第10卷 第7期中华男科学杂志Vol.10 No.72004年7月National Journal of AndrologyJul.2004・论著・隐睾患儿手术治疗后青春期性发育的临床和内分泌观察丁德刚,李启忠,范小玲,杜 涛(河南省人民医院泌尿外科,河南郑州450003)摘要: 目的:观察隐睾患儿术后青春期性发育的状况。
方法:随访调查184例隐睾患儿术后青春期阴毛发育程度、阴茎长度和周径、睾丸体积和血清黄体生成素(LH )、卵泡刺激素(FSH )、睾酮(T )水平。
比较不同手术年龄、隐睾位置和手术方式对疗效的影响。
结果:①双侧隐睾固定术组的阴毛发育程度、阴茎长度和周径、睾丸体积和T 明显降低;FSH 和LH 明显升高。
②单侧隐睾固定术组的术侧睾丸体积明显小于下降侧、但明显大于未治疗组的隐睾侧;单侧隐睾固定术及切除术组的FSH 明显高于正常组、但切除术组的FSH 又明显高于固定术组。
③手术年龄<5岁组的阴毛发育程度、阴茎长度和周径、术侧睾丸体积和T 均明显大于≥5岁组;后者的FSH 明显高于前者。
④高位型的术侧睾丸体积明显降低,FSH 明显升高。
睾丸体积与FSH 呈负相关关系。
结论:隐睾间质细胞功能损伤程度较轻,单侧隐睾术后青春期性征发育可表现为正常,早期手术可防止隐睾和对侧正常下降睾丸生精功能的损害。
关键词:隐睾;睾丸;隐睾固定术;儿童;性发育;青春期中图分类号:R697+.22;R726.9 文献标识码:A 文章编号:100923591(2004)0720503203①Sexual Development in Adolescents after Surgical Treatment for CryptorchidismDing Degang ,Li Qizhong ,Fan X iaoling ,Du T aoDepartment o f Urology ,the People ’s Hospital o f Henan Province ,Zhengzhou ,Henan 450003,China (Ding DG ,Li QZ ,Fan XL ,Du T )Correspondence to :Ding Degang ,E 2mail :dingdeg @Abstract : Objective :T o investigate the sexual development in adolescents after surgical treatment for undescended testes. Methods :One hundred and eighty 2four adolescents underg oing surgery for cryptorchidism before the age of 10years ,22cases received no surgical manage 2ment for unilateral undescended testes ,and 25normal controls were studied.The pubic stage ,the natural length and girth of the penis ,the v olume of the testis ,serum luteinizing horm one (LH ),follicle 2stimulating horm one (FSH )and testosterone (T )were examined to find out the effect of age ,the location of the testis and operative procedures on prognosis. Results :The pubic stage ,the length and girth of the penis ,the v olume of the testis and T decreased ,but FSH and LH increased significantly in 18adolescents who had underg one bilateral orchiopexy.The v olume of the unilaterally undescended testis was significantly smaller than that of the normally descended contralateral g onad in 152ado 2lescents who had underg one unilateral orchiopexy.FSH was significantly higher in the adolescents surgically treated for unilateral cryp 2torchidism.Those treated by unilateral orchiectomy presented significantly higher levels of FSH than those by unilateral