睾丸横过异位的临床诊治及分析
发布时间：2019-06-19 07:54
【摘要】：背景睾丸横过异位(transverse testicular ectopia,TTE)是泌尿生殖系统一种罕见的先天性疾病,是指双侧睾丸下降过程中同时进入一侧腹股沟管,双侧睾丸位于同侧腹股沟区或阴囊内。睾丸横过异位常以阴囊空虚或腹股沟肿物为主诉入院,因无特征性的临床表现,术前常不能明确诊断,而诊断为隐睾或腹股沟斜疝,行手术治疗才得以发现。文献中对异位睾丸的局部解剖特点报告不同,导致对睾丸横过异位的病因及机制的阐述各种各样,尚无统一的认识。因睾丸横过异位保守及药物治疗无效,发现后及早治疗可降低睾丸退行性变及睾丸肿瘤的发生率,且可永久性改善外观缺陷,故多建议及早行手术治疗。现存的手术方式较多,但各有优势及缺点。既往国内外相关文献均侧重于病例报告,而无详尽的统计分析结果。本研究对国内外所报告的睾丸横过异位病例进行统计,以了解睾丸横过异位的一般特征。研究目的本研究针对睾丸横过异位的病因及发病机制、临床表现、辅助检查、病理学特点、诊断及鉴别诊断、治疗及预后进行分析阐述,以提出一个可供临床医师参考的诊疗体系。材料与方法回顾性分析2000年7月至2017年1月于郑州大学第一附属医院诊治的睾丸横过异位13例,1982年4月至2016年6月我国报道的睾丸横过异位108例,1960年1月至2017年1月国外所报道的睾丸横过异位154例,分析其临床表现、影像学检查、实验室检查、手术治疗及预后情况。具体资料如下:⑴一般资料:(1)我院:就诊年龄2个月到27岁,平均年龄7.92±9.38岁。(2)国内:就诊年龄4天到69岁,平均年龄14.87±14.18岁。(3)国外:就诊年龄15天到65岁,平均年龄9.39±9.74岁。⑵临床表现:(1)我院:阴囊空虚10例(77%),腹股沟或阴囊肿物9例(69%),婚后不育1例(8%),斜疝术中发现睾丸异常1例(8%)。(2)国内:阴囊空虚64例(59%),腹股沟或阴囊肿物56例(52%),不育9例(8%)。(3)国外:阴囊空虚85例(63%),腹股沟或阴囊肿物99例(73%),不育6例(4%)。(3)合并症:(1)我院:腹股沟斜疝9例(69%),苗勒管持续综合征5例(38%),鞘膜积液2例(15%),睾丸附睾分离2例(15%),尿道下裂1例(8%),不育症1例(8%)。(2)国内:腹股沟斜疝48例(44%),苗勒管持续综合征28例(26%),睾丸附睾分离10例(9%),不育症9例(8%),鞘膜积液8例(7%),睾丸肿瘤3例(3%),异位睾丸扭转3例(3%),尿道下裂2例(2%)。(3)国外:腹股沟斜疝90例(74%),苗勒管持续综合征39例(32%),睾丸附睾分离1例(0.8%),鞘膜积液5例(4%),睾丸肿瘤10例(8%),尿道下裂4例(3%),不育症8例(7%)。(4)影像学检查:(1)我院:超声检查13例,CT检查2例,MRI检查3例。(2)国内:超声检查59例,CT检查17例,MRI检查3例。(3)国外:超声检查61例,CT检查7例,MRI检查18例。(5)实验室检查:(1)我院:染色体核型检查7例,性激素检查6例,精液检查2例。(2)国内:染色体核型检查21例,性激素检查17例,精液检查9例。(3)国外:染色体核型检查35例,性激素检查10例,精液检查5例。结果(1)影像学检查:(1)我院:超声检查13例,明确诊断10例(76%);CT检查2例,明确诊断2例(100%);MRI检查3例,明确诊断2例(67%)。(2)国内:超声检查59例,明确诊断38例(64%);CT检查17例,明确诊断14例(82%);MRI检查3例,明确诊断3例(100%)。(3)国外:超声检查61例,明确诊断31例(51%);CT检查7例,明确诊断4例(57%);MRI检查18例,明确诊断12例(67%)。(2)实验室检查:(1)我院:染色体核型检查7例,均提示46,XY;性激素检查6例,均正常;精液检查2例,无精子1例,精子活性差1例。(2)国内:染色体核型检查21例,均为46,XY;性激素检查17例,正常13例;精液检查9例,精子活力差6例,无精子2例,精子正常1例。(3)国外:染色体核型检查35例,正常33例;性激素检查10例,正常9例;精液检查5例,正常2例。(3)手术方式:(1)我院:跨阴囊纵隔睾丸固定术7例(54%),睾丸复位固定术4例(31%),双睾丸同侧阴囊固定术1例(8%),未行手术治疗1例(8%)。腹腔镜辅助手术治疗5例。(2)国内:跨阴囊纵隔睾丸固定术33例(31%),睾丸复位固定术18例(17%),睾丸固定术4例(4%,具体不详);双睾丸同侧阴囊固定术13例(12%),睾丸切除术15例(14%),精索动静脉切断术2例(2%),未行手术治疗9例(8%),手术方式不详14例(13%)。腹腔镜辅助手术治疗17例。(3)国外:跨阴囊纵隔睾丸固定术66例(43%),睾丸复位固定术12例(8%),睾丸固定术26例(17%,具体不详),双睾丸同侧阴囊固定术3例(2%),腹膜外睾丸固定术5例(3%),睾丸切除术16例(10%),精索动静脉切断术2例(1%),未行手术治疗2例(1%),手术方式不详22例(14%)。行腹腔镜辅助手术治疗42例。(4)预后:(1)我院:行跨阴囊纵隔睾丸固定术1例后伴发睾丸附睾炎;行双睾丸同侧阴囊固定术1例术后一侧阴囊发育差;未行手术治疗1例仍在观察中;余行手术治疗10例预后好。行腹腔镜辅助手术治疗预后较好。(2)国内:术后睾丸萎缩7例,睾丸恶变1例,伴发睾丸附睾炎1例。行腹腔镜辅助手术治疗预后好。(3)国外:睾丸萎缩1例,睾丸恶变1例,死亡1例。结论1.阴囊空虚患者除应检查正常睾丸下降途径外,还需检查睾丸异位常见部位。2.睾丸横过异位缺乏特征性的临床表现,明确诊断需要详细的体格检查,超声、CT、MRI可协助诊断。3.手术治疗是睾丸横过异位唯一的治疗方法,可选用腹腔镜辅助跨阴囊纵隔睾丸固定术。
[Abstract]:Background: TTE is a rare congenital disease of the genitourinary system. It refers to the simultaneous access to one side of the inguinal canal in the two-sided testicle descending process, and the bilateral testis is located in the same ipsilateral inguinal region or the scrotum. Testicular cross-heterotopic heart is usually admitted to the hospital due to the empty or inguinal swelling of the scrotum. Because of the non-characteristic clinical manifestation, the diagnosis can not be clearly diagnosed before the operation, and the diagnosis is the cryptorchidism or the inguinal hernia, and the