合并肛门直肠畸形的附睾炎-睾丸炎：41 例的汇总回顾。

Epididymo-orchitis complicating anorectal malformations: collective review of 41 cases.

机构信息

Division of Pediatric Surgery, Rajah Muthiah Medical College, Annamalai University, Tamilnadu, India.

出版信息

J Urol. 2011 Oct;186(4):1467-72. doi: 10.1016/j.juro.2011.05.066.

DOI:10.1016/j.juro.2011.05.066

PMID:21862041

Abstract

PURPOSE

Epididymo-orchitis is a devastating complication of imperforate anus. Without proper treatment the condition may result in infertility. Nevertheless, the exact etiology and optimal management of epididymo-orchitis in anorectal malformation are unknown.

MATERIALS AND METHODS

Retrospective review of our hospital records between 1997 and 2010 identified 6 cases of epididymo-orchitis in 82 boys with anorectal malformation. Extensive search of the literature revealed 35 additional cases. Clinical details of these 41 patients were analyzed using chi-square testing.

RESULTS

Epididymo-orchitis occurred predominantly (86%) in high or intermediate anorectal malformation with rectourinary fistula. Median age at onset of epididymo-orchitis was 6 months and there was no side predilection. Urinary tract infection was noted in 54% of patients. Persistent mesonephric duct syndrome (27%), urethroejaculatory duct reflux (22%), vasovesical ectopia (10%), neurovesical dysfunction (34%) and urethral stricture/stenosis (17%) were frequently associated risk factors for epididymo-orchitis. In 73% of patients epididymo-orchitis recurred with exclusive antibiotic treatment. Diverting colostomy was ineffective in preventing epididymo-orchitis. Division of rectourinary fistula was curative in 36% of patients, while in 34% epididymo-orchitis recurred even after division of rectourinary fistula. Division of rectourinary fistula is likely to resolve epididymo-orchitis in the absence of additional risk factors. Vasectomy was required in 22% of patients to prevent recurrence.

CONCLUSIONS

In addition to rectourinary fistula, urinary reflux into the vas deferens and neurovesical dysfunction are major risk factors for epididymo-orchitis in anorectal malformation. Division of rectourinary fistula is curative in only a third of cases. In the remaining cases some form of surgical disruption of the vas deferens is needed to resolve recurrent epididymo-orchitis.

摘要

目的

隐睾症是肛门闭锁的一种严重并发症。如果不进行适当的治疗，可能会导致不育。然而，隐睾症在肛门直肠畸形中的病因和最佳治疗方法尚不清楚。

材料和方法

对 1997 年至 2010 年期间我院病历的回顾性研究，共发现 82 例肛门直肠畸形男孩中有 6 例发生隐睾症。通过广泛的文献检索，共发现 35 例额外病例。采用卡方检验对这 41 例患者的临床资料进行分析。

结果

隐睾症主要发生于高位或中位肛门直肠畸形伴直肠尿道瘘（86%）。隐睾症的发病中位年龄为 6 个月，无侧别差异。54%的患者有尿路感染。持续性中肾管综合征（27%）、尿道射精管反流（22%）、膀胱输尿管异位（10%）、神经膀胱功能障碍（34%）和尿道狭窄/梗阻（17%）是隐睾症的常见相关危险因素。73%的患者仅用抗生素治疗就可使隐睾症复发。结肠造口术不能预防隐睾症。直肠尿道瘘切开术对 36%的患者有疗效，而在 34%的患者中，即使切开直肠尿道瘘，隐睾症仍会复发。在没有其他危险因素的情况下，切开直肠尿道瘘可能会治愈隐睾症。22%的患者需要行输精管切除术以预防复发。