睾丸横过异位畸形的诊断和治疗:附1例报告并文献复习

Diagnosis and treatment of transverse testicular ectopia: a case report with literature review

目的结合1例睾丸横过异位患者的诊治过程,复习有关文献探讨其病因学、诊断方法和治疗措施。方法本院收治1例青年男性患者存在左侧睾丸横过异位伴同侧精索鞘膜积液,右侧腹股沟斜疝,右侧附睾囊肿,手术证实右侧腹股沟2根输精管和2根精索,右侧阴囊内2个睾丸。将异位的左侧睾丸通过阴囊纵隔复位固定于对侧阴囊肉膜下,并行左侧精索鞘膜大部切除,右侧腹股沟疝修补术,右侧附睾囊肿切除术。根据该患者的临床表现、诊断和治疗过程,结合相关文献对该病的整体临床特征进行分析。结果本例患者术后诊断为:①左侧睾丸横过异位;②左侧精索鞘膜积液;③右侧腹股沟复发疝;④右侧附睾囊肿;⑤弱精症。术后患者病情恢复顺利,术后随访3个月,复查见患者双侧睾丸位置良好,形态大小和血供正常。其他伴随异常均消失。结论睾丸横过异位作为一种罕见的生殖系发育畸形,常伴有腹股沟疝、精索鞘膜积液甚至苗勒氏管持续存在综合征等多种异常,宜及早采取手术治疗并同时纠正伴随病变。为避免伴随的胚胎发育残迹的远期癌变,术后需长期随访。

Objective To discuss the etiology, diagnosis and treatment of transverse testicular ectopia （TTE）. Methods Here reports a case of transverse testicular ectopia, which was found with 2 vas deferens and 2 spermatic cord, 2 testes on the right side of the inguinal canal and the scrotum during the operation. The spermatic cords were fully free, and the ectopic testis was fixed by traverse the scrotal mediastinum. The associated anomaly such as the right inguinal hernia was repaired and the hydrocele of spermatic cord was treated by resection of the redundant tunica vaginalis at the same time. The clinical data of this case was analyzed according to its manifestation, diagnosis and treatment, combined with literature review. Results This case was finally diagnosed as left transverese testicular ectopia, left funicular hydocele, right recurrent inguinal hernia, right epididymal cyst, and asthenozoospermia. Bilateral testes were in proper positions with normal vascular supply in 3 months after the operation. During follow-up, the patient had biliteral testes in normal positions, in well shape and blood supply. Conclusion TTE is a rare congenital abnormality of testicular maldescent. It is usually accompanied by other anomalies such as inguinal hernia, hydrocele and persistent or rudimentary Mullerian remnants. Early operation is the best option for TTE treatment. Long-term postoperative follow-up is highly recommended to prevent the risk of malignancy in the embryonic remnants.