腹腔镜下切除不可触及隐睾残迹的病理分析
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摘要
目的探讨腹腔镜下切除不可触及型隐睾患儿睾丸残迹的必要性。方法回顾性分析2015年1月至2018年12月共16例隐睾患儿,月龄11～98月,平均(36.0±25.4)个月,均为单侧,左侧12例(75%),右侧4例(25%),术前彩超提示阴囊、腹股沟区、腹腔内至肾门未见睾丸样物,通过腹腔镜检查,14例(85.7%)鞘突管已闭合,输精管和精索发育差,已进入腹股沟区。通过腔镜下游离,将输精管末端牵回腹腔内切除,切除末端送病理检测。结果病理提示,8例(50%)送检组织为横纹肌、纤维血管脂肪组织,未见睾丸组织;3例(18.75%)为附睾及输精管组织;1例(6.25%)送检物为纤维脂肪组织中仅见2个腺管;符合左侧发育不良睾丸组织2例(12.5%);另外2例(12.5%)患儿输精管和精索末端于腹腔内发育中断,未进一步处理。结论腹腔镜下腹股沟管内环已闭合,输精管和精索已进入腹股沟管内,不可触及型隐睾病理结果未见恶变肿瘤组织,是否行隐睾残迹常规切除需结合多方面因素决定。
Objective To explore the necessity of laparoscopic resection of testicular remnants in children with unreachable cryptorchidism.Methods A retrospective analysis was performed on a total of 16 children with cryptorchidism treated during Jan.2015 and Dec.2018 were involved.The children aged 11 to 98 months,average(36.0±25.4)months.All 16 cases were unilateral.The cryptorchidism was on the left side in12 cases(75%),and on the right side in4 cases(25%).Preoperatively ultrasonography showed no testicular remnants in the scrotum,inguinal region,abdominal cavity or renal hilum.Laparoscopy indicated that in 14 cases(87.5%),the inguinal canal was closed,the vas deferens and spermatic cords developed poorly and had entered the inguinal region.The end of the vas deferens was retracted to the abdominal cavity and excised.The excised tissues underwent pathological examination.Results The pathological results showed:in8 cases(50%),the tissues were striated muscles and fibrous vascular adipose tissues,and no testicular tissues were found;in3 cases(18.75%),the tissues were epididymis and vas deferens;in1 case(6.25%),glandular tubes were found in the fibrous adipose tissues;in2 cases(12.5%),the left testicular tissues were underdeveloped;in 2 cases(12.5%),the vas deferens and the end of spermatic cord stopped developing in the abdominal cavity,so no further intervention was performed.Conclusion Whether to perform routine cryptorchidectomy depends on many factors,such as whether the inner ring of inguinal canal has closed,whether the vas deferens and spermatic cord have entered the inguinal canal,and whether malignant tumor tissue was found in the pathological results of unreachable cryptorchidism.
Objective To explore the necessity of laparoscopic resection of testicular remnants in children with unreachable cryptorchidism.Methods A retrospective analysis was performed on a total of 16 children with cryptorchidism treated during Jan.2015 and Dec.2018 were involved.The children aged 11 to 98 months,average(36.0±25.4)months.All 16 cases were unilateral.The cryptorchidism was on the left side in12 cases(75%),and on the right side in4 cases(25%).Preoperatively ultrasonography showed no testicular remnants in the scrotum,inguinal region,abdominal cavity or renal hilum.Laparoscopy indicated that in 14 cases(87.5%),the inguinal canal was closed,the vas deferens and spermatic cords developed poorly and had entered the inguinal region.The end of the vas deferens was retracted to the abdominal cavity and excised.The excised tissues underwent pathological examination.Results The pathological results showed:in8 cases(50%),the tissues were striated muscles and fibrous vascular adipose tissues,and no testicular tissues were found;in3 cases(18.75%),the tissues were epididymis and vas deferens;in1 case(6.25%),glandular tubes were found in the fibrous adipose tissues;in2 cases(12.5%),the left testicular tissues were underdeveloped;in 2 cases(12.5%),the vas deferens and the end of spermatic cord stopped developing in the abdominal cavity,so no further intervention was performed.Conclusion Whether to perform routine cryptorchidectomy depends on many factors,such as whether the inner ring of inguinal canal has closed,whether the vas deferens and spermatic cord have entered the inguinal canal,and whether malignant tumor tissue was found in the pathological results of unreachable cryptorchidism.
