未触及睾丸隐睾症的诊治进展

张富勋; 张帆; 卢一平

doi:10.13201/j.issn.1001-1420.2019.08.017

未触及睾丸隐睾症的诊治进展

- 四川大学华西医院泌尿外科/泌尿外科研究所(成都, 610041)

详细信息

通讯作者: 卢一平,E-mail:yipinglu@163.com

中图分类号: R726.9

收稿日期: 2018-08-27

Advances in diagnosis and treatment of cryptorchidism with nonpalpable testis

- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

More Information

Corresponding author: LU Yiping, E-mail: yipinglu@163.com

Received Date: 27 August 2018

摘要

摘要: 隐睾症是男性最常见的性发育障碍疾病，可见于3.5%的新生儿。尽管约一半的新生儿隐睾可自发下降，但是部分男性睾丸在儿童后期还会不断上升，维持隐睾状态。隐睾患者中有15%~20%的未降睾丸不能触及，称之为未触及睾丸或不可触及睾丸（NPT）的隐睾症。NPT中60%为无活力睾丸（NVT），包括睾丸残迹、睾丸结节、睾丸缺如和阴囊内萎缩睾丸等，剩下的40%为形态大致正常的腹腔内睾丸（IAT）和腹腔外睾丸（EAT）。目前临床上对NPT隐睾的处理仍存在较大争议。本文将从病因、术前检查评估、手术方式选择、新兴技术和临床尚存争议等方面对NPT隐睾作一综述。
- 隐睾症 /
- 睾丸 /
- 病因 /
- 评估 /
- 处理
Abstract: Cryptorchidism is the most common disorder of sexual development in boys and affects 3.5% of male newborns.Although approximately half of newborn undescended testes descend spontaneously, some of testicles will continue to ascend later in childhood and maintain cryptorchidism.Approximately 15% to 20% of undescended testes are nonpalpable, which could be termed as cryptorchidism with nonpalpable testis (NPT).Nonviable NPTs including testicular remnants, testicular nubbins, vanished testes and scrotal atrophic testes account for 60%.The remaining 40% are relatively normal size intra-or extra-abdominal testes.The current clinical manangement of cryptorchidism with NPT remains controversial.This review serves as an update on several aspects such as etiology, preoperative examination and evaluation, surgical options, emerging procedures and clinical ongoing controversies.
- cryptorchidism /
- testes /
- etiology /
- evaluation /
- management

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参考文献(46)

