Nataraja Ramesh Mark, Yeap Evie, Healy Costa J, Nandhra Inderpal S, Murphy Feilim L, Hutson John M, Kimber Chris
Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Melbourne, 3168, Australia.
Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Pediatr Surg Int. 2018 Mar;34(3):353-361. doi: 10.1007/s00383-017-4206-0. Epub 2017 Nov 9.
There is no consensus in the literature about the necessity for excision of testicular remnants in the context of surgery for an impalpable testis and testicular regression syndrome (TRS). The incidence of germ cells (GCs) within these nubbins varies between 0 and 16% in previously published series. There is a hypothetical potential future malignancy risk, although there has been only one previously described isolated report of intratubular germ-cell neoplasia. Our aim was to ascertain an accurate incidence of GCs and seminiferous tubules (SNTs) within excised nubbins and hence guide evidence-based practice. The systematic review protocol was designed according to the PRISMA guidelines, and subsequently published by the PROSPERO database after review (CRD42013006034). The primary outcome measure was the incidence of GCs and the secondary outcome was the incidence of SNTs. The comprehensive systematic review included articles published between 1980 and 2016 in all the relevant databases using specific search parameters and terms. Strict inclusion and exclusion criteria were ultilised to identify articles relevant to the review questions. Twenty-nine paediatric studies with a total of 1455 specimens were included in the systematic review. The mean age of the patients undergoing nubbin resection was 33 months and the TRS specimen was more commonly excised from the left (68%). The incidence of SNTs was 10.7% (156/1455) and the incidence of GCs, 5.3% (77/1455). Histological analysis excluding the presence of either SNTs or GCs was consistent with TRS, fibrosis, calcification or haemosiderin deposits. There is limited evidence on subset analysis that GCs and SNTs may persist with increasing patient age. This systematic review has identified that 1 in 20 of resected testicular remnants has viable GCs and 1 in 10 has SNTs present. There is insufficiently strong evidence for the persistence of GCs and SNTs with time or future malignant potential. Intra-abdominal TRS specimens may contain more elements and, therefore, require excision, although this is based on limited evidence. However, there is no available strong evidence to determine that a TRS specimen requires routine excision in an inguinal or scrotal position.
对于在不可触及睾丸及睾丸退化综合征（TRS）手术中是否有必要切除睾丸残端，文献中尚无共识。在既往发表的系列研究中，这些小结节内生殖细胞（GCs）的发生率在0%至16%之间。尽管此前仅有一篇关于管内生殖细胞瘤的孤立报道，但存在潜在的未来恶性肿瘤风险。我们的目的是确定切除的小结节内GCs和生精小管（SNTs）的准确发生率，从而指导循证实践。系统评价方案根据PRISMA指南设计，经审核后由PROSPERO数据库发布（CRD42013006034）。主要结局指标是GCs的发生率，次要结局是SNTs的发生率。全面的系统评价纳入了1980年至2016年间在所有相关数据库中发表的文章，使用了特定的搜索参数和术语。采用严格的纳入和排除标准来确定与评价问题相关的文章。系统评价纳入了29项儿科研究，共1455个标本。接受小结节切除患者的平均年龄为33个月，TRS标本更常见于左侧切除（68%）。SNTs的发生率为10.7%（156/1455），GCs的发生率为5.3%（77/1455）。排除SNTs或GCs存在的组织学分析与TRS、纤维化、钙化或含铁血黄素沉积一致。关于亚组分析的证据有限，即GCs和SNTs可能随患者年龄增长而持续存在。这项系统评价发现，切除的睾丸残端中，20个中有1个有存活的GCs，10个中有1个有SNTs。关于GCs和SNTs随时间持续存在或未来恶性潜能，证据不够充分有力。腹腔内TRS标本可能含有更多成分，因此需要切除，尽管这基于有限的证据。然而，没有有力证据确定腹股沟或阴囊位置的TRS标本需要常规切除。
