腹内型隐睾继发精原细胞瘤MSCT表现与病理分析

目的探讨腹内型隐睾继发精原细胞瘤的MSCT表现,以提高该病诊断准确性。方法分析经手术病理证实的6例腹腔内精原细胞瘤的MSCT征象,包括病变的位置、大小、生长方式,肿块长轴方向、增强供血动脉与引流静脉显示、强化模式及程度。结果6例均为单发腹内肿块,左侧2例,右侧4例。1例位于腹膜后,5例位于腹腔内。平扫肿块密度不均,呈囊实性改变,境界清楚,中央见不规则的低密度坏死区。增强后病灶实性部分均呈轻、中度强化,并呈持续性强化,坏死区未见强化。6例均行CTA检查,其中1例位于后腹膜,CTA见髂外动脉分支供血;5例位于腹腔内,CTA均显示睾丸动脉供血、睾丸回流静脉增粗。1例双侧睾丸缺如;5例单侧睾丸缺如。结论腹内型精原细胞瘤的影像表现有一定的特异性,当CTA显示供血睾丸动脉和增粗引流静脉,结合隐睾病史,可明显提高腹内型隐睾继发精原细胞瘤诊断准确性。     

Androgen and estrogen receptor expression in the spinal segments of the genitofemoral nerve during testicular descent

Aim

During testicular descent (TD), the genitofemoral nerve (GFN) is masculinized by androgen. This study aimed to test whether androgen receptor (AR), estrogen receptorα (ERA), or estrogen receptor β (ERB) are expressed during TD in the GFN spinal segments and dorsal root ganglia (DRG) in normal and flutamide-treated rats.

Methods

Time-mated Sprague-Dawley dams were injected with flutamide (75 mg/kg, subcutaneously (S/C) in sunflower oil) on embryonic (E) days 16 to 19. Embryonic and postnatal (P) male L1-2 spinal cord segments were collected (E16, E17, E19, P0, P2, and P4) in control and flutamide-treated groups (n = 5-10). Samples were fixed in 4% paraformaldehyde. Five-micrometer-thick sections were prepared immunohistochemically for AR, ERA, and ERB.

Results

During TD, ERB was expressed in L1-2 DRG. Surprisingly, AR was not expressed in prenatal DRG, only after P2. There was no ERA expression. Flutamide had no effect on AR, ERB, or ERA expression in the L1-2 DRG during TD.

Conclusion

During the E window of androgen sensitivity, the GFN is not directly masculinized, with little AR expression and no change with flutamide over this period. Estrogen receptor β is expressed in the DRG during TD. However, its relevance is yet to be determined.     

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.     

超声诊断睾丸微石症与睾丸相关疾病的关系研究

目的探讨睾丸微石症(testicular microlithiasis,TM)与睾丸相关疾病的关系。方法回顾性分析6 622例有阴囊症状、经阴囊超声检查发现睾丸微石症(TM)患者的临床资料。结果检出率为3.35%,其中双侧为多,占比为89.1%,TM组与非TM组中睾丸附睾炎的发生率分别为13.45%,14.09%,2组比较P为0.82,x2为0.051,隐睾发生率分别为2.70%,2.37%,2组比较P为0.753,x2为0.098,差异无统计学意义;TM组与非TM组精索静脉曲张发生率分别为49.5%,40.21%,2组比较P为0.0053,x2为7.75,2组差异有统计学意义。结论睾丸微石症发生率不低,其为常见病,其与睾丸附睾炎、隐睾无明确相关关系,而与精索静脉曲张明显相关,超声检查是睾丸微石症确诊和随访的主要工具。     

