睾丸附属结构的形态和组织病理学分析

Morphologic and histopathologic analysis of testicular appendages

目的:统计睾丸各附属结构的发生率,观察其形态,分析其组织病理学来源。方法:2009年5月至2013年7月行阴囊手术的患者54例,其中儿童15例,成人39例,共计67个睾丸术中被探查,统计睾丸附属结构的检出率,并切除送病理学检查,明确其组织来源。结果:睾丸附件检出率80.6%(54/67),附睾附件检出率23.9%(16/67),旁睾检出率1.5%(1/67),上迷管检出率3.0%(2/67),下迷管检出率1.5%(1/67)。儿童睾丸附属结构检出率高于成人(93.3%vs 80.8%),但无统计学意义(χ2=1.339,P>0.05),儿童睾丸附件和附睾附件带蒂率显著高于成人(82.4%vs 54.7%,χ2=4.149,P<0.05)。睾丸附件病理检查为副中肾管源性,附睾附件、旁睾和上下迷管均为中肾管源性。结论:睾丸附属结构包括睾丸附件、附睾附件、旁睾、上迷管和下迷管5种胚胎残基,其中睾丸附件是副中肾管残基,其余4种为中肾管残基。这些附属结构的临床意义在于它们的扭转倾向。

Objective： To investigate the incidence of testicular appendages, observe their morphology, and analyze their his- topathological origins. Methods： We observed 67 testes in 54 patients （15 children and 39 adults） undergoing scrotal surgery, in- vestigated the incidence of testicular appendages, and identified their histopathological origins. We used the Chi-square test to compare the findings from the children and adult patients, with P 〈 0.05 as statistically significant. Results ： The detection rates of the appen- dix testis, appendix epididymis, paradidymis, vas aberrans superior, and vas aberrans inferior were 80.6% （54/67）, 23.9% （ 16/ 67 ）, 1.5% （1/67）, 3.0% （2/67）, and 1.5% （1/67）, respectively. The incidence of testieular appendages was higher in children than in adults （93.3% vs 80.8% ）, but with no statistically significant difference （X^2 = 1. 339, P 〉 0.05）, and that of the appendix testis and epididymis with pedicles was significantly higher in the former than in the latter （82.4% vs 54.7%, X^2 = 4. 149, P 〈 0.05 ）. Pathological examination showed that the appendix testis originated from the paramesonephric duct, while the appendix epididy- mis, paradidymis, vas aberrans superior, and vas aberrans inferior from the mesonephric duct. Conclusion： Testicular appendages consist of five embryonic remnants, including appendix testis, appendix epididymis, paradidymis, vas aberrans superior, and vas aber-rans inferior. The appendix testis originates from the paramesonephric duct, and the other four from the mesonephric duct. The clinical implication of these testicular appendages is their tendency to torsion.