睾丸横过异位8例临床分析

Clinical analysis of 8 cases of transverse testicular ectopia

目的探讨睾丸横过异位(TTE)的临床特点、诊断方法和治疗效果。方法回顾性分析2004年5月至2018年11月新乡市中心医院泌尿外一科、郑州大学第一附属医院小儿外科收治的8例TTE患儿的临床资料,分析总结其临床特点、诊断方法、手术治疗效果及随访结果等。结果8例TTE患儿,年龄1岁5个月至5岁。左侧6例,右侧2例。均因阴囊空虚就诊。合并苗勒管永存综合征(PMDS)3例,合并尿道下裂1例。5例术前明确诊断,其中超声诊断4例,磁共振成像诊断1例。2例患儿行腹腔镜探查,其中1例行腹腔镜下阴囊内固定术,另1例因精索发育差而中转为开放手术(行跨阴囊纵隔睾丸固定术)。行开放手术探查的6例患儿中,1例因精索黏连紧密行双睾丸同侧阴囊固定术,另5例行跨阴囊纵隔睾丸固定术。3例PMDS患儿术中均切除苗勒管残留物。所有患儿术后未发生伤口感染和血肿,1例行跨阴囊纵隔睾丸固定术患儿术后11个月发生睾丸附睾炎,并波及对侧,予抗炎治疗后好转。术后随访3个月至4年,患儿超声检查均提示双侧睾丸大小及血供正常,均未发生睾丸萎缩。结论对于单侧隐睾合并对侧腹股沟肿物患儿应考虑TTE的可能,超声检查是首选的诊断方法,腹腔镜手术在TTE的诊断和治疗中具有重要作用,有助于发现残留苗勒管结构等异常。

Objective To study the clinical manifestations,diagnostic methods and therapeutic outcomes of transverse testicular ectopia(TTE).Methods Clinical data of 8 cases of TTE treated in the Department of the First Urologic Surgery,Xinxiang Central Hospital and Department of Pediatric Surgery,the First Affiliated Hospital of Zhengzhou University from May 2004 to November 2018 were retrospectively analyzed.Clinical manifestations,diagnostic methods,surgical treatment and follow-up results of TTE were summarized.Results The age of 8 cases of TTE was 1 year 5 months to 5 years.Among the 8 cases of TTE,6 cases were involved with the left side and 2 cases with the right side.All patients were admitted due to scrotal emptiness.Three cases were combined with persistent Müllerian duct syndrome(PMDS)and 1 case combined with hypospadias.Preoperative diagnosis of TTE was definitely made in 5 cases,involving 4 cases diagnosed by ultrasound and 1 case diagnosed by magnetic resonance imaging.Laparoscopy was performed in 2 cases,including 1 case treated with laparoscopic scrotopexy,and the other one transferred to an open surgery of trans-septal orchiopexy due to poor development of the spermatic cord.Open surgery was performed in 6 cases,including 1 case with bilateral testicular fixation in the ipsilateral scrotum due to adhesion of spermatic cord closely,and 5 cases with trans-septal orchiopexy.Müllerian ducts residues were excised during surgery in 3 cases combined with PMDS.Postoperative wound infection or hematoma was not reported in all cases.Orchiepididymitis and the involvement of contralateral testes occurred in 1 case treated with trans-septal orchiopexy at 11 months postoperatively,which were relieved after anti-inflammatory treatment.All cases were postoperatively followed up for 3-48 months,and the development and blood supply of bilateral testes were detected normal by ultrasonography.Postoperative testicular atrophy was not reported.Conclusions The possibility of TTE should be considered in patients with unilateral cryptorchidism combined with contralateral inguinal mass.Ultrasonography is preferred to the diagnosis of TTE.Laparoscopic surgery plays an important role in the diagnosis and treatment of TTE,which is helpful to identify abnormalities in the Müllerian duct structure.