睾丸切除术在小儿发育不良隐睾手术治疗中的应用

Application experience of orchidectomy in the treatment of cryptorchidism in children with dysplasia

目的通过分析发育不良隐睾患儿的病例资料，探讨如何把握睾丸切除术在小儿发育不良隐睾手术治疗中的应用。方法收集安徽医科大学附属安徽省儿童医院泌尿外科2005年7月至2016年5月行外科手术治疗术中证实睾丸发育不良隐睾患儿207例，均为真性隐睾。年龄0.6-11.4岁[（4.7±1.2）岁]。其中左侧隐睾78例，右侧隐睾104例，双侧隐睾25例。所有病例术前均行超声检查，提示未见睾丸53例，提示睾丸萎缩或发育不良154例。所有病例均行外科手术治疗，其中单纯经腹股沟切口149例，腹股沟切口联合腹腔镜探查47例，单纯行腹腔镜手术11例。术中均与患儿家长沟通，睾丸轻、中度发育不良均保留睾丸167例；睾丸重度发育不良及睾丸萎缩40例，其中腹内单侧隐睾16例，腹外单侧隐睾22例均行睾丸切除术，2例腹外双侧睾丸重度发育不良患儿征求家长意见后行双侧睾丸下降固定术，所有切除标本术后均送病理检验。术后通过电话随访186例，失访21例，随访时间1-128个月[（53±8）个月]，术后3-6个月均行超声睾丸检查，了解双侧睾丸发育情况及有无睾丸发育不良或睾丸萎缩。结果所有患儿均顺利完成手术，术后顺利出院，切除睾丸组术中证实精索血管纤细、睾丸发育差或萎缩；保留睾丸组术后随访超声检查提示未见明显睾丸样结构6例，完全萎缩12例，部分萎缩48例，均未行再次手术探查切除，无萎缩93例，无隐睾术后癌变病例。切除睾丸组健侧睾丸均正常发育。结论轻、中度睾丸发育不良可行保留睾丸手术，重度睾丸发育不良或睾丸萎缩征得家长同意后选择合理手术方式。

Objective By analyzing the cases of cryptorchidism owing to dysplasia in children to explore how to apply orchidectomy in the treatment of children with cryptorchidism.Methods Two hundred and seven cryptorchi-dism patients with dysplasia who underwent surgical treatment were collected in the Department of Urology, Anhui Province Children′s Hospital Affiliated to Anhui Medical University from July 2005 to May 2016.All the patients were true cryptorchidism, aged from 0.6 to 11.4 years [（4.7±1.2）years]. There were 78 cases of left cryptorchidism, 104 cases of right cryptorchidism and 25 cases of bilateral cryptorchidism.All cases underwent ultrasound examination before surgery, showing that there were no testis in 53 cases, testicular atrophy or dysplasia in 154 cases.All cases underwent surgical treatment, including 149 cases of inguinal incision alone, groin incision combined with laparoscopic exploration in 47 cases and simple laparoscopic surgery in 11 cases.Communication with the parents of all the children was conducted during operation.One hundred and sixty-seven cases of mild and moderate testicular dysplasia underwent testicular descending fixation.Forty cases of severe dysplasia or testicular atrophy, including 16 cases of intrahepatic unilateral cryptorchidism and 22 cases of unilateral cryptorchidism outside the abdomen which underwent testicular resection, while 2 cases of bilateral cryptorchidism with severe dysplasia underwent bilateral testicular descent fixation after communication with the parents of the children during operation.All the specimens were sent for pathological examination after the operation.One hundred eighty-six cases were followed up from 1 to 128 months [（53±8） months], and 21 cases were lost.Ultrasound examination was performed from 3 to 6 months after the operation to observe the development of bilateral testis and whether testicular dysplasia or testicular atrophy existed.Results All the children successfully underwent the operation and discharged from hospital.The group who underwent testicular had confirmed slim blood vessels in spermatic cord and poor testicular development through operation, while another group in postoperative follow up ultrasound showed that there was no obvious testicular-like structure in 6 cases, complete atrophy in 12 cases and partial atrophy in 48 cases and no atrophy in 93 cases.No patients had testicular resection again and no canceration after the operation.The healthy sides of the testicular resection in another group all had normal development.Conclusions Mild and moderate testicular dysplasia in children can choose testicular descending fixation, while severe dysplasia or testicular atrophy should select a reasonable surgical approach after communication with families.