operation of the operation can be found. In the literature, the local anatomic characteristics of the ectopic testis are reported to be different, which leads to a wide range of explanation of the causes and mechanisms of the testis crossing the ectopic testis, and there is no unified understanding. Because of the ineffectiveness of the testicular cross-heterotopic conservative and drug treatment, the early treatment of the testis can reduce the incidence of the testicular degeneration and the testicular tumor, and can permanently improve the appearance defect, so that the operation treatment can be performed at an early stage. There are many existing methods of operation, but there are advantages and disadvantages. The relevant literature at home and abroad is focused on case reports without detailed statistical analysis results. This study is a study of the testicular cross-heterotopic cases reported at home and abroad in order to understand the general characteristics of the testis crossing the heterotopic. The purpose of this study is to analyze the causes and pathogenesis, clinical manifestation, auxiliary examination, pathological features, diagnosis and differential diagnosis, treatment and prognosis of the testicular cross-heterotopic. Materials and Methods: The diagnosis and treatment of the testis of the first affiliated hospital of Zhengzhou University from July 2000 to January 2017 was analyzed retrospectively. The testicular cross-heterotopic of 108 cases, from April 1982 to June 2016, was reported in China from Jan.,1960 to Jan.2017, and the testicular cross-heterotopic in 154 cases reported from January 1960 to January 2017. The clinical manifestation, imaging examination, laboratory examination, operation treatment and prognosis were analyzed. The specific information is as follows: (1) The general information of the hospital: (1) Our hospital: the medical treatment age is from 2 months to 27 years, with a mean age of 7.92 to 9.38 years. (2) Domestic: The age of treatment is 4 days to 69 years, with a mean age of 14.87 and 14.18 years. (3) Foreign: The age of treatment was 15 days to 65 years, with a mean age of 9.39 and 9.74 years. The clinical manifestations were as follows: (1) In our hospital,10 cases (77%) of the scrotum,9 (69%) of the inguinal or scrotal mass,1 (8%) of the infertility after the marriage, and 1 (8%) of the testis in the oblique hernia. (2) There were 64 cases (59%) of the scrotum,56 (52%) of the inguinal or scrotal mass, and 9 (8%) of the infertility. (3) There were 85 cases (63%) of the scrotum,99 (73%) of the groin or scrotum,6 (4%) of infertility. (3) Complication: (1) In our hospital,9 cases (69%),5 cases (38%),2 cases (15%),2 cases (15%),1 case (8%) of hypospadias and 1 case (8%) of infertility. (2) There were 48 cases (44%),28 cases (26%),10 (9%),9 (8%),8 (7%) and 3 (3%) of testicular tumor. There were 3 cases (3%) of ectopic testis and 2 (2%) hypospadias. (3) There were 90 cases (74%),39 cases (32%),1 (0.8%),5 (4%),10 (8%),4 (3%) hypospadias and 8 (7%) of infertility. (4) Imaging: (1) In our hospital, there were 