Objective:To investigate the effect of treatment with orchiopexy at different ages on the clinical outcomes of nonobstructive azoospermia (NOA) patients with a history of cryptorchidism who underwent microdissection testicular sperm extraction (microTESE) combined with intracytoplasmic sperm injection (ICSI).Methods:NOA patients undergoing microTESE combined with ICSI from December 2013 to August 2019 in the ICSI treatment cycle in Assisted Reproduction Center of Northwest Women and Children's Hospital were collected in this retrospective cohort study. According to the history of cryptorchidism, the patients were divided into cryptorchidism group and non-cryptorchidism group. The sperm retrieval rates (SRRs) were assessed between these two groups. Then, based on the timing of treatment with orchiopexy, the NOA patients with orchidopexy were subdivided into prepubertal group and pubertal-postpubertal group. The SRRs and the pregnancy outcomes were also assessed.Results:There were 34 NOA patients with cryptorchidism and 604 NOA patients without cryptorchidism underwent microTESE. The SRRs in NOA patients with or without cryptorchidism were 85.3% (29/34) and 40.2% (243/604), respectively. The differences were statistically significant ( P<0.001). In the prepubertal surgery group, sperm was detected in 17 cases, while in the pubertal-postpubertal surgery group, the sperm was detected in 12 cases. The differences were statistically significant ( P=0.044). The total clinical pregnancy rate of cryptorchidism NOA patients treated with ICSI was 65.4% (17/26). Among these individuals, the clinical pregnancy rate of the prepubertal group was 62.5% (10/16) and the pubertal-postpubertal group was 70.0% (7/10). There were no statistical differences in clinical pregnancy rate. Some other clinical pregnancy outcomes, including miscarriage rate in early pregnancy, the rate of cycle with 2PN and the rate of cycle with top-quality embryo, also showed no differences between the two groups. In pathology analysis, all the cryptorchidism NOA patients with failure sperm retrieval were Sertoli cell only syndrome (SCOS). The pubertal-postpubertal group had a significant higher morbidity of SCOS [76.5% (13/17)] compared with the prepubertal group [35.3% (6/17)] ( P=0.016). In addition, the volume of testis, the level of follicle-stimulating hormone and testosterone were not statistically associated with SRR. Conclusion:The SRR of NOA patients with cryptorchidism was higher than those without cryptorchidism. The age at orchidopexy operation may have little effect on the pregnancy outcome of ICSI. It may be more beneficial for microTESE to obtain sperm by undergoing orchiopexy as early as possible.

目的:探讨单孔腹腔镜下行鞘状突高位结扎术治疗小儿腹阴囊型鞘膜积液的临床效果。方法:回顾性分析本院泌尿外科2013年6月至2018年6月收治的46例应用脐部单孔腹腔镜下行鞘状突高位结扎术治疗的腹阴囊型鞘膜积液患儿的临床资料，对术中局部解剖、手术时间、出血量、术后疗效、并发症及术后随访进行分析。结果:治愈率100%，其中1例中转腹股沟切口手术，术中见腹股沟阴囊囊性肿物经腹股沟管向腹腔内延伸成"葫芦"状或菜花状，其中合并对侧内环口未闭合的患儿20例，单侧手术时间(15.4±2.8)min，合并对侧内环口未闭合的手术时间(19.6±3.5)min，术中出血量1～2 mL，术后患侧阴囊包块明显缩小，1～2周后完全吸收，均未发生阴囊血肿、精索损伤、肠黏连、腹腔内脏器官损伤等并发症。术后随访未见睾丸萎缩、鞘膜积液复发等。结论:单孔腹腔镜下行鞘状突高位结扎术治疗小儿腹阴囊型鞘膜积液疗效确切，且较传统手术而言，具有操作简便、损伤小、恢复快、并发症少等优点，值得临床推广应用。

