| Objective: Cryptorchidism is a common malformation of the reproductive system in children.Surgery is the main method to treat cryptorchidism.The traditional fixation of cryptorchidism usually needs to cut off the gubernaculum testis.However,as one of the important sources of testicular blood supply,it is not clear whether the testicular blood supply will be affected to some extent in a short time after the blood supply of gubernaculum testis is cut off.In order to understand the influence of the gubernaculum testis blood supply on testicular blood supply and its influence on cryptorchidism The short-term effect of testicular blood supply after testicular operation was studied.Methods: 1.Experimental group: Data were collected from children with cryptorchidism in the groin area and children with testicular effusion from October 2018 to October 2019.Children in the cryptorchidism group were grouped according to whether the testicular lead was broken during the operation.During the visual inspection,the spermatic cord was thinner,and after the testicular lead was clamped,there were obvious visual ischemia such as testicular whitening and dorsal membrane shrinkage.Children with cryptorchidism retained the testicular lead as the retention lead group,children with cryptorchidism removed from the gubernaculum testis were disconnected from the lead group,and children with testiculareffusion were the hydrocele group.2.Experimental test content : 2.1 Intraoperative observation and comparison of gubernaculum testis adhesion,appearance and vascular distribution of gubernaculum testis,and changes in testicular appearance before and after clamping of gubernaculum testis.2.2 The PHILIPS Doppler ultrasound system(CX-50)detects testicular ultrasound and spectral information,and measures peak systolic velocity(PSV)and end-diastolic blood flow in the testicular middle arteries of the two groups of children.Blood flow parameters such as end diastolic velocity(EDV).2.3 At 1 month postoperative follow-up,the PHILIPS Doppler ultrasound system(CX-50)was used to percutaneously detect PSV and EDV in the cryptorchid testis and testicular effusion group.The PSV and EDV data of the three groups of children with effusion group during and after the operation.3.Statistical analysis:SPSS 22.0 was used for statistical description and analysis of the data,and the measurement data of normal distribution or approximate normal distribution was described by ? x ± s;pairwise comparison was performed by LSD-t test;repeated measurement design analysis of variance was used to compare three different time points PSV value and EDV value,P <0.05 is considered statistically significant.Results:1.In 23 cases of cryptorchidism,the age distribution ranged from 12 to 23 months.In 11 cases,the fine spermatic cord was observed by macroscopic observation during the operation,and obvious testiculardefects such as whitening of the testicles and shrinkage of the dorsal membranes were observed after clamping the gubernaculum testis.Blood manifestations,testicular retention was in the retention retention group,and 12 in the disconnection guidance group;12 children in the hydrothorax group,aged between 12-24 months,there was no significant difference in general information among the three groups.Significance(P> 0.05).2.1 In the cryptorchidism test group,the testes did not descend to the normal position,and the gubernaculum testis developed better.They were more developed than children with hydrocele and showed a cord-like shape.The blood supply is abundant,and it can be seen that the gubernaculum testis blood supply is mainly distributed in two types: one is a single branched lead type,and the other is a branched lead type.There are multiple collateral blood vessels at the base of the lead.The spermatic cord blood vessels,epididymal blood vessels,and vas deferens vessels coincided with each other.There were 12 cases of cryptorchidism in children with thin spermatic cord blood vessels,combined with small vas deferens and testicular epididymis separation.In the normal position,the gubernaculum testis ends in the scrotum and are connected to the testicular mesangial sac.The upper end is double-layered and continuous with the anterior and posterior sheaths surrounding the testicular ligament,and the testicles stop at 6 o'clock At the lower edge of the sheath sac,the gubernaculum testis is degraded,and the blood vessels on it are sparse and messy.There is nofixed feature.The blood supply is not abundant.2.2 In the retention lead group,the PSV of the middle testicular artery before clamping the band was 7.83 ± 1.43,and the PSV after clamping the gubernaculum was 5.93 ± 0.94.There was a significant decrease in PSV after clamping the gubernaculum testis(P <0.05);The PSV before pinching the gubernaculum testis was 7.79 ± 1.78,and the PSV after pinching the gubernaculum testis was 5.76 ± 0.74.The PSV measured after pinching the gubernaculum testis was significantly different from that before the pinch(P <0.05).In the testicular effusion group,the PSV was8.28 ± 1.66 before clamping and the PSV was 8.04 ± 1.52 after clamping.There was no significant difference between the two(P> 0.05).After a follow-up of 1 month,In the test group,the testicular medial arterial PSV was 7.70 ± 1.29,which was not decreased compared with the value before the pinch of the testicular strip(P> 0.05).The PSV of middle testicular artery was 8.11 ± 1.18 in the hydrocele group.there was no decrease compared with the value measured before the pinch of the pinch band during the operation(P> 0.05);In the cryptorchidism group,the PSV of the middle testicular artery was 4.22 ± 0.54 PSV,which was lower than that before the ligation(P <0.05).2.3 In the retention group,the EDV of the middle testicular artery before clamping the testis was 5.79 ± 0.61,and the EDV after clamping the gubernaculum testis was 3.83 ± 0.55.The EDV after clamping the gubernaculum testis was lower than that before the clampinggubernaculum testis(P <0.05);The EDV of the middle testicular artery before the testicular pinching was 5.77 ± 0.72 in the disconnected band group,and the EDV was 4.54 ± 0.73 after the pinching of gubernaculum testis.The EDV was lower than that before the pinching of gubernaculum testis(P < 0.05);The EDV of the test group was 6.18 ±1.06 before clamping the gubernaculum testis and 5.88 ± 1.37 after clamping the band.There was no decrease in EDV before and after clamping the gubernaculum testis(P> 0.05).During the follow-up at 1month after operation,the EDV of the middle testicular artery in the retention lead group was 5.83 ± 0.35,and there was no significant difference compared with the pre-clamping lead(P> 0.05).The EDV decreased before clamping the gubernaculum testis(P <0.05);the EDV value of the middle testicular artery during the 1 month postoperative follow-up was 6.06 ± 1.26,which was not significantly different from that of the middle testicular artery before the clamping gubernaculum testis(P> 0.05).Conclusion: 1.Testicular blood supply and distribution characteristics in children with cryptorchidism are different from those of hydrocele.2.The preservation of the gubernaculum can improve the blood supply of the testis after cryptorchidism,which has positive significance for some special children,such as children with poor spermatic cord development. |
PDF Full Text Request