Levard G, Laberge J M
Department of Surgery, Montreal Children's Hospital, McGill University, Quebec, Canada.
Eur J Pediatr Surg. 1997 Jun;7(3):163-5. doi: 10.1055/s-2008-1071081.
Cryptorchidism is frequently associated with gastroschisis, yet little is published on its management in such circumstances. In a review of 10 consecutive boys with gastroschisis since 1980, 4 had undescended testes. Gestational age and birth weight did not differ from the 6 boys with normally descended testes. The first two patients had associated arthrogryposis multiplex congenita. The first underwent bilateral orchidopexy at 9 years of age for inguinal testes. In the second patient, the left testis was intraabdominal at the level of the sigmoid colon at birth; at 3 months of age, when a left inguinal hernia repair was required, left groin exploration revealed the testis at the internal ring and orchidopexy was performed successfully. In the third patient the left spermatic vessels were divided at the time of gastroschisis repair and the testis anchored in the prebubic area. The second-stage orchidopexy was performed at 16 months. In the last patient the intraabdominal testis could be placed in a scrotal pouch without mobilisation or division of the vessels. From our experience and a review of the literature we conclude that: 1) undescended testes are frequently associated with gastroschisis; 2) mechanical factors rather than prematurity are likely responsible for this association; 3) if the testis easily reaches the scrotum, orchidopexy can be done safely at the time of gastroschisis repair; 4) if the testis does not reach easily and appears to have a gubernaculum, it may be preferable to leave it in place since spontaneous descent can occur.
隐睾症常与腹裂相关，但关于在这种情况下其治疗的文献报道较少。在对自1980年以来连续10例腹裂男童的回顾中，有4例睾丸未降。其胎龄和出生体重与6例睾丸已降的男童无差异。前两名患者伴有先天性多发性关节挛缩症。首例患者9岁时因腹股沟隐睾接受了双侧睾丸固定术。第二例患者出生时左侧睾丸位于乙状结肠水平的腹腔内；3个月大时，因需要进行左侧腹股沟疝修补术，左侧腹股沟探查发现睾丸位于内环处，成功实施了睾丸固定术。第三例患者在腹裂修补时切断了左侧精索血管，将睾丸固定在耻骨前区域。二期睾丸固定术于16个月时进行。最后一例患者的腹腔内睾丸无需游离或切断血管即可放入阴囊袋中。根据我们的经验及文献回顾，我们得出以下结论：1）隐睾症常与腹裂相关；2）这种关联可能是由机械因素而非早产导致的；3）如果睾丸能轻易降至阴囊，可在腹裂修补时安全地进行睾丸固定术；4）如果睾丸不易降至阴囊且似乎有睾丸引带，由于可能会自然下降，或许最好让其留在原位。