目的:观察腹腔镜肾盂成形术与传统肾盂成形术在小儿肾积水中的应用效果.方法:60例小儿肾积水患者随机分为对照组、观察组,对照组采用传统肾盂成形术治疗,观察组采用腹腔镜肾盂成形术治疗.比较两组手术指标、术后并发症、治疗前后肾血流动力学指标变化、血β2-MG、α1-M G、Scr水平变化.结果:两组手术时间、术中出血量、进食时间、住院时间比较,差异均无统计学意义(P>0.05).两组术后尿路感染、吻合口尿漏、吻合口梗阻、肠梗阻等并发症发生率差异无统计学意义(P>0.05).治疗后,两组肾血流动力学指标PS、ED、TAMx、TAMn均显着高于同组治疗前(P<0.05).治疗后,观察组PS、ED、TAMx、TAMn显着高于对照组(P<0.05).治疗后,两组血清β2-MG、α1-MG水平均显着低于同组治疗前(P<0.05).治疗后,观察组血清β2-MG、α1-MG水平显着低于对照组(P<0.05).结论:采用腹腔镜式肾盂成形术治疗小儿肾积水,可显著改善患儿血流动力学状态,改善肾功能.

患儿 男,1 岁9 个月,以左侧腹股沟阴囊红肿痛4d入院.入院前4d无诱因左侧腹股沟及阴囊出现包块,发病第2 天开始发热并波动于37.8℃～39.0℃,包块渐增大,左侧阴囊红肿进行性加重,当地医院抗感染治疗无效转我院.发病以来患儿正常进食,无恶心、呕吐,无腹胀,大小便正常.家长否认既往左侧腹股沟及阴囊包块病史.体检:生命体征平稳,神志清楚,精神可,腹稍膨隆,未见胃肠型,腹肌软,无压痛,未闻及气过水声.左侧腹股沟至阴囊区域隆起大小约8.0 cm×4.0 cm×3.0 cm包块(图1),活动度差,左阴囊红肿皮温高,压痛明显,左侧睾丸触诊欠清,右侧腹股沟区及睾丸无异常,肛诊无异常.血常规:WBC 13.33×109/L,N 0.66, Hb 121 g/L.超声检查报告:腹腔未见异常,左侧睾丸上方囊性包块,其内液性暗区,暗区内见强回声分隔光带,未探及肠管,左侧睾丸血流信号弱,考虑精索鞘膜积液并感染(图2、3).腹部 X线平片示:肠淤胀,膈下未见游离气体(图4).

目的 探讨新生儿睾丸扭转的诊疗体会.方法 回顾分析我院近5年收治的12例新生儿睾丸扭转的诊治过程及随访结果 ,并复习相关文献.结果12例患儿年龄8 h～15 d,左侧7例,右侧5例;入院查体患侧阴囊为暗红色或黑紫色,肿胀,内可及质硬包块,患侧睾丸位置偏高,触痛阳性;彩超提示患侧睾丸增大,密度不均,血流信号减弱或消失;1例入院时已发病3d以上,家属拒绝手术,余11例行阴囊探查术,术中均发现精索睾丸扭转并已坏死,11例行患睾切除,8例择期行对侧睾丸固定术;病理结果示睾丸大片出血坏死.所有患儿随访6个月至2年,保守治疗的1例患儿彩超提示患侧睾丸已萎缩,超声检查时均未发现对侧睾丸异常,其中2例患儿术后2年的对侧睾丸较同龄儿增大.结论 新生儿睾丸扭转的睾丸坏死率极高,对于新生儿阴囊无诱因的红肿胀痛等情况,应积极实施阴囊探查术.

目的 总结小儿肾母细胞瘤的临床特点、治疗及预后,评价不同因素对其生存率的影响.方法 回顾性分析2003年1月～2016年12月手术治疗的86例肾母细胞瘤的临床资料,采用Ka plan-Meier曲线进行生存率分析.结果 86例患儿中男59例,女27例,年龄0.7～5.8岁,平均(2.09±0.90)岁.术前化疗65例,直接手术21例,手术完整切除82例.随诊2～165月,中位随访时间53(2～165)月.死亡15例,1年、3年、5年的预期总生存率分别为91.6％、80.4％、80.4％.单因素预后分析显示病理分型及临床分期与生存率有关(P＜0.01).术前化疗患儿生存率高于未化疗息儿(P＜0.05),3岁以下患儿生存率高于3岁以上患儿(P＜0.05).结论 术前化疗及早期治疗能够有效改善预后,提高肾母细胞瘤患者的生存率.

Objective:To find out the characteristics of Wilms' tumor presented with renal trauma and obtain the good management of these patients.Method:The five clinical cases of pediatric Wilms' tumors were studied and literature about Wilms' tumors was reviewed.Result:The main symptoms are always pain of abdomen or anemia.The serious is related to the degree of renal trauma.Conclusion:The diagnosis of Wilms tumor presented with renal trauma should be relay on examination,ultrasound and computed tomography.Renal arteriography can display the origin of hemorrhaging,at the same time effective embolism can be given to the patient.Biopsy of mass is the gold criterion of preoperative patient.It's suggested that comprehensive and individual therapy should be given to these patients.

