儿童隐睾伴附睾畸形的新分类探讨

目的 :探讨隐睾伴附睾畸形的新分类及治疗措施。　方法 :隐睾组患儿 15 3例 ,睾丸鞘膜组患儿 14 4例。术中通过观察睾丸附睾间位置关系 ,测量附睾长度 ,触摸有无附睾闭锁、输精管缺如、附睾及输精管梗阻 ,将隐睾伴发附睾畸形分为输精道管有梗阻型 (Ⅰ型 ) ,再细分为 ⅠA、ⅠB、ⅠC三组 ;输精管可能有梗阻型 (Ⅱ 型 ) ,包括 ⅡA、ⅡB2组 ;输精管无梗阻型 (Ⅲ 型 )分成 ⅢA、ⅢB 2组。　结果 :隐睾组共 2 0 1个睾丸 ,伴发附睾畸形 4 7个 ,畸形率2 3.4 %。双侧隐睾 4 8例 ,11例发生附睾畸形 ,且双侧为同一类型 :ⅠB 2例 ,ⅠC 2例 ,ⅡA 1例 ,ⅢA 4例 ,ⅢB 2例 ,行睾丸固定或切除术。睾丸鞘膜积液组共 15 5个睾丸 ,伴发附睾畸形 16例 ,畸形率 10 .3%。两组附睾畸形率差异有显著性 (P <0 .0 5 )。　结论 :隐睾伴发附睾畸形的发病率高于正常睾丸 ,对严重附睾畸形的双侧隐睾不应都行睾丸切除术。

Discussion of New Classification of Epididymal Malformation in Cryptorchidism of Children

OBJECTIVES: To discuss the new classification of epididymal malformation in cryptorchidism. METHODS: One hundred and fifty-three boys who were two to four year old underwent orchidopexy for cryptorchidism and 144 hydroceles who were two to eight year old were enrolled into control. Based on the observation of the status between testis and epididymia, the length of epididymis and the configuration of epididymis as well as spermaduct, we divided epididymal malformations in cryptorchidism into three types. Type I: obstruction of sperm transport, including I A, I B and I C; Type II: possible obstruction of sperm transport, defined by II A and II B; Type III: no obstruction of sperm transport, classified into III A and III B. RESULTS: There were 47 (23.4%) out of 201 undescended testes with malformation of epididymides and 16 (10.3%) out of 155 testes in the control(P < 0.05). 11 of 48 cases of bilateral cryptorchidism had the same malformations, with 2 cases of type IB, 2 of IC, 1 of II A, 4 of III A and 2 of IV B underwent orchidopexy or orchiectomy. CONCLUSIONS: These data showed that the incidence of epididymal abnormalities in cryptorchidism was higher than that in the hydroceles and it's not essential to have orchiectomy unlimitedly to serious epididymal abnormalities.