Trotter G W
Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins.
Vet Clin North Am Equine Pract. 1988 Dec;4(3):493-513. doi: 10.1016/s0749-0739(17)30625-9.
Surgical exploration of the horse that has presumably had a normal castration or a previously successful cryptorchid surgery remains a distinct challenge. No hard and fast rules dictate a proper course of action for each case. If a horse was anesthetized for routine castration, discovered to have only one scrotal testis, had a brief exploratory on the nondescended side and was recovered, trauma to the inguinal region would probably be sufficiently minimal that an inguinal approach could be used at subsequent exploratory surgery. If the inguinal canal was extensively manipulated and the tail of the epididymis was inadvertently removed, however, one of the alternate approaches would be advisable. Where previous history is unknown, external and rectal palpation, hormonal assays, and careful evaluation of the scrotal/inguinal scars under anesthesia are advisable prior to proceeding with a specific course of action. As previously cited, "one hopes for the best but prepares for the worst." Where inguinal canals are being explored in the supposedly previously castrated horse that still has aggressive male behavior, the surgeon is searching for vaginal process and contents or the stump of the spermatic cord. If the stump is identified to suggest complete previous castration, the stump should contain cremaster muscle, parietal vaginal tunic, testicular vessels, and ductus deferens. If a second nonvascular tubular structure is found but no testicular vessels are found, the tail of the epididymis was inadvertently removed and assumed to be hypoplastic testis. This determination can be difficult to make on gross observation of the stump. Again, a thorough case workup helps one plan in advance for what should be found at surgery.
对一匹推测已进行正常去势或先前隐睾手术成功的马进行手术探查仍然是一项独特的挑战。没有硬性规定来指导针对每个病例的正确行动方案。如果一匹马因常规去势而麻醉,发现只有一个阴囊睾丸,对未降侧进行了简短探查并恢复,那么腹股沟区域的创伤可能足够小,后续探查手术可以采用腹股沟入路。然而,如果腹股沟管被广泛操作且附睾尾部被意外切除,那么采用其他方法之一是可取的。如果既往病史不明,在采取特定行动方案之前,建议进行外部和直肠触诊、激素检测,并在麻醉下仔细评估阴囊/腹股沟瘢痕。如前所述,“抱最好的希望,做最坏的打算”。在对仍有攻击性行为的推测已去势的马进行腹股沟管探查时,外科医生要寻找鞘突及其内容物或精索残端。如果确定残端提示先前已完全去势,残端应包含提睾肌、鞘膜壁层、睾丸血管和输精管。如果发现第二个无血管的管状结构但未发现睾丸血管,那么附睾尾部被意外切除并被假定为发育不全的睾丸。仅通过对残端的大体观察很难做出这种判断。同样,全面的病例检查有助于提前规划手术中应该发现什么。