Elder J S
Rainbow Babies and Childrens Hospital, Cleveland, Ohio.
Surg Clin North Am. 1988 Oct;68(5):983-1005. doi: 10.1016/s0039-6109(16)44633-5.
Cryptorchidism is the most common disorder of sexual differentiation in males, with an incidence of 3.4 per cent in the term newborn, decreasing to 0.8 per cent at 1 year of age. The mechanisms of normal testicular descent are multifactorial and include an intact hypothalamic-pituitary-testicular axis, as well as a normal gubernaculum and epididymis. In boys with cryptorchidism, the testes demonstrate degenerative changes histologically as early as 1 to 2 years of age. Both testes may be affected, even with a unilateral undescended testis. The most important long-term complications of cryptorchidism include infertility and testicular cancer. The risk of malignancy is 10 to 40 times higher in men with cryptorchidism than in normal men and is highest in men who have had an intra-abdominal testis and in certain intersex conditions. Orchiopexy does not appear to lessen this risk. In clinical trials in the United States, hormonal therapy with hCG or GnRH has not been effective in causing testicular descent; therefore, orchiopexy remains standard treatment. However, hCG is recommended if the clinician suspects that a testis is retractile. Orchiopexy should be performed between 12 and 18 months of age to prevent the degenerative changes that are demonstrable by 2 years.
隐睾症是男性最常见的性分化异常疾病，足月儿的发病率为3.4%，1岁时降至0.8%。正常睾丸下降的机制是多因素的，包括完整的下丘脑-垂体-睾丸轴，以及正常的睾丸引带和附睾。在患有隐睾症的男孩中，早在1至2岁时，睾丸在组织学上就会出现退行性变化。即使是单侧隐睾，双侧睾丸都可能受到影响。隐睾症最重要的长期并发症包括不育和睾丸癌。隐睾症患者患恶性肿瘤的风险比正常人高10至40倍，在有腹腔内睾丸的男性和某些两性畸形情况下风险最高。睾丸固定术似乎并不能降低这种风险。在美国的临床试验中，使用人绒毛膜促性腺激素（hCG）或促性腺激素释放激素（GnRH）进行激素治疗在促使睾丸下降方面并未取得成效；因此，睾丸固定术仍然是标准治疗方法。然而，如果临床医生怀疑睾丸可回缩，则建议使用hCG。应在12至18个月大时进行睾丸固定术，以防止在2岁时出现可证实的退行性变化。
