隐睾术后随访超声发现睾丸微小结晶的 相关因素分析：单中心近两年 回顾性队列研究

Analysis of Factors Associated with Testicular Microlithiasis Detected on Follow-Up Ultrasonography after Orchiopexy for Cryptorchidism: A Single-Center Retrospective Cohort Study over the Past Two Years

摘要: 目的：探讨隐睾患儿术后随访超声检出睾丸微小结晶(testicular microlithiasis, TM)与手术年龄、术前睾丸位置及侧别的相关性。方法：回顾性纳入本院近两年行隐睾睾丸固定术并完成术后阴囊超声随访的患儿300例。排除术前已存在TM、睾丸萎缩及合并明显鞘膜积液或腹股沟疝等影响判读者。随访时间窗为术后约1个月首次复查、末次随访至12个月，中位随访时间6个月(四分位距3~9个月)。TM诊断参照ESUR共识：睾丸实质内多发点状强回声灶(直径通常<3 mm，无声影)，按单视野灶数分为有限型(<5个/视野)与经典型(≥5个/视野)。所有检查使用同院同型号超声设备，双医师独立判读并复核。按年龄(≤24月龄、>24月龄)、术前位置(阴囊上型、腹股沟及以上) (注：本文所述阴囊上型即睾丸位置位于阴囊较高位置，未能到达正常位置且须手术的隐睾类型)及侧别(单侧、双侧)分层，采用χ²检验或Fisher精确检验比较TM发生率，并计算粗OR及95%置信区间。结果：术后随访检出TM 24例(8.0%)，均为有限型。>24月龄组TM发生率高于≤24月龄组(12.26% vs 3.45%, P = 0.005, OR = 3.91, 95%CI 1.42~10.77)。腹股沟及以上组高于阴囊上型组(11.24% vs 3.82%, P = 0.019, OR = 3.19, 95%CI 1.16~8.79)。单侧组高于双侧组(10.53% vs 3.64%, P = 0.045, OR = 3.12, 95%CI 1.04~9.37)。结论：隐睾患儿术后随访超声检出TM与手术年龄偏晚及术前位置较高相关；侧别差异可能受事件数限制，仍需更大样本进一步验证。

Abstract: Objective: To investigate the associations between postoperative detection of testicular microlithiasis (TM) on follow-up ultrasonography and age at orchiopexy, preoperative testicular position, and laterality in boys with cryptorchidism. Methods: This retrospective study included 300 boys who underwent orchiopexy for cryptorchidism at our institution over the past two years and completed postoperative scrotal ultrasonographic follow-up. Patients were excluded if TM was present preoperatively, if testicular atrophy was documented, or if significant concomitant conditions that could affect image interpretation (e.g., hydrocele or inguinal hernia) were present. Follow-up ultrasonography was scheduled at approximately 1 month postoperatively, with the last follow-up to 12 months; the median follow-up duration was 6 months (interquartile range, 3~9 months). TM was defined according to the ESUR consensus as multiple punctate echogenic foci within the testicular parenchyma (typically <3 mm, without acoustic shadowing) and graded as limited TM (<5 foci per field of view) or classic TM (≥5 foci per field of