13 cases of ultrasonic examination,2 cases of CT and 3 cases of MRI. (2) In the country, there were 59 cases of ultrasonic examination,17 cases of CT and 3 cases of MRI. (3) Foreign:61 cases of ultrasonic examination,7 cases of CT examination and 18 cases of MRI. (5) Laboratory examination: (1) Our hospital:7 cases of chromosome karyotype examination,6 cases of sex hormone examination and 2 cases of semen examination. (2) There were 21 cases of chromosome karyotype,17 cases of sex hormone and 9 cases of semen examination. (3) There were 35 cases of chromosome karyotype,10 cases of sex hormone and 5 cases of semen examination. Results (1) Imaging examination: (1) In our hospital, there were 13 cases of ultrasonic examination,10 cases (76%) were diagnosed,2 cases (100%) were diagnosed with CT,3 cases were examined by MRI, and 2 cases (67%) were diagnosed. (2) In the country,59 cases were examined by ultrasonography,38 cases (64%) were diagnosed,17 cases were examined by CT,14 cases (82%) were diagnosed,3 cases were examined by MRI, and 3 cases (100%) were diagnosed. (3) Foreign:61 cases were examined by ultrasonography,31 cases (51%) were diagnosed,7 cases were examined by CT,4 cases (57%) were diagnosed,18 cases were examined by MRI, and 12 cases (67%) were diagnosed. (2) Laboratory examination: (1) In our hospital, there were 7 cases of chromosome karyotype,46, XY,6 cases of sex hormone test,2 cases of semen examination,1 case of azoospermia and 1 case of poor sperm activity. (2) There were 21 cases of chromosome karyotype,46, XY,17 cases of sex hormone,13 cases of normal,9 cases of semen examination,6 cases of sperm motility,2 cases of azoospermia and 1 case of normal sperm. (3) There were 35 cases of chromosome karyotype,33 cases of normal sex,10 cases of sex hormone examination,9 normal cases,5 cases of semen examination and 2 normal cases. (3) The method of operation: (1) In our hospital,7 cases (54%),4 cases (31%),1 case (8%), and 1 (8%) of non-operative treatment. Laparoscopic-assisted surgery for 5 cases. (2) In the country,33 cases (31%),18 (17%),4 (4%), and 15 (14%) orchiectomy were performed in 33 cases (31%),18 (17%) and 4 (4%) of the testis. In 2 cases (2%) of varicocele,9 cases (8%) were treated without operation, and 14 cases (13%) were operated in an unknown manner. Laparoscopic-assisted operation in 17 cases. (3) In the foreign countries,66 cases (43%),12 cases (8%),26 (17%, unspecified),3 (2%), and 5 (3%) of extraperitoneal testicular fixation were performed in the scrotal and mediastinal testis. There were 16 cases (10%) of orchiectomy,2 (1%) of varicocele,2 (1%) in non-operative treatment, and 22 (14%) in the operation. 