Punwani Vishal V, Wong Jeremy S Y, Lai Christopher Y H, Chia Jessalynn C Y, Hutson John M
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Urology, The Royal Children's Hospital, Parkville, Victoria, Australia; Douglas Stephens Surgical Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
J Pediatr Surg. 2017 Nov;52(11):1842-1847. doi: 10.1016/j.jpedsurg.2016.12.009. Epub 2016 Dec 21.
BACKGROUND/AIM: Testicular ectopia is rare, but the large range of anatomical locations described in the literature has spawned an abundance of possible theories to explain etiology. However, as the anatomical characteristics of normal testicular descent have only been elucidated recently, many of the theories of testicular ectopia do not incorporate this new perspective. In this study we aimed to determine what was in the literature about ectopic testis since 1980, and then try to explain the different anatomical variants in the light of current knowledge about testicular descent.
A literature search was performed and all articles in English published since 1980 about testicular ectopia using several key words were identified.
A total of 271 articles in English were found, of which 31 addressed the pathophysiology and are the primary focus of this study. Case reports and reviews described perineal ectopia (×4), transverse testicular ectopia (×11), and abdominal ectopia (×2), along with 3 reviews/case reports addressing diagnosis and management. A range of proposed causes were found, including obstructed 'third inguinal ring' at neck of scrotum, abnormal CGRP function, aberrant distal gubernacular attachment, mechanical hindrance from retained Müllerian ducts, defective gubernacular formation or disruption of the gubernacular attachment to the testis.
After reviewing the proposed theories, we propose a unifying theory, based on current knowledge of testicular descent, where testicular ectopia can be explained by a) anomalous attachment of the gubernaculum to the anterior abdominal wall during transabdominal descent, or b) aberrant migration of the gubernaculum during the inguinoscrotal phase of testicular descent.
背景/目的：睾丸异位很少见，但文献中描述的解剖位置范围广泛，催生了大量关于病因的可能理论。然而，由于正常睾丸下降的解剖特征直到最近才得以阐明，许多睾丸异位理论并未纳入这一新观点。在本研究中，我们旨在确定自1980年以来文献中关于异位睾丸的内容，然后根据目前关于睾丸下降的知识来解释不同的解剖变异。
进行文献检索，使用几个关键词确定自1980年以来发表的所有英文关于睾丸异位的文章。
共找到271篇英文文章，其中31篇涉及病理生理学，是本研究的主要重点。病例报告和综述描述了会阴异位（4例）、横位睾丸异位（11例）和腹部异位（2例），还有3篇综述/病例报告涉及诊断和管理。发现了一系列提出的病因，包括阴囊颈部“第三腹股沟环”受阻、降钙素基因相关肽（CGRP）功能异常、远端睾丸引带附着异常、残留苗勒管的机械阻碍、睾丸引带形成缺陷或睾丸引带与睾丸附着的破坏。
在回顾了提出的理论后，我们基于目前对睾丸下降的认识提出了一个统一的理论，其中睾丸异位可以通过以下方式解释：a）在经腹下降过程中睾丸引带与前腹壁的异常附着，或b）在睾丸下降的腹股沟阴囊阶段睾丸引带的异常迁移。
