睪丸橫過(guò)異位的臨床診治及分析
發(fā)布時(shí)間：2019-06-19 07:54
【摘要】：背景睪丸橫過(guò)異位(transverse testicular ectopia,TTE)是泌尿生殖系統(tǒng)一種罕見(jiàn)的先天性疾病,是指雙側(cè)睪丸下降過(guò)程中同時(shí)進(jìn)入一側(cè)腹股溝管,雙側(cè)睪丸位于同側(cè)腹股溝區(qū)或陰囊內(nèi)。睪丸橫過(guò)異位常以陰囊空虛或腹股溝腫物為主訴入院,因無(wú)特征性的臨床表現(xiàn),術(shù)前常不能明確診斷,而診斷為隱睪或腹股溝斜疝,行手術(shù)治療才得以發(fā)現(xiàn)。文獻(xiàn)中對(duì)異位睪丸的局部解剖特點(diǎn)報(bào)告不同,導(dǎo)致對(duì)睪丸橫過(guò)異位的病因及機(jī)制的闡述各種各樣,尚無(wú)統(tǒng)一的認(rèn)識(shí)。因睪丸橫過(guò)異位保守及藥物治療無(wú)效,發(fā)現(xiàn)后及早治療可降低睪丸退行性變及睪丸腫瘤的發(fā)生率,且可永久性改善外觀缺陷,故多建議及早行手術(shù)治療�，F(xiàn)存的手術(shù)方式較多,但各有優(yōu)勢(shì)及缺點(diǎn)。既往國(guó)內(nèi)外相關(guān)文獻(xiàn)均側(cè)重于病例報(bào)告,而無(wú)詳盡的統(tǒng)計(jì)分析結(jié)果。本研究對(duì)國(guó)內(nèi)外所報(bào)告的睪丸橫過(guò)異位病例進(jìn)行統(tǒng)計(jì),以了解睪丸橫過(guò)異位的一般特征。研究目的本研究針對(duì)睪丸橫過(guò)異位的病因及發(fā)病機(jī)制、臨床表現(xiàn)、輔助檢查、病理學(xué)特點(diǎn)、診斷及鑒別診斷、治療及預(yù)后進(jìn)行分析闡述,以提出一個(gè)可供臨床醫(yī)師參考的診療體系。材料與方法回顧性分析2000年7月至2017年1月于鄭州大學(xué)第一附屬醫(yī)院診治的睪丸橫過(guò)異位13例,1982年4月至2016年6月我國(guó)報(bào)道的睪丸橫過(guò)異位108例,1960年1月至2017年1月國(guó)外所報(bào)道的睪丸橫過(guò)異位154例,分析其臨床表現(xiàn)、影像學(xué)檢查、實(shí)驗(yàn)室檢查、手術(shù)治療及預(yù)后情況。具體資料如下:⑴一般資料:(1)我院:就診年齡2個(gè)月到27歲,平均年齡7.92±9.38歲。(2)國(guó)內(nèi):就診年齡4天到69歲,平均年齡14.87±14.18歲。(3)國(guó)外:就診年齡15天到65歲,平均年齡9.39±9.74歲。⑵臨床表現(xiàn):(1)我院:陰囊空虛10例(77%),腹股溝或陰囊腫物9例(69%),婚后不育1例(8%),斜疝術(shù)中發(fā)現(xiàn)睪丸異常1例(8%)。(2)國(guó)內(nèi):陰囊空虛64例(59%),腹股溝或陰囊腫物56例(52%),不育9例(8%)。(3)國(guó)外:陰囊空虛85例(63%),腹股溝或陰囊腫物99例(73%),不育6例(4%)。(3)合并癥:(1)我院:腹股溝斜疝9例(69%),苗勒管持續(xù)綜合征5例(38%),鞘膜積液2例(15%),睪丸附睪分離2例(15%),尿道下裂1例(8%),不育癥1例(8%)。(2)國(guó)內(nèi):腹股溝斜疝48例(44%),苗勒管持續(xù)綜合征28例(26%),睪丸附睪分離10例(9%),不育癥9例(8%),鞘膜積液8例(7%),睪丸腫瘤3例(3%),異位睪丸扭轉(zhuǎn)3例(3%),尿道下裂2例(2%)。(3)國(guó)外:腹股溝斜疝90例(74%),苗勒管持續(xù)綜合征39例(32%),睪丸附睪分離1例(0.8%),鞘膜積液5例(4%),睪丸腫瘤10例(8%),尿道下裂4例(3%),不育癥8例(7%)。(4)影像學(xué)檢查:(1)我院:超聲檢查13例,CT檢查2例,MRI檢查3例。(2)國(guó)內(nèi):超聲檢查59例,CT檢查17例,MRI檢查3例。(3)國(guó)外:超聲檢查61例,CT檢查7例,MRI檢查18例。