orchiopexy.The pubic stage ,the length and girth of the penis ,the v olume of the testis and T were significantly higher ,but FSH lower in the adolescents treated be 2fore the age of 5years than at the age of 5or older.The decrease in testicular v olume was significantly greater in adolescents with intra 2abdomi 2nal testes.S ignificant negative correlation was found between FSH and testicular v olume. Conclusion :Leydig cell function seems relatively・305・①收稿日期:2004204201;修回日期:2004205210作者简介:丁德刚(19652),男,河南固始县人,副主任医师,硕士,从事泌尿外科专业。
通讯作者:丁德刚,E 2mail :dingdeg @resistant to the hostile environment of the cryptorchidism.Early diagnosis and management of the undescended testis are needed to preserve fer2 tility. Natl J Androl,2004,10(7):5032505K ey w ords:cryptorchidism;testis;orchiopexy;boy;sexual development;puberty 对我院1988～1999年手术治疗的部分隐睾患儿随访调查,采用体格检查及测定血清黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)水平的研究方法,观察隐睾术后青春期性发育的状况,探讨了手术年龄、隐睾位置和手术方式对疗效的影响。
1 资料和方法1.1 临床资料 手术治疗组为184例隐睾患儿,手术时平均年龄4.3(1.5～10.0)岁,随访平均年龄15.5 (14.0～16.5)岁。
单侧隐睾166例,双侧18例;外环型(低位型)29侧,腹股沟型(中位型)141侧,腹内型(高位型)32侧,根据手术方式及术时年龄的分组情况见表1。
按同年龄(上、下相差≤4个月)的条件,选择未治疗组22例,平均年龄15.7(14.5～16.5)岁,均为单侧隐睾;对照组25例,平均年龄15.4(14～16)岁,无生殖系统及全身疾病。
3组间年龄构成比差别均无显著性(P>0.05)。
1.2 研究方法1.2.1 体检 检查阴毛发育程度[1]。
测量阴茎非勃起状态:长度 直立位阴茎角90°时尿道口至耻骨联合的水平距离;周径 测量阴茎体前、后端及正中的周径,取平均值。
B超测量睾丸的上下(a)、左右(b)和前后(c)径,以πabc/6计算每侧睾丸体积[2],双侧隐睾及正常组均取平均值。
1.2.2 血清性激素水平测定 采集晨8:00～9:00空腹静脉血5ml,分离血清后置-20℃保存待测。
采用放射免疫分析法(RI A)测定血清LH、FSH及T 水平。
1.3 统计学分析 数据以x±s表示,多样本均数比较用方差分析,两样本均数比较用q或t检验,率比较用χ2检验。
P<0.05为差异有显著性。
2 结果2.1 双侧隐睾固定术患儿的检测结果 与对照、单侧隐睾固定术及切除术组比较,双侧隐睾固定术组的阴毛发育程度、阴茎长度和周径、睾丸体积和T明显降低;FSH和LH明显升高(P均<0.05,表1)。
2.2 单侧隐睾患儿的检测结果 单侧隐睾固定术及切除术组的阴毛发育程度、阴茎长度和周径、下降侧睾丸体积、T及LH与对照组比较差异无显著性(P均>0.05);隐睾固定术组的术侧睾丸体积明显小于下降侧(P<0.01),但明显大于未治疗组的隐睾侧(P<0.01);固定术及切除术两组的下降侧睾丸体积明显大于未治疗组的隐睾侧(P<0.01);固定术及切除术两组的FSH明显高于对照组(P<0.05),但切除术组的FSH又明显高于固定术组(P<0.05)。
2.3 手术年龄对疗效的影响 单侧隐睾固定术中,手术年龄<5岁组的阴毛发育程度、阴茎长度和周径、术侧睾丸体积和T明显大于≥5岁组(P< 0.01);后者的FSH明显高于前者(P均<0.05);两者的下降侧睾丸体积差异无显著性(P>0.05),见表1。
2.4 隐睾位置对疗效的影响 单侧睾丸固定术的4岁≤手术年龄<5岁组中,低位(9例)和中位型(37例)的各项检测结果差异均无显著性(P>0.05)。
与低位和中位型比较,高位型的术侧睾丸体积明显降低、FSH明显升高(P均<0.05),其余检测指标差异无显著性(P>0.05)。
2.5 睾丸体积与FSH、LH的相关性 统计学分析表明,睾丸体积与FSH呈负相关关系(r=-0.291, P<0.05)、与LH无明显相关关系(P>0.05)。