引文
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[4]BADER MI,PEERAULLY R,BAATH M,et al.The testicular regression syndrome-do remnants require routine excision?[J].J Pediatr Surg,2011,46(2):384-386.
[5]HEGARTY PK,MUSHTAQ I,SEBIRE NJ.Natural history of testicular regression syndrome and consequences for clinical management[J].J Pediatr Urol,2007,3(3):206-208.
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[7]MIZUNO K,KOJIMA Y,KAMISAWA H,et al.Feasible etiology of vanishing testis regarding disturbance of testicular development:Histopathological and immunohistochemical evaluation of testicular nubbins[J].Int J Urol,2012,19(5):450-456.
[8]UEDA N,SHIROYANAGI Y,SUZUKI H,et al.The value of finding a closed internal ring on laparoscopy in unilateral nonpalpable testis.[J].J Pediatr Surg,2013,48(3):542-546.
[9]STORM D,REDDEN T,AGUIAR M,et al.Histologic evaluation of the testicular remnant associated with the vanishing testes syndrome:is surgical management necessary?[J].Urology,2007,70(6):1200-1206.
[10]WOOD HM,ELDER JS.Cryptorchidism and testicular cancer:separating fact from fiction[J].J Urol,2009,181(2):452-461.
[11]NATARAJA RM,YEAP E,HEALY CJ,et al.Presence of viable germ cells in testicular regression syndrome remnants:Is routine excision indicated?A systematic review[J].Pediatr Surg Int,2018,34(3):353-361.
[12]文卫军,郑抗洪,石宇强,等.腹腔镜下隐睾诊治的临床应用研究[J].临床医学工程,2011,18(4):518-519.
[13]杨华军,唐达星.儿童睾丸退化综合征187例临床病理特点分析[J].中华小儿外科杂志,2017,38(3):216-219.
[2]李索林,张潍平,李龙,等.隐睾症腹腔镜手术操作指南(2017版)[J].临床小儿外科杂志,2017(6):523-532.
[3]郭应禄,周利群.坎贝尔-沃尔什泌尿外科学[M].北京:北京大学医学出版社,2009:3975-3978.
[4]BADER MI,PEERAULLY R,BAATH M,et al.The testicular regression syndrome-do remnants require routine excision?[J].J Pediatr Surg,2011,46(2):384-386.
[5]HEGARTY PK,MUSHTAQ I,SEBIRE NJ.Natural history of testicular regression syndrome and consequences for clinical management[J].J Pediatr Urol,2007,3(3):206-208.
[6]NATARAJA RM,ASHER CM,NASH R,et al.Is routine excision of testicular remnants in testicular regression syndrome indicated[J].J Pediatr Urol,2015,11(3):151.
[7]MIZUNO K,KOJIMA Y,KAMISAWA H,et al.Feasible etiology of vanishing testis regarding disturbance of testicular development:Histopathological and immunohistochemical evaluation of testicular nubbins[J].Int J Urol,2012,19(5):450-456.
[8]UEDA N,SHIROYANAGI Y,SUZUKI H,et al.The value of finding a closed internal ring on laparoscopy in unilateral nonpalpable testis.[J].J Pediatr Surg,2013,48(3):542-546.
[9]STORM D,REDDEN T,AGUIAR M,et al.Histologic evaluation of the testicular remnant associated with the vanishing testes syndrome:is surgical management necessary?[J].Urology,2007,70(6):1200-1206.
[10]WOOD HM,ELDER JS.Cryptorchidism and testicular cancer:separating fact from fiction[J].J Urol,2009,181(2):452-461.
[11]NATARAJA RM,YEAP E,HEALY CJ,et al.Presence of viable germ cells in testicular regression syndrome remnants:Is routine excision indicated?A systematic review[J].Pediatr Surg Int,2018,34(3):353-361.
[12]文卫军,郑抗洪,石宇强,等.腹腔镜下隐睾诊治的临床应用研究[J].临床医学工程,2011,18(4):518-519.
[13]杨华军,唐达星.儿童睾丸退化综合征187例临床病理特点分析[J].中华小儿外科杂志,2017,38(3):216-219.