(5)實(shí)驗(yàn)室檢查:(1)我院:染色體核型檢查7例,性激素檢查6例,精液檢查2例。(2)國(guó)內(nèi):染色體核型檢查21例,性激素檢查17例,精液檢查9例。(3)國(guó)外:染色體核型檢查35例,性激素檢查10例,精液檢查5例。結(jié)果(1)影像學(xué)檢查:(1)我院:超聲檢查13例,明確診斷10例(76%);CT檢查2例,明確診斷2例(100%);MRI檢查3例,明確診斷2例(67%)。(2)國(guó)內(nèi):超聲檢查59例,明確診斷38例(64%);CT檢查17例,明確診斷14例(82%);MRI檢查3例,明確診斷3例(100%)。(3)國(guó)外:超聲檢查61例,明確診斷31例(51%);CT檢查7例,明確診斷4例(57%);MRI檢查18例,明確診斷12例(67%)。(2)實(shí)驗(yàn)室檢查:(1)我院:染色體核型檢查7例,均提示46,XY;性激素檢查6例,均正常;精液檢查2例,無(wú)精子1例,精子活性差1例。(2)國(guó)內(nèi):染色體核型檢查21例,均為46,XY;性激素檢查17例,正常13例;精液檢查9例,精子活力差6例,無(wú)精子2例,精子正常1例。(3)國(guó)外:染色體核型檢查35例,正常33例;性激素檢查10例,正常9例;精液檢查5例,正常2例。(3)手術(shù)方式:(1)我院:跨陰囊縱隔睪丸固定術(shù)7例(54%),睪丸復(fù)位固定術(shù)4例(31%),雙睪丸同側(cè)陰囊固定術(shù)1例(8%),未行手術(shù)治療1例(8%)。腹腔鏡輔助手術(shù)治療5例。(2)國(guó)內(nèi):跨陰囊縱隔睪丸固定術(shù)33例(31%),睪丸復(fù)位固定術(shù)18例(17%),睪丸固定術(shù)4例(4%,具體不詳);雙睪丸同側(cè)陰囊固定術(shù)13例(12%),睪丸切除術(shù)15例(14%),精索動(dòng)靜脈切斷術(shù)2例(2%),未行手術(shù)治療9例(8%),手術(shù)方式不詳14例(13%)。腹腔鏡輔助手術(shù)治療17例。(3)國(guó)外:跨陰囊縱隔睪丸固定術(shù)66例(43%),睪丸復(fù)位固定術(shù)12例(8%),睪丸固定術(shù)26例(17%,具體不詳),雙睪丸同側(cè)陰囊固定術(shù)3例(2%),腹膜外睪丸固定術(shù)5例(3%),睪丸切除術(shù)16例(10%),精索動(dòng)靜脈切斷術(shù)2例(1%),未行手術(shù)治療2例(1%),手術(shù)方式不詳22例(14%)。行腹腔鏡輔助手術(shù)治療42例。(4)預(yù)后:(1)我院:行跨陰囊縱隔睪丸固定術(shù)1例后伴發(fā)睪丸附睪炎;行雙睪丸同側(cè)陰囊固定術(shù)1例術(shù)后一側(cè)陰囊發(fā)育差;未行手術(shù)治療1例仍在觀察中;余行手術(shù)治療10例預(yù)后好。行腹腔鏡輔助手術(shù)治療預(yù)后較好。(2)國(guó)內(nèi):術(shù)后睪丸萎縮7例,睪丸惡變1例,伴發(fā)睪丸附睪炎1例。行腹腔鏡輔助手術(shù)治療預(yù)后好。(3)國(guó)外:睪丸萎縮1例,睪丸惡變1例,死亡1例。結(jié)論1.陰囊空虛患者除應(yīng)檢查正常睪丸下降途徑外,還需檢查睪丸異位常見(jiàn)部位。2.睪丸橫過(guò)異位缺乏特征性的臨床表現(xiàn),明確診斷需要詳細(xì)的體格檢查,超聲、CT、MRI可協(xié)助診斷。3.手術(shù)治療是睪丸橫過(guò)異位唯一的治療方法,可選用腹腔鏡輔助跨陰囊縱隔睪丸固定術(shù)。
[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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.9
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相關(guān)期刊論文 前10條
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