42 cases were treated with laparoscopic assisted operation. (4) Prognosis: (1): (1) Our hospital:1 case of transscrotal and mediastinal testicular fixation with orchiepididymitis;1 case of bilateral scrotal fixation on the same side of the bilateral testis;1 case of scrotal development of one side after operation;1 case of non-operative treatment is still in observation; and 10 cases of the remaining operative treatment have good prognosis. Laparoscopic-assisted surgical treatment has a good prognosis. (2) In the country, there were 7 cases of testicular atrophy,1 case of testicular malignant transformation and 1 case of epididymitis. Laparoscopic-assisted operation in the treatment of the prognosis is good. (3) abroad:1 case of testicular atrophy,1 case of testicular malignant transformation and 1 case of death. Conclusion 1. In that scrotal empty patient, the common site of the testis should also be examined in addition to the normal testicular descent. The testicular cross-topic lacks a characteristic clinical manifestation, and it is clear that the diagnosis requires detailed physical examination, ultrasound, CT, and MRI to assist in the diagnosis. Surgical treatment is the only treatment method of the testis crossing the heterotopic, and can be used for laparoscopic assisted transscrotal and mediastinal testicular fixation.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.9
[Abstract]:Background: TTE is a rare congenital disease of the genitourinary system. It refers to the simultaneous access to one side of the inguinal canal in the two-sided testicle descending process, and the bilateral testis is located in the same ipsilateral inguinal region or the scrotum. Testicular cross-heterotopic heart is usually admitted to the hospital due to the empty or inguinal swelling of the scrotum. Because of the non-characteristic clinical manifestation, the diagnosis can not be clearly diagnosed before the operation, and the diagnosis is the cryptorchidism or the inguinal hernia, and the operation of the operation can be found. In the literature, the local anatomic characteristics of the ectopic testis are reported to be different, which leads to a wide range of explanation of the causes and mechanisms of the testis crossing the ectopic testis, and there is no unified understanding. Because of the ineffectiveness of the testicular cross-heterotopic conservative and drug treatment, the early treatment of the testis can reduce the incidence of the testicular degeneration and the testicular tumor, and can permanently improve the appearance defect, so that the operation treatment can be performed at an early stage. There are many existing methods of operation, but there are advantages and disadvantages. The relevant literature at home and abroad is focused on case reports without detailed statistical analysis results. This study is a study of the testicular cross-heterotopic cases reported at home and abroad in order to understand the general characteristics of the testis crossing the heterotopic. The purpose of this study is to analyze the causes and pathogenesis, clinical manifestation, auxiliary examination, pathological features, diagnosis and differential diagnosis, treatment and prognosis of the testicular cross-heterotopic. Materials and Methods: The diagnosis and treatment of the testis of the first affiliated hospital of Zhengzhou University from July 2000 to January 2017 was analyzed retrospectively. The testicular cross-heterotopic of 108 cases, from April 1982 to June 