Department of Pediatric Surgery, Kawaguchi Municipal Medical Center, 180 Nishi-araijuku, Kawaguchi, Saitama, 333-0833, Japan.
Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Pediatr Surg Int. 2020 Oct;36(10):1189-1195. doi: 10.1007/s00383-020-04720-1. Epub 2020 Jul 22.
To elucidate the natural history of asymptomatic hydroceles (AHs) in children with conservative management and to discuss management strategies for AHs in children.
We retrospectively reviewed 113 children with AHs who were followed without immediate surgery. Patients were divided into four groups according to age at presentation; group 1: ≤ 1 month, group 2: 1-12 months, group 3: 12-24 months, and group 4: > 24 months. Ages at spontaneous resolution or surgery were reviewed. To assess the effect of AH on the testis, testicular size before and after conservative management was compared in 11 cases.
In groups 1, 2, 3, and 4, spontaneous resolution occurred in 94.3%, 75.0%, 65.0%, and 33.3%, and the average time to resolution from presentation was 5, 5, 17, and 9 months, respectively. 41 patients underwent surgery at a mean age of 4.2 years. The testicular size did not differ significantly between before and after conservative management (14.4 vs. 14.5 mm, p = 0.483).
About one-third of children over 2 years of age achieve spontaneous resolution. Hydroceles with conservative management may not affect the testicular size. Thus, initial conservative management before surgery is recommend for AHs in children, even over 2 years of age.
阐明儿童采用保守治疗的无症状性鞘膜积液（AHs）的自然病程，并讨论儿童 AHs 的治疗策略。
我们回顾性分析了 113 例接受非手术保守治疗的 AHs 患儿。根据就诊时的年龄将患者分为 4 组；第 1 组：≤1 个月；第 2 组：1-12 个月；第 3 组：12-24 个月；第 4 组：>24 个月。回顾自发缓解或手术的年龄。为了评估 AH 对睾丸的影响，我们比较了 11 例接受保守治疗前后的睾丸大小。
第 1、2、3 和 4 组的自发缓解率分别为 94.3%、75.0%、65.0%和 33.3%，从就诊到缓解的平均时间分别为 5、5、17 和 9 个月。41 例患儿在平均年龄为 4.2 岁时接受了手术。保守治疗前后睾丸大小无显著差异（14.4 vs. 14.5mm，p=0.483）。
约三分之一的 2 岁以上儿童可自发缓解。采用保守治疗的鞘膜积液可能不会影响睾丸大小。因此，即使是 2 岁以上的儿童，在手术前也建议先进行初始的保守治疗。