目的 探讨小儿包皮龟头炎的治疗方法 .方法 选取2015年3月至2016年4月在我院门诊治疗的120例包皮龟头炎患儿,根据治疗方式的不同分为3组,观察组1:给予红霉素软膏+康复新液治疗;观察组2:给予红霉素软膏+苯扎氯铵溶液治疗;对照组:给予1:5000高锰酸钾溶液治疗.结果 观察组1总有效率为95.8%,观察组2总有效率为97.3%,对照组总有效率为77.1%.两观察组间总有效率比较无明显差异(P>0.05);观察组与对照组之间总有效率比较均有明显差异(P<0.05).结论 红霉素软膏+康复新液或苯扎氯铵溶液治疗小儿包皮龟头炎副作用少,效果显著.

目的 探讨重度尿道下裂的治疗方式及体会.方法 回顾性分析2008年10月至2014年6月我院收治的重度尿道下裂患儿54例,一期成形43例,其中Snodgrass 9例,Duckett 24例,Duckett+Duplay 7例,Onlay 3例;二期成形11例,均给予Snodgrass尿道成形术.观察患儿的临床效果.结果 术后随访6个月以上,一期成形术成功30例(69.76﹪);其中Snodgrass 6例,Duckett 18例,Duckett+Duplay 4例,Onlay 2例;共发生尿道瘘9例(20.93﹪),尿道狭窄4例(9.30﹪).二期成形术成功8例(72.73﹪),尿道瘘3例(27.27﹪).两组治愈率和并发症发生率比较,差异无统计学意义(P>0.05).结论 对于重度尿道下裂的患者,术者应该根据临床经验,充分评估患者阴茎发育情况、阴茎下弯程度及尿道修复材料是否丰富等,灵活选用适当的手术方法 ,才能达到最好的治疗效果.

Objetive To investigate the treatment and clinical efficacy of anterior urethral valves in chil-dren. Methods 11 cases range from 3 month to 8 year with mean age 32 month with anterior urethral valves in our department were analyzed retrospectively from Jan 2003 to May 2013.Eight of them were cut valves u-sing 7.5F or 9F cystourethroscopy at 4:00,6:00 and 8:00 point of the urethra.And the catheter was to be kept 10 days.Three of them combined anterior urethral diverticulum,two patients were treated of the operation diver-ticulum resection and urethroplasty,one patient was treated of the operation diverticulum resection and urethro-plasty after the cystostomy. Results All operations were successful.All patients urinated normally without u-rethral fistula and spongiosum injury.Follow-up of 3 months to 4 years average 1.5 years,leukocytes in urine disappear.The mass was disappearing between penis and scrotum.Tow patients have hydronephrosis and three patients have vesicoureteral reflux.Hydronephrosis and vesicoureteral reflux was relieved than before.Serum u-rea and creatinine were normal. Conclusions Cutting valves using cystourethroscopy is a viable method to treat anterior urethral valves with exact effect fewer complications and good prognosis.Diverticulum resection and urethroplasty is a good choice to the patient who was suffering anterior urethral valves combined anterior u-rethral diverticulum.

目的 探讨儿童原发性输尿管息肉所致肾积水的临床特点及临床诊治方法. 方法 对16例原发性输尿管息肉致肾积水患儿的临床表现、实验室检查、影像学检查资料及手术治疗方法进行回顾性分析.结果 16例患儿间断脐周痛3例、间断患侧腰痛13例;患儿术前经B超、静脉肾盂造影、CT、MRI、磁共振水成像、核素肾扫描检测确诊9例. 16例均手术顺利、术后恢复良好. 术后随访3个月~5年,临床症状均消失,肾积水明显减轻或无进展,未见息肉复发. 结论 儿童原发性输尿管息肉致肾积水临床表现典型;单一影像学检查表现不典型,术前诊断较困难;手术治疗以离断性肾盂成形术为主.

