Turek P J, Ewalt D H, Snyder H M, Stampfers D, Blyth B, Huff D S, Duckett J W
Department of Pediatric Urology, Children's Hospital of Philadelphia, Pennsylvania.
J Urol. 1994 Mar;151(3):718-20; discussion 720-1. doi: 10.1016/s0022-5347(17)35069-3.
On surgical exploration for impalpable testes, there is often found nothing or a nubbin of tissue at the end of the spermatic vessels. This situation is commonly referred to as an absent testis. Controversy exists on how to establish correctly this diagnosis and the degree of investigation required. In addition, there is disagreement concerning whether an absent testis results from early torsion or endocrinopathic event. What is accepted is that the spermatic vessels are singularly important in establishing testis location. In this study, the pathological findings of 117 cases of absent testis diagnosed by surgical exploration at our hospital were reviewed. This diagnosis represented 10% of 1,225 patients explored for cryptorchidism from 1985 to 1991. Average patient age at operation was 26.8 months (range 5 months to 14 years). Of these children 78 (67%) presented with an impalpable left testis. At operation 3 patients (3%) underwent laparoscopy only, while all others had groin exploration with or without transperitoneal exposure to ensure identification of spermatic vessels. In 110 cases surgical specimens or nubbins were excised. Pathological study of these remnants revealed vas deferens in 89 cases (81%), epididymal tissue in 40 (36%) and small amounts of seminiferous tubules with germinal elements in 7 (6.4%). Only 26 specimens (24%) had sufficient vascular tissue present to be suggestive of spermatic vessels. A significant number showed the presence of calcification (35.5%) and hemosiderin (30%) deposits within the remnant. A subset of patients with absent testis possesses testicular tissue of presumed increased malignant potential. Therefore, surgical exploration with spermatic vessel identification and remnant removal is the gold standard for the diagnosis and treatment of the absent testis. The surgeon continues to be responsible for spermatic vessel identification, since the vessels may be recognized at pathological examination in less than 25% of the cases. Also, the common finding of calcification and hemosiderin lends weight to the torsion etiology over endocrinopathy for an absent testis.
在对无法触及的睾丸进行手术探查时，通常在精索血管末端找不到任何东西或仅有一小团组织。这种情况通常被称为睾丸缺如。关于如何正确做出这一诊断以及所需的检查程度存在争议。此外，对于睾丸缺如是由早期扭转还是内分泌病变引起也存在分歧。大家公认的是，精索血管对于确定睾丸位置极为重要。在本研究中，回顾了我院通过手术探查诊断为睾丸缺如的117例病例的病理结果。这一诊断占1985年至1991年间因隐睾症接受探查的1225例患者的10%。手术时患者的平均年龄为26.8个月（范围为5个月至14岁）。这些儿童中78例（67%）表现为左侧睾丸无法触及。手术时，3例患者（3%）仅接受了腹腔镜检查，而其他所有患者都进行了腹股沟探查，有的还进行了经腹膜暴露，以确保识别精索血管。110例患者切除了手术标本或组织小块。对这些残余组织的病理研究显示，89例（81%）有输精管，40例（36%）有附睾组织，7例（6.4%）有少量含有生殖细胞的生精小管。只有26个标本（24%）有足够的血管组织提示精索血管。相当数量的标本显示残余组织内存在钙化（35.5%）和含铁血黄素（30%）沉积。一部分睾丸缺如的患者拥有推测恶性潜能增加的睾丸组织。因此，识别精索血管并切除残余组织的手术探查是睾丸缺如诊断和治疗的金标准。外科医生仍负责识别精索血管，因为在不到25%的病例中，血管在病理检查时才能被识别。此外，钙化和含铁血黄素的常见发现支持睾丸缺如的扭转病因学说而非内分泌病变学说。