经阴囊单切口与腹股沟阴囊双切口睾丸下降固定术的对比研究

目的 比较经阴囊皮纹单切口(Bianchi术)与传统经腹股沟及阴囊双切口睾丸固定术治疗儿童低位隐睾的临床疗效、微创优势及适应证选择. 方法 回顾性研究2006年3月至2011年5月72例(78侧)行睾丸下降固定术的隐睾患儿资料,患儿均能在麻醉状态下将睾丸推出外环口及以下.以年龄相差不超过3个月、术前睾丸位置相同、术者相同、隐睾侧别相同为配对条件,采用1:1配对分组的方法将患者分为Bianchi术(A组)和经传统腹股沟及阴囊双切口睾丸下降固定术(B组),两组均为36例39侧.平均年龄为5.4岁(A组)、5.5岁(B组).比较两组平均手术时间、平均恢复站立活动时间、术后并发症、手术成功率. 结果 72例手术均顺利完成.两组平均手术时间分别为33、41 min,差异有统计学意义(P =0.0022).平均恢复站立活动时间分别为1.2、5.4d,差异有统计学意义(P=0.0003).随访3～ 65个月,两组均未发生睾丸萎缩、睾丸回缩、腹股沟斜疝、鞘膜积液等并发症. 结论 Bianchi术具有手术时间短、创伤小、术后痛苦小、恢复快、美容等优势,可用于治疗麻醉状态下能将睾丸推出外环口及以下的隐睾.     

Assessment of referral patterns for boys with suspected undescended testes and identification of risk factors to aid diagnosis

IntroductionUndescended testis (UDT) is a clinical diagnosis and a common reason for referral to paediatric urology outpatients. Our aim was to assess current referral patterns at our unit and to identify predictive factors that may better aid primary care physicians (PCP) in diagnosing UDT based on history and physical exam.MethodsA retrospective analysis of referrals to outpatients from 2014 to 2016 was performed to assess current referral patterns including referral source, age, reason for referral and outcome following assessment by a single consultant paediatric urologist.A prospective analysis of new referrals was performed to identify predictive factors which may aid in the diagnosis of UDT including gestational age, presence of scrotal asymmetry and previously obtained imaging.ResultsFrom 2014 to 2016, 259 boys were referred with suspected UDT. The majority of referrals were received from PCPs (62%) followed by Neonatology (29%), Paediatrics (8%) and general surgery (1%). Median age at time of assessment was 29 (5–180) months. One hundred and eight (41.7%) boys were diagnosed with UDT.There were 74 boys assessed prospectively. Median age at assessment was 24.5 (6–171) months. We identified 3 predictors of a diagnosis of UDT; history of prematurity (p = 0.001), UDT mentioned to the parents at birth (p = 0.027) and scrotal asymmetry on examination (p < 0.001). Greatest diagnostic inaccuracy was found in boys referred beyond one year of age (27.7%). In this cohort, the absence of all three risk factors was associated with a negative predictive value of 94.1%.ConclusionThe majority of boys with suspected UDT are referred beyond the age recommended for orchidopexy (6–12 months). The majority of boys referred for assessment did not have UDT. We have identified three predictive factors that may aid referring physicians when assessing boys, particularly those older than 1 year.     

血清抗苗勒管激素和血清抑制素B水平对隐睾症患者睾丸功能评价的意义

目的探讨血清抗苗勒管激素(AMH)和血清抑制索B(INH-B)对隐睾症患者睾丸功能评价的意义。方法采用酶免疫吸附试验(ELISA)检测2018年11月至2019年7月本院收治的53例隐翠症患儿的INH-B及AMH水平(设为病例组),其中单侧隐翠患儿31例(右侧隐睾19例,左侧隐睾12例),双侧隐睾患儿22例。年龄(55.0±3.5)个月。另随机选取51例正常男性儿童作为对照组,年龄(54.6±2.7)个月。两组在术前及术后6个月时随访测定血清AMH和INH-B以及相关发育参数。分析比较各组之间和手术前后血清激素水平差异。结果两组除睾丸体积参数外的其余生殖器发育相关参数比较,差异均有统计学意义(P<0.05)。单侧隐睾与双侧隐翠患者的血清INH-B值[(71.36±6.80)pg/mLvs.(68.08±7.10)pg/mL]和AMH值[(115.44±8.90)ng/mL vs.(110.32±9.10)ng/mlL]比较,差异有统计学意义(P<0.05)。两组术前检测血清INH-B值,分别是(69.97±7.50)pg/mL和(75.15±6.30)pg/mL,差异有统计学意义(P<0.05)。两组术前检测血清AMH值,分别是(113.32±9.30)ng/ml,(127.80±8.7)ng/mL,差异均有统计学意义(P<0.05)。病例组术后6个月随访时检测血清INH-B值为(72.81±6.80)pg/mL,血清AMH值为(119.79 ± 7.3)ng/mL;与术前血清AMH.INH-B水平比较,差异均有统计学意义(P<0.05)。结论血清AMH和INH-B水平可作为评估隐睾症患者评估睾丸功能的可靠指标,并且能评价睾丸固定术后睾丸功能恢复情况。     

