Van Kote G, Servant J M, Leyder P, Dreux Boucart H, Bouju P
Service de Chirurgie Viscérale Infantile, Hôpital Robert-Ballanger, Aulnay-sous-Bois.
Chir Pediatr. 1988;29(5):281-6.
The authors presents 2 observations of testicular autotransplantation at 11 and 13 years age; the 2 boys had bilateral cryptorchism. Analysis of the literature allows good conclusions for the liability of this technique with less than 20% of secondary atrophies. Particularly interesting to note 2 successful operation on children 2 years old. The indications are limited, mainly discussed is bilateral abdominal cryptorchism (mostly Prune Belly Syndrome). The autotransplantation is reserved for the normal appearance testicles with good hormonal function. The operation is preferable using inguino-iliac extra-peritoneal pass; that exploration is very important and at last only in 20% of abdominal cryptorchism could autotransplantation be considered. The malignancy transformation risk is poor if break down is done before 10 years old, however a regular and very long follow-up is necessary: Clinic, vascular, biopsies sometimes at a little doubt. Preservation of hormonal function and fertility hope represent the expected advantages; spermatic analysis are still absent because the too recent autotransplantation. As for usual testicular ectopies for sure it would be preferable to do early autotransplantation, just after 2 years of age, if this is possible.
作者介绍了2例分别在11岁和13岁时进行睾丸自体移植的病例;这2名男孩均患有双侧隐睾症。对文献的分析得出了关于该技术可靠性的良好结论,继发性萎缩发生率低于20%。特别值得注意的是2例对2岁儿童进行的成功手术。其适应症有限,主要讨论的是双侧腹腔隐睾症(大多为梅干腹综合征)。自体移植仅适用于外观正常且激素功能良好的睾丸。手术最好采用腹股沟-髂骨腹膜外通道;该探查非常重要,最终只有20%的腹腔隐睾症患者可考虑进行自体移植。如果在10岁之前进行手术,恶变风险较低,但仍需要定期且长期的随访:包括临床、血管检查,有时活检也会存在一些疑问。保留激素功能和生育希望是预期的优势;由于自体移植时间过近,目前仍缺乏精液分析。对于常见的睾丸异位症,如果可能的话,肯定最好在2岁之后尽早进行自体移植。