目的 评价和比较Snodgrass和Onlay两种术式治疗尿道下裂的临床疗效.方法 对2006年11月至2012年7月施行Snodgrass和Onlay手术的140例尿道下裂患儿的临床资料进行回顾性分析.结果 Snodgrass组治愈率为73.7%,尿道瘘发生率为18.4%,尿道狭窄发生率为11.8%;Onlay组治愈率为93.8%,尿道瘘发生率为6.3%,尿道狭窄发生率为1.6%.两组比较,治愈率Onlay组显著高于Snodgrass组,P<0.05;尿道瘘及尿道狭窄发生率Onlay组显著低于Snodgrass组,P<0.05.结论 对背侧包皮丰富,尿道板发育良好,且不伴严重下弯的尿道下裂患儿,Onlay术式疗效优于Snodgrass术式.

目的 探讨医用透明硅胶膜(Mepitel)作为尿道下裂手术后阴茎包扎敷料的特点和优势.方法 2007年7月至2008年10月作者对35例尿道下裂手术患儿采用Mepitel作为术后阴茎包扎材料,对42例尿道下裂手术患儿采用尼龙纱布作为包扎材料.77例患儿均伴不同程度阴茎下弯,均行一期尿道成形术,手术由同一名医师完成,手术方式包括MAPGI、Onlay、Duckett、Mathieu、Snodgrass以及Duckett+ Duplay术等.比较两种材料包扎阴茎所需时间、拆除包扎时间、拆除时疼痛程度、拆除后创面残留分泌物、术后阴茎瘢痕以及并发症等方面的差异.结果 两组阴茎包扎时间差异无统计学意义[ (2.44±0.83)min vs(2.22±0.60)min,F=5.511,t=1.322,P=0.191)].拆除包扎时间差异有统计学意义[(1.22±0.67)min vs (4.85±2.90)min,F=22.228,t=-7.864,P =0.000)].拆除包扎后创面残留分泌物:Mepitel组6例,尼龙纱组19例,差异有统计学意义(x2=6.873,P=0.009).拆除包扎过程中患儿疼痛评分:Mepitel组优于尼龙纱组[(3.37±1.78)分vs(5.79±1.97)分,F=0.726,t=-5.588,P=0.000)],术后并发症:Mepitel组6例,尼龙纱组12例,差异无统计学意义(x2=1.392,P=0.238).术后3个月阴茎外观基本无瘢痕:Mepitel组28例(80％),尼龙纱组22例(52.4％),差异有统计学意义(x2=6.396,P=0.011).结论 Mepitel作为尿道下裂手术后阴茎包扎敷料具有损伤小,痛苦小,易操作的优点.

Objective To summarize the characteristics and clinical outcome of 14 cases of Henoch-Schonlein purpura (HSP) in children with acute scrotum as its first symptom.Methods We retrospectively reviewed the clinical data of 14 male children with HSP between July 2001 and March 2010.None of the children had skin eruption at the time of admission.Eight children were diagnosed as epididymo-orchitis.Three were diagnosed as torsion of the testicular appendage.Two children were diagnosed as testicular torsion.And one child was diagnosed as having bilateral testicular contusions.One case had associated abdominal pain,one case had left knee joint swelling and pain.Results Five children developed skin purpura 2-8 hours after admission.In eight cases,eruptions were found 12 36 hours after admission in 12 to 36 hours.In the patient who had right knee joint swelling and pain,skin eruption developed on the second day.The scrotal symptoms gradually disappeared in all after medical treatment.No complication was noted during follow up 3 months- 5years (mean 30 months) after discharge.Conclusions Henoch-Schonlein purpura (HSP) in children with acute scrotum as its first symptom is a relatively rare event,but should be borne in mind for doctors.Ultrasonography has high diagnostic accuracy in children with an acute scrotum,and this should be performed with careful physical examination to avoid unnecessary surgery.

Objective To investigate the clinical features,diagnosis and treatment of neonatal testicular torsion.Methods The clinical features,ultrasound examination results,pathological findings,treatment,and follow-up results of neonatal testicular torsion treated in our hospital during the past 5 years were retrospectively analyzed and the literature was reviewed.Results A total of 8 cases of neonatal testicular torsion was collected(age 7 h~8 d;left side 3,right side 5).All patients presented swollen dark red or dark purple scrotum,in which hard mass with tenderness was detected.Ultrasound examination showed enlarged heterogeneous testis,with blood flow decreased or disappeared.Scrotal exploration revealed spermatic cord torsion and testis necrosis.Pathological examinations showed bleeding and necrosis in a large area.7 cases received orchiectomy,5 of which underwent orchiopexy of the contralateral testis 2~4 weeks later.The 1 case whose parents refused to remove the testis developed testicular atrophy 3 months later.All contralateral testes were normal during the follow-up of 3~12 months.Conclusions The incidence of testicular necrosis is high in neonatal testicular torsion.When neonatal scrotum presents swelling,tenderness or color change,scrotal surgical exploration should be performed as early as possible to eliminate the possibility of testicular torsion.