[1]	Elder J S.Surgical Management of the Undescended Testis:Recent Advances and Controversies[J].Eur JPediatr Surg, 2016, 26 (5):418-426.
[2]	Kvist K, Clasen-Linde E, Langballe O, et al.The Expression of Markers for Intratubular Germ Cell Neoplasia in Normal Infantile Testes[J].Front Endocrinol (Lausanne), 2018, 9:286.
[3]	Bae K H, Park J S, Jung H J, et al.Inguinal approach for the management of unilateral nonpalpable testis:is diagnostic laparoscopy necessary?[J].J Pediatr Urol, 2014, 10 (2):233-236.
[4]	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.
[5]	Elsherbeny M, Abdallah A, Abouzeid A, et al.Staged laparoscopic traction orchiopexy for intra-abdominal testis:Is it always feasible?[J].J Pediatr Urol, 2018, 14 (3):267.e1-267.e4.
[6]	Bracho-Blanchet E, Unda-Haro S, Ordorica-Flores R, et al.Laparoscopic treatment of nonpalpable testicle.Factors predictive for diminished size[J].J Pediatr Surg, 2016, 51 (7):1201-1206.
[7]	Braga L H, Kim S, Farrokhyar F, et al.Is there an optimal contralateral testicular cut-off size that predicts monorchism in boys with nonpalpable testicles?[J].JPediatr Urol, 2014, 10 (4):693-698.
[8]	Berger C, Haid B, Becker T, et al.Nonpalpable testes:Ultrasound and contralateral testicular hypertrophy predict the surgical access, avoiding unnecessary laparoscopy[J].J Pediatr Urol, 2018, 14 (2):163.e1-163.e7.
[9]	Alzahem A.Laparoscopy-assisted orchiopexy versus laparoscopic two-stage fowler stephens orchiopexy for nonpalpable testes:Comparative study[J].Urol Ann, 2013, 5 (2):110-114.
[10]	Tasian G.Ultrasound:A poor diagnostic test for cryptorchidism[J].Can Urol Assoc J, 2015, 9 (11-12):391-391.
[11]	Kolon T F, Herndon C D, Baker L A, et al.Evaluation and treatment of cryptorchidism:AUA guideline[J].JUrol, 2014, 192 (2):337-345.
[12]	Emad-Eldin S, Abo-Elnagaa N, Hanna S A, et al.The diagnostic utility of combined diffusion-weighted imaging and conventional magnetic resonance imaging for detection and localization of non palpable undescended testes[J].J Med Imaging Radiat Oncol, 2016, 60 (3):344-351.
[13]	Raicevic M, Saxena A K.Laparoscopic management of Müllerian duct remnants in the paediatric age:Evidence and outcome analysis[J].J Minim Access Surg, 2018, 14 (2):95-98.
[14]	Castillo-Ortiz J, Muñiz-Colon L, Escudero K, et al.Laparoscopy in the surgical management of the non-palpable testis[J].Front Pediatr, 2014, 2:28-28.
[15]	Arena S, Impellizzeri P, Perrone P, et al.Is inguinal orchidopexy still a current procedure in the treatment of intraabdominal testis in the era of laparoscopic surgery?[J].J Pediatr Surg, 2017, 52 (4):650-652.
[16]	Sepúlveda X, Egaña P L.Current management of nonpalpable testes:a literature review and clinical results[J].Transl Pediatr, 2016, 5 (4):233-239.
[17]	AbouZeid A A, Mousa M H, Soliman H A, et al.Intraabdominal testis:histological alterations and significance of biopsy[J].J Urol, 2011, 185 (1):269-274.
[18]	Jawdat J R, Kocherov S, Chertin B.One-Stage Laparoscopic Orchiopexy for the Treatment of Intraabdominal Testis[J].Isr Med Assoc J, 2016, 18 (11):669-672.
[19]	Casanova N C, Johnson E K, Bowen D K, et al.TwoStep Fowler-Stephens orchiopexy for intraabdominal testes:a 28-year single institution experience[J].JUrol, 2013, 190 (4):1371-1376.
[20]	王欣, 关勇, 孟庆娅, 等.腹腔镜微创手术与传统开放手术治疗小儿隐睾的疗效对比研究[J].临床泌尿外科杂志, 2017, 32 (1):39-41.
[21]	Ekwunife O H, Modekwe V I, Ugwu J O, et al.Early Experience with Laparoscopic Management of Nonpalpable Undescended Testes[J].Niger J Surg, 2017, 23 (2):115-118.
[22]	Fine R G, Franco I.Laparoscopic orchiopexy and varicocelectomy:is there really an advantage?[J].Urol Clin North Am, 2015, 42 (1):19-29.
[23]	Frimberger D, Malm-Buatsi E, Kropp B P, et al.Reliance of preoperative scrotal examination versus final operative findings in the evaluation of non-palpable testes[J].J Pediatr Urol, 2015, 11 (5):255.e1-255.e5.