2016, was reported in China from Jan.,1960 to Jan.2017, and the testicular cross-heterotopic in 154 cases reported from January 1960 to January 2017. The clinical manifestation, imaging examination, laboratory examination, operation treatment and prognosis were analyzed. The specific information is as follows: (1) The general information of the hospital: (1) Our hospital: the medical treatment age is from 2 months to 27 years, with a mean age of 7.92 to 9.38 years. (2) Domestic: The age of treatment is 4 days to 69 years, with a mean age of 14.87 and 14.18 years. (3) Foreign: The age of treatment was 15 days to 65 years, with a mean age of 9.39 and 9.74 years. The clinical manifestations were as follows: (1) In our hospital,10 cases (77%) of the scrotum,9 (69%) of the inguinal or scrotal mass,1 (8%) of the infertility after the marriage, and 1 (8%) of the testis in the oblique hernia. (2) There were 64 cases (59%) of the scrotum,56 (52%) of the inguinal or scrotal mass, and 9 (8%) of the infertility. (3) There were 85 cases (63%) of the scrotum,99 (73%) of the groin or scrotum,6 (4%) of infertility. (3) Complication: (1) In our hospital,9 cases (69%),5 cases (38%),2 cases (15%),2 cases (15%),1 case (8%) of hypospadias and 1 case (8%) of infertility. (2) There were 48 cases (44%),28 cases (26%),10 (9%),9 (8%),8 (7%) and 3 (3%) of testicular tumor. There were 3 cases (3%) of ectopic testis and 2 (2%) hypospadias. (3) There were 90 cases (74%),39 cases (32%),1 (0.8%),5 (4%),10 (8%),4 (3%) hypospadias and 8 (7%) of infertility. (4) Imaging: (1) In our hospital, there were 13 cases of ultrasonic examination,2 cases of CT and 3 cases of MRI. (2) In the country, there were 59 cases of ultrasonic examination,17 cases of CT and 3 cases of MRI. (3) Foreign:61 cases of ultrasonic examination,7 cases of CT examination and 18 cases of MRI. (5) Laboratory examination: (1) Our hospital:7 cases of chromosome karyotype examination,6 cases of sex hormone examination and 2 cases of semen examination. (2) There were 21 cases of chromosome karyotype,17 cases of sex hormone and 9 cases of semen examination. (3) There were 35 cases of chromosome karyotype,10 cases of sex hormone and 5 cases of semen examination. Results (1) Imaging examination: (1) In our hospital, there were 13 cases of ultrasonic examination,10 cases (76%) were diagnosed,2 cases (100%) were diagnosed with CT,3 cases were examined by MRI, and 2 cases (67%) were diagnosed. (2) In the country,59 cases were examined by ultrasonography,38 cases (64%) were diagnosed,17 cases were examined by CT,14 cases (82%) were diagnosed,3 cases were examined by MRI, and 3 cases (100%) were diagnosed. (3) Foreign:61 cases were examined by ultrasonography,31 cases (51%) were diagnosed,7 cases were examined by CT,4 cases (57%) were diagnosed,18 cases were examined by MRI, and 12 cases (67%) were diagnosed. (2) Laboratory examination: (1) In our hospital, there were 7 cases of chromosome karyotype,46, XY,6 cases of sex hormone test,2 cases of semen examination,1 case of azoospermia and 1 case of poor sperm activity. (2) There were 