Transscrotal orchidopexy: orchidopexy revised

In a study of 120 orchidopexies for palpable undescended testes, the observation of Schuller [9] and Bevan [1, 2] that most testicular undescent was associated with a shorter than normal processus vaginalis was confirmed. Division of the processus vaginalis allowed 1.5–3.5 cm of further testicular descent. The testicular vascular pedicle was always long enough to allow tension-free placement of the testis in an ipsilateral extradartos pouch except in those testes that had been retained at a high level within the inguinal canal. It is proposed that the majority of orchidopexies for palpable undescended testes should commence with a scrotal incision, and that an additional groin incision and retroperitoneal vascular pedicle mobilisation be reserved for the few high testes that will not otherwise reach the scrotum. The technique has the advantage of a single incision, much less dissection and disruption of tissue, greater comfort for the day-case child, rapid healing with excellent cosmesis, and a well maintained testicular position in the scrotum. The high scrotal incision allows such easy direct access to the processus vaginalis and external inguinal ring that we also recommend this approach for routine inguinal herniotomy in children. Offprint requests to: A. Bianchi     

Early medical and surgical treatment of cryptorchidism: clinical,anatomic, and histologic findings

In 56 boys more than 6 month of age with cryptorchidism, luteinizing hormone releasing hormone (LHRH) was administered as a nasal spray 1.2 mg/day for 4 weeks. The nonresponders received human chorionic gonadotropin (HCG) 500 IU i.m. three times a week for 3 weeks. With the combined treatment, 46.5% of testes descended into the scrotum. Testicular descent occured more often in patients whose testes were located in a lower position. The initial position of the testes at clinical examination correlated significantly with the position at surgical inspection and the extent of epididymal malformation: the higher the clinical position of the testes, the more pronounced the maldescent and epididymal malformation. Histological findings indicated a paucity of germinal epithelium and atrophy of the Leydig cells. A significant inverse correlation existed between age at surgery and number of spermatogonia. Therefore, we advocate the earliest feasible treatment for cryptorchidism with a combination of LHRH and HCG, and for non-responders a surgical corrective procedure.     

Success and Relapse Rate after Treatment of Cryptorchidism with Intranasal LHRH

In a collaborative study 119 cryptorchid prepubertal children with 67 unilaterally and 104 bilaterally undescended testes were treated for four weeks with intranasal LHRH 1.2 mg daily. The age range was 1 1/12 to 12 3/12 2 years with a median of 3 10/12 years. Complete descent was observed in 64 testes (37 %) and partial descent in another 47 testes (27 %). Positive responders were equally distributed in all age groups. At a follow-up of 57 patients at least six months after the end of treatment, 40 % of the previously fully descended testes were found at higher locations, more than half at the scrotal neck. We conclude that LHRH therapy for cryptorchidism is effective and without any major side-effects. It may be particularly useful in children of one to three years of age where hCG is practically useless and surgical repair is the only alternative to date. However, efforts should be directed towards elaboration of treatment schedules which would avoid the high relapse rate.