children

AIM: Testicular tumors are not common pediatric solid tumors, especially in Asian children. There have been few reviews of cases in Japan to date. We present the clinical features of 14 pediatric testicular tumor patients. METHODS: Clinical features of 14 testicular tumor patients, such as chief complaints, age at diagnosis, pathology, stages, treatments and prognosis, were examined from medical records. Two patients had their semen tested at adolescence. RESULTS: Of the 14 prepubescent patients, 12 (85.7%) patients were diagnosed before 3 years of age. Ten cases (71.4%) were diagnosed as yolk sac tumors, three (21.4%) as mature teratomas and one case as an epidermoid cyst. Nine cases (90.0%) among the 10 cases of yolk sac tumor were diagnosed as stage I and one case was stage IV. One stage I yolk sac tumor patient developed lung metastasis later. Eventually, two yolk sac tumor patients died, despite chemotherapy. While all the cases with a diagnosis before 2 years of age survived, 67% (2/3) of cases with a diagnosis after the age of 2 died of tumors. Semen analysis in two patients showed normospermia. CONCLUSION: In the present study, the most common testicular tumors were yolk sac tumors and the patients diagnosed before 2 years of age showed favorable results. Age could be a relapse risk factor in yolk sac tumors. Guidelines for handling testicular tumors in children is not yet well established in Japan. An organized system seems necessary to gather and accumulate the results of the cases in Japan in order to develop better guidelines for treatment.     

Ultrasonographic gastric antral area and gastric contents volume in children

Background: Cross‐sectional gastric antral area (GAA) measurements by ultrasonography (US) have been proposed for preoperative assessment of gastric volume in adults but not been validated in children. This study investigates whether in children gastric volumes can be predicted by US performed in different patient positions. Method: Gastric fluid and air volumes were examined by magnetic resonance imaging before or up to 120 min after ingestion of 7 ml·kg^?1 diluted raspberry syrup in healthy volunteers who had fasted overnight. GAA was measured with US three times each in supine (SUP), elevated 45° degree supine (E45) and right decubital (RDC) position using imaging planes defined by vascular landmarks. Correlation coefficients (Pearson) between GAA and gastric volumes were calculated and Bland–Altman analysis performed. Results: Sixteen children aged from 6.4 to 12.8 (9.2) years were included in 23 examinations: 6 after overnight fasting, 3 directly after, and 14 with a delay of 74 ± 35 min after fluid intake. GAA was 221 ± 116, 218 ± 112, and 347 ± 188 mm² for SUP, E45, and RDC position, respectively. The best correlation between body weight corrected total gastric/gastric fluid volume (TGV_w/GFV_w) with GAA was found for RDC position (R = 0.79; P < 0.01/R = 0.78; P < 0.01). Bias and precision of calculated and measured GFV_w was 0 ± 2.8 ml·kg^?1. Conclusion: Correlations between GAA and TGV_w or GFV_w in children are best in the RDC position, but not sufficient to predict GFV_w with a given GAA. Interpretation of isolated GAA values may be misleading.     

Clinical significance of unilateral testicular obstruction in subfertile males

Unilateral testicular obstruction has been defined by exploratory scrototomy in 80 spontaneously infertile males. The most common sites of obstruction were either in the tail of the epididymis after previous infection (40 cases) or in the vas deferens due to congenital absence or after previous infection or surgery (24 cases). Half of the patients had severe oligozoospermia (less than 5 million/ml) and three-quarters had developed antisperm antibodies, often in high titres. Spermatogenesis was shown by testicular biopsy to be normal (Johnsen score-count greater than 8.0) in almost all of the obstructed testes, and serum FSH levels were normal. Following surgical reconstruction, with prednisolone therapy if indicated by high antisperm antibody titres, 19 (32%) of 60 patients with adequate follow-up successfully impregnated their female partners, with the best results occurring in 30 men who started with sperm counts less than 5 million/ml, 12 of whom (40%) were successful. Removal of irreparably blocked testes in 10 men led to profound falls in high antisperm antibody titres, with production of two pregnancies. Unilateral testicular obstruction appears to be a correctable cause of infertility in some human males.     

肾移植对慢性肾功能不全尿毒症期患者睾丸体积及生育力指数的影响

目的 探讨肾移植对男性慢性肾功能不全尿毒症期患者睾丸体积及生育力指数的影响.方法 解放军第117医院肾移植中心30例慢性肾功能不全尿毒症期患者于肾移植术前以及术后1个月、3个月和1年应用彩超进行睾丸体积监测,并与20名正常男性的睾丸体积比较.另检测40例尿毒症期和40例肾移植受者的精液,并根据公式[精子密度(×106/mL)×精子活动力×精子正常形态率]计算出生育力指数.结果 慢性肾功能不全尿毒症期患者的睾丸体积术前左侧为(6.82±1.49)mL, 右侧为(7.46±1.89)mL;肾移植术后1个月、3个月和1年左侧分别为(8.25±1.67)mL、(9.31±1.56) mL和(9.80±1.51)mL,右侧分别为(9.18±1.76) mL、(10.41±1.43) mL和(11.09±1.45)mL,肾移植受者术后1个月、3个月和1年的睾丸体积均大于尿毒症期患者,差异有显著性意义(均P<0.01).正常对照组生育力指数为13.03(14.26),肾移植受者的生育力指数为7.19(10.18), 而尿毒症期患者的生育力指数仅为0.23(0.76).尿毒症期患者的生育力指数比肾移植受者和正常对照组均小,差异有显著性意义(均P<0.01). 结论 慢性肾功能不全尿毒症期患者睾丸体积缩小,生育力指数下降, 而成功的肾移植可以明显改善尿毒症期患者的睾丸体积及生育力指数.     

