隐睾儿童手术近期疗效及手术时机的探讨

Clinical study of age factor in cryptorchidism and optimal timing of cryptorchid opexy in children

目的 探讨隐睾儿童年龄因素与睾丸固定术近期疗效的关系及手术时机的选择。 方法 采用放射免疫法 (RIA)和免疫组织化学方法检测 88例隐睾儿童手术前后 6个月血清表皮生长因子 (EGF)、睾酮 (T)、5α 二氢睾酮 (5α DHT)、雌二醇 (E2 )、促黄体生成素 (LH)、卵泡刺激素 (FSH)、催乳素 (PRL)水平和隐睾组织表皮生长因子受体 (EGFR)、雄激素受体 (AR)的表达以及隐睾的组织学变化 ,分析年龄与上述指标及隐睾分型的关系。 结果 88例隐睾儿童 10 8枚睾丸中 ,高位型隐睾多见于 2～ 4岁组 (9/2 4,3 7.5% ) ,低位型多见于 10～ 14岁组 (2 0 /2 4,81.8% ) ,差异有非常显著性意义 (P<0 .0 1) ,而单、双侧型与年龄无关 (P >0 .0 5)。 5～ 9岁隐睾儿童术前血清EGF ,T ,5α DHT值均显著降低 (P <0 .0 5) ,血清FSH ,LH水平则显著升高 (P <0 .0 5)。≥ 5岁患儿血清EGF、隐睾组织病理及EGFR和AR表达较 2～ 4岁组差。患儿术后血清EGF、T、5α DHT值较术前均有明显增高 (P <0 .0 5) ,而术后血清E2 ,FSH值显著低于术前 (P <0 .0 1)。 结论 睾丸固定术有利于生殖内分泌功能恢复及睾丸组织的生长发育 ,是治疗隐睾症的可靠方法。依据 4岁前隐睾病理学和性激素内分泌改变较轻以及2岁以后睾丸仍有向下迁移趋势的特点 。

ObjectiveTo study the age factor in cryp to rchidism in children,the optimal timing of cryptorchidopexy and short-term effe ct following the operation.MethodsThe levels of serum epidermal growth factor(EGF),testosterone(T),5α-dihydrotestosterone (5α-DHT) ,estradiol(E 2),luteinizing hormone(LH),follicle-stimulating hormone(FSH) and prolactin(PRL) were measured with radioimmunoassay (RIA) in 88 children with cry ptorchidism before and after operation,and the expression of EGF receptor(EGF-R ) and androgen receptor(AR) was determined using immunohistochemical technique. ResultsAmong the 88 children with cryptorchidism,the i mpalpable testes were more common in 2-to 4-year group (9/24,37.5%),whereas th e extracanalicular testes were more common in 10-to 14-year group (20/24, 81. 8 %).The difference was significant ( P <0.01).The levels of EGF,T,5α-DHT were significantly lower,while those of FSH and LH were markedly higher in 5-to 9-year children with cryptorchidism,compared with those of the normal ( P <0.05).The level of serum EGF was lower and the EGF- R and AR expression of cryptochidial testes in more than 5-year group was signi ficantly lower compared with those of 2-to 4-year group( P <0.05).The post- operative levels of EGF,T,5α-DHT all increased significantly ( P <0.05),whil e the post-operative levels of E 2, FSH decreased significantly ( P <0.01) c ompared with the pre-operative levels.ConclusionsCryp torchidopexy is beneficial to restoring of testicular structure and function in short period.So this procedure can be used as a reliable measure for cryptochidi sm.It is believed that the optimal timing of cryptorchidopexy for children shoul d be under 2 years and at least no more than 4 years,because the damage of testi cular structure and function in cryptorchidism before 4 years is mild and the cr yptorchidial testis can still progress descendingly after 2 years of age.