21 cases of chromosome karyotype,46, XY,17 cases of sex hormone,13 cases of normal,9 cases of semen examination,6 cases of sperm motility,2 cases of azoospermia and 1 case of normal sperm. (3) There were 35 cases of chromosome karyotype,33 cases of normal sex,10 cases of sex hormone examination,9 normal cases,5 cases of semen examination and 2 normal cases. (3) The method of operation: (1) In our hospital,7 cases (54%),4 cases (31%),1 case (8%), and 1 (8%) of non-operative treatment. Laparoscopic-assisted surgery for 5 cases. (2) In the country,33 cases (31%),18 (17%),4 (4%), and 15 (14%) orchiectomy were performed in 33 cases (31%),18 (17%) and 4 (4%) of the testis. In 2 cases (2%) of varicocele,9 cases (8%) were treated without operation, and 14 cases (13%) were operated in an unknown manner. Laparoscopic-assisted operation in 17 cases. (3) In the foreign countries,66 cases (43%),12 cases (8%),26 (17%, unspecified),3 (2%), and 5 (3%) of extraperitoneal testicular fixation were performed in the scrotal and mediastinal testis. There were 16 cases (10%) of orchiectomy,2 (1%) of varicocele,2 (1%) in non-operative treatment, and 22 (14%) in the operation. 42 cases were treated with laparoscopic assisted operation. (4) Prognosis: (1): (1) Our hospital:1 case of transscrotal and mediastinal testicular fixation with orchiepididymitis;1 case of bilateral scrotal fixation on the same side of the bilateral testis;1 case of scrotal development of one side after operation;1 case of non-operative treatment is still in observation; and 10 cases of the remaining operative treatment have good prognosis. Laparoscopic-assisted surgical treatment has a good prognosis. (2) In the country, there were 7 cases of testicular atrophy,1 case of testicular malignant transformation and 1 case of epididymitis. Laparoscopic-assisted operation in the treatment of the prognosis is good. (3) abroad:1 case of testicular atrophy,1 case of testicular malignant transformation and 1 case of death. Conclusion 1. In that scrotal empty patient, the common site of the testis should also be examined in addition to the normal testicular descent. The testicular cross-topic lacks a characteristic clinical manifestation, and it is clear that the diagnosis requires detailed physical examination, ultrasound, CT, and MRI to assist in the diagnosis. Surgical treatment is the only treatment method of the testis crossing the heterotopic, and can be used for laparoscopic assisted transscrotal and mediastinal testicular fixation.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.9
【参考文献】
相关期刊论文 前10条
1 张华,林进汉,韩警晓;两侧隐睾、尿道下裂伴睾丸横过异位一例[J];温州医学院学报;1999年01期
2 朱全道;陶钱贵;;卵巢两性母细胞瘤一例[J];河南医药;1984年02期
3 何恢绪;;睾丸横过异位、双睾附睾分离及与子宫并存一例报告[J];男性学杂志;1988年04期
4 李永海，，南勋义，穆俊武;伴睾丸横过异位的苗勒管持续存在综合征一例报告[J];中华泌尿外科杂志;1994年04期
5 席志军,那彦群,张晓春,郝金瑞,郭应禄;腹腔镜对隐睾的定位作用(附12例报告)[J];中华泌尿外科杂志;2001年05期
6 胡强,徐汇义,仇学文,徐卓群,王志荣,阮钧,诸明;异位睾丸七例报告[J];中华泌尿外科杂志;2002年02期
7 张钦明,陈永卫,侯大为,郭卫红;睾丸横过异位[J];中华小儿外科杂志;2003年02期
8 周福金,王夫,何春芬,邵锡柱,张媛,王永岚;睾丸横过异位伴苗勒管源囊肿一例[J];中华小儿外科杂志;2003年04期
9 汪诗俊,诸禹平;横过异位睾丸3例[J];黑龙江医药科学;2000年02期
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