Objective To explore the feasibility, surgical techniques and efficacy of modified Bianchi (single incision on scrotal median line) orchiopexy in children with low bilateral undescended testes. Methods From September 2010 to May 2011, 9 children aging from 14 to 136 months (average 70 months) with congenital bilateral undescended testes underwent modified Bianchi procedure in our department. The testis of them could be touched in groin area in supine position; hydrocele and hernia were not complicated in them via pre-operative ultrasonic examination. Operation was performed via scrotal median line approach to dissect the perididymis to the external inguinal ring. High ligation was performed if the processus vaginalis was found open. No need to dissect gubernaculums if the testis was released and remain in a scrotal position for less tension. Finally, testis was fixed onto the dartos pouch. All children were averagely followed up for 8 months (ranging from 3 months to 1 year). The occurrence of hernia or hydrocele formation, change of position and size of testes, were observed. Results All cases were successfully operated without complications. No testicular retract and atrophy, hernia and hydrocele formation was noted. The efficacy was satisfactory. Conclusions Bianchi procedure is feasible and safe procedure for low palpable undescended testes, especially for those gliding bilateral testes, and can be utilized in clinics.

目的 探讨腹部小切口离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的临床疗效.方法 2010年12月至2011年12月作者采用腹部小切口腹膜外入路行离断式肾盂成形术,治疗/小儿肾盂输尿管连接部梗阻患儿33例,分析其手术入路、临床效果及并发症情况.结果 33例均手术成功,平均手术时间(89±37)min,平均出血量(16±12)mL,伤口愈合良好.术后随访3～12个月,无吻合口狭窄、尿瘘、泌尿系感染等并发症,患儿肾盂均不同程度缩小,肾实质增厚.结论 腹部小切口离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻,操作简单,损伤少,并发症少,疗效好,值得临床推广.

目的探讨小儿巨输尿管症(MU)的诊断和治疗。方法回顾性分析原发性MU29例(先天性9例,原发反流性12例,原发梗阻性8例)和继发性MU12例的临床资料。结果先天性MU及原发反流性MU21例行输尿管裁剪整形及膀胱再植,随访1～2年未见异常。原发梗阻性MU中2例肾发育不良并输尿管闭锁行肾及输尿管切除,6例输尿管末端狭窄行狭窄段切除,随访2～6年,除2例术后发生输尿管残端综合症二次手术外其余未见异常。继发性MU12例在解除原发病后行输尿管裁剪整形及膀胱再植,随访3年未见异常。结论小儿MU诊断主要依据病史及影像学检查,输尿管裁剪整形膀胱再植术为有效方法;继发性MU在原发病解除后,MU无改善,应及时行MU根治术,改良膀胱外隧道式输尿管膀胱吻合术简单、效果好。

Objective:To explore the cause,classification,diagnosis and management of hydronephrosis in children.Methods:Retrospective analysis was done on clinical data of 548 cases hydronephrosis in children.Results:Among 548 cases,476 cases were under 2 years old,54 cases among 2-8 years old,18 cases older than 8 years.436 patients were done with surgery,and 112 patients relieved without any surgery.Among the cases with surgery,423 were treated with Anderson-Hynes operation for ureteropelvic junction obstruction;6 were treated with uretero-ureter anastomosis for ureteral polyps;2 were treated with lithotomy for renal calculus;5 were treated with nephrectomy for severe hydronephrosis.Among 436 patients done with surgery,64 were with multi-stenosis of ureter;48 were with bilateral hydronephrosis;4 were with solitary kidney with hydronephrosis;2 were with duplex kidney with hydronephrosis of inferior part;5 were with aberration of blood vessels.Conclusion:Ureteropelvic junction obstruction is the mostl common reason of hydronephrosis in Children;we don't positively suggest nephrectomy for every severe hydronephrosis;dynamic observation is better for light cases.