儿童睾丸不全扭转的临床特点

目的:分析儿童睾丸不全扭转的临床特点,以提高对睾丸不全扭转的临床认识。方法:回顾性分析2007年4月至2017年4月收治的37例睾丸不全扭转患儿的临床资料,对患儿的病史特点,体格检查、实验室和超声检查结果,治疗结果进行分析。结果:37例患儿中位数年龄为5.7(1～14)岁,高发年龄2～4岁和12～14岁;病程时间12～96 (48±8)h。术前彩色超声检查,31例(83.8%)显示患侧睾丸内可见血流信号,但血流信号较健侧减少,6例(16.2%)睾丸内血流信号正常,但睾丸呈横位。术中逆时针扭转27例(72.9%),顺时针扭转10例(27.1%);7例(18.9%)扭转90°,20例(54.0%)扭转180°,10例(27.1%)扭转270°;31例(83.8%)为睾丸鞘膜内扭转,6例(16.2%)为睾丸鞘膜外扭转;根据Arda "睾丸组织出血3级评分系统",16例(43.3%)患儿睾丸评分为I级,21例(56.7%)为II级;37例患儿术中均予以保留患侧睾丸。术后随访1年,6例(16.2%)患儿出现睾丸萎缩。结论:儿童睾丸不全扭转发病年龄小,扭转度数全部360°(以扭转180°为主),术后睾丸存活率高是其临床特点,术前彩色多普勒检查提示睾丸血流信号减少对其有重要诊断价值。     

Evaluation of preoperative testicular volume in Japanese children with unilateral cryptorchidism

Objectives  We measured the testis volume of patients with unilateral cryptorchidism preoperatively and compared with a unilateral hydrocele testis to assess testicular development in these patients. Patients and methods  The present study included 129 children (ranging in age from 10 months to 5 years) with unilateral cryptorchidism who were treated from 2000 to 2006 at our institution. We evaluated the correlation between testicular volume and the location of testes or the age of these children. We also examined the testicular volume of 50 children with unilateral hydrocele testis (range, 8 months to 5 years). Results  There was no difference in testicular volume among each position of the undescended testis. The volumes of both undescended testes and hydrocele testes did not change until 5 years of age. There was a significant difference in testicular volume between undescended and hydrocele testes. The average testicular volume of cryptorchidism is significantly smaller than that of hydrocele testes both under and over 2 years old. Conclusions  From the viewpoint of undescended testicular volume, cryptorchid children should be operated on as early as possible.     

儿童与成人单纯性睾丸卵黄囊瘤临床特点对比分析

目的:通过对比儿童与成人单纯睾丸卵黄囊瘤的特点,提高睾丸卵黄囊瘤的诊疗水平。方法:选取2008年5月至2018年7月病理确诊的单纯性睾丸卵黄囊瘤75例患者为研究对象,其中64例患者年龄18岁设为儿童组,11例患者年龄≥18岁设为成人组。回顾性分析所有患者的临床资料,比较两组患者临床表现、实验室检查、病理学表现、临床分期、治疗方案及预后。结果:儿童组年龄6个月至5岁[(1.38±0.89)岁],肿瘤大小0.9～6.0(2.48±1.12) cm;成人组年龄25～49岁,中位年龄34(29,46)岁,肿瘤大小3.5～6.3(5.16±1.32) cm;两组最常见的就诊原因为患侧睾丸无痛性肿大,4例(6.3%)儿童,5例(45.5%)成人以睾丸疼痛就诊。儿童与成人组肿瘤直径及首诊表现差异有统计学意义(P0.05)。所有患者均行根治性高位精索离断式睾丸切除术,儿童组24例行化疗,1例行腹膜后淋巴结清扫术(RPLND);成人组5例行化疗,3例行RPLND。所有患者术前甲胎蛋白(AFP)均不同程度升高。病理结果示肿瘤细胞小,核仁明显,胞质多空泡,形态不规则,细胞排列疏松,细胞内外可见透明小体。10例患者失访,余65例随访10～78(52.00±23.78)个月;儿童组2例单纯转移,3例单纯复发,3例复发伴转移,5例死亡;成人组5例单纯转移,1例单纯复发,1例复发伴转移,4例死亡。结论:成人与儿童睾丸卵黄囊瘤在临床表现、生物学行为、治疗、预后等方面有很大区别。儿童睾丸卵黄囊瘤患者多为临床I期,首选根治性睾丸切除术,预后良好;成人患者恶性程度较高,易复发和转移,预后较差,应联合根治性睾丸切除术、RPLND及化疗等治疗方式。