[24]	Gonzalez K W, Dalton B G, Snyder C L, et al.The anatomic findings during operative exploration for nonpalpable testes:A prospective evaluation[J].J Pediatr Surg, 2016, 51 (1):128-130.
[25]	Grinspon R P, Habib C, Bedecarrás P, et al.Compensatory function of the remaining testis is dissociated in boys and adolescents with monorchidism[J].Eur J Endocrinol, 2016, 174 (3):399-407.
[26]	Sturm R, Kurzrock E, Amend G, et al.Blind ending vessels on diagnostic laparoscopy for nonpalpable testis:Is a nubbin present?[J].J Pediatr Urol, 2017, 13 (4):392.e1-392.e6.
[27]	Nataraja R M, Yeap E, Healy C J, 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.
[28]	Iwatsuki S, Naiki T, Kawai N, et al.Nonpalpable testicular pure seminoma with elevated serum alpha-fetoprotein presenting with retroperitoneal metastasis:a case report[J].J Med Case Rep, 2016, 10 (1):114.
[29]	Stedman F, Bradshaw C J, Kufeji D.Current Practice and Outcomes in the Management of Intra-abdominal Testes[J].Eur J Pediatr Surg, 2015, 25 (5):409-413.
[30]	Hamidi N, Telli O, Bagci U, et al.Outcomes of Laparoscopic Treatment Modalities for Unilateral Non-palpable Testes[J].Front Pediatr, 2016, 4:13-13.
[31]	Rogers E, Teahan S, Gallagher H, et al.The role of orchiectomy in the management of postpubertal cryptorchidism[J].J Urol, 1998, 159 (3):851-854.
[32]	Gurney J K, McGlynn K A, Stanley J, et al.Risk factors for cryptorchidism[J].Nat Rev Urol, 2017, 14 (9):534-548.
[33]	Chan K W, Lee K H, Wong H Y, et al.Use of laparoscopy as the initial surgical approach of impalpable testes:10-year experience[J].World J Clin Pediatr, 2015, 4 (4):155-159.
[34]	AbouZeid A A, Moussa M H, Shalaby M S, et al.Feasibility and safety of monopolar diathermy as an alternative to clip ligation in laparoscopic Fowler-Stephens orchiopexy[J].JPediatr Surg, 2012, 47 (10):1907-1912.
[35]	Hay S A.Collateral circulation after spermatic vessel ligation for abdominal testis and its impact on staged laparoscopically assisted orchiopexy[J].J Laparoendosc Adv Surg Tech A, 2007, 17 (1):124-127.
[36]	Kojima Y, Mizuno K, Kamisawa H, et al.Laparoscopic management of nonpalpable testis:new treatment strategy[J].J Endourol, 2011, 25 (4):635-640.
[37]	Dessanti A, Falchetti D, Iannuccelli M, et al.Cryptorchidism with short spermatic vessels:staged orchiopexy preserving spermatic vessels[J].J Urol, 2009, 182 (3):1163-1167.
[38]	Shehata S, Shalaby R, Ismail M, et al.Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique):stretching the limits for preservation of testicular vasculature[J].J Pediatr Surg, 2016, 51 (2):211-215.
[39]	Muñoz C J, Nguyen H T, Houck C S.Robotic surgery and anesthesia for pediatric urologic procedures[J].Curr Opin Anaesthesiol, 2016, 29 (3):337-344.
[40]	Yamada Y, Naitoh Y, Kobayashi K, et al.Laparoendoscopic Single-Site Surgery for Pediatric Urologic Disease[J].J Endourol, 2016, 30 (1):24-27.
[41]	胡金鼎, 石汝骥, 孙亚军, 等.隐睾含有绒癌成分的混合型生殖细胞肿瘤1例[J].临床泌尿外科杂志, 2018, 33 (3):249-250.
[42]	Nataraja R M, Asher C M, Nash R, et al.Is routine excision of testicular remnants in testicular regression syndrome indicated?[J].J Pediatr Urol, 2015, 11 (3):151.e1-151.e5.
[43]	Akdemir F, Aldemir M, Orhun H S.Intratesticular calcified nodule[J].Turk J Urol, 2017, 43 (4):563-565.
[44]	Broderick K M, Martin B G, Herndon C D, et al.The current state of surgical practice for neonatal torsion:a survey of pediatric urologists[J].J Pediatr Urol, 2013, 9 (5):542-545.
[45]	Martin A D, Rushton H G.The prevalence of bell clapper anomaly in the solitary testis in cases of prior perinatal torsion[J].J Urol, 2014, 191 (5 Suppl):1573-1577.
[46]	Nataraja R M, Asher C M, Nash R, et al.Is routine excision of testicular remnants in testicular regression syndrome indicated?[J].J Pediatr Urol, 2015, 11 (3):151.e1-151.e5.