Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.
J Pediatr Surg. 2011 Sep;46(9):1798-803. doi: 10.1016/j.jpedsurg.2011.01.017.
Cryptorchidism is commonly associated with gastroschisis. Management of the undescended testes varies with regard to technique and timing of orchidopexy. To evaluate the appropriate timing of and procedure for orchidopexy in patients with gastroschisis, we reviewed our experience.
Male neonates admitted between January 1999 and September 2010 with gastroschisis were reviewed. This retrospective study was conducted after institutional review board approval. Testis location at birth was recorded, and outcomes for those with undescended testes were analyzed.
Sixty-two males with gastroschisis were identified, and 24 had cryptorchidism (38.7%) affecting 31 testes. All babies had an initial watch-and-wait approach without any attempt at orchidopexy during gastroschisis closure. Those with extraabdominal testes at birth had the testicle repositioned in the abdomen before gastroschisis closure. Mean follow-up was 27.3 months. At follow-up, 54.8% of the testes relocated without intervention and 38.7% required orchidopexy. Laparoscopy was used in 5 patients to perform the orchidopexy. A total of 3 testes required orchiectomy secondary to atrophy, one of which had previously undergone an orchidopexy. Two of the orchiectomies were performed laparoscopically.
The watch-and-wait approach for cryptorchidism in gastroschisis is safe and appropriate, with a high rate of spontaneous migration during the first year of life and greater than 90% testes viable at follow-up. Laparoscopy is a safe and feasible option for management of undescended testes that remain intraabdominal at follow-up.
隐睾症通常与腹裂有关。隐睾的治疗方法因睾丸固定术的技术和时间而异。为了评估腹裂患儿睾丸固定术的适当时机和方法，我们回顾了我们的经验。
回顾 1999 年 1 月至 2010 年 9 月期间因腹裂住院的男性新生儿。本回顾性研究在机构审查委员会批准后进行。记录出生时睾丸的位置，并分析隐睾患儿的结局。
确定了 62 名患有腹裂的男性，其中 24 名患有隐睾症（38.7%），影响 31 个睾丸。所有婴儿在腹裂关闭期间均采用初始观察等待方法，而不尝试进行睾丸固定术。出生时睾丸位于腹腔外的婴儿，在腹裂关闭前将睾丸重新定位到腹部。平均随访时间为 27.3 个月。随访时，54.8%的睾丸无需干预即可自行复位，38.7%需要进行睾丸固定术。5 名患者采用腹腔镜进行睾丸固定术。共有 3 个睾丸因萎缩而需要进行睾丸切除术，其中 1 个曾行睾丸固定术。其中 2 例睾丸切除术采用腹腔镜进行。
对于腹裂患儿的隐睾症，观察等待方法是安全且合适的，在出生后第一年有很高的自发迁移率，随访时超过 90%的睾丸存活。腹腔镜是一种安全可行的选择，可用于处理随访时仍位于腹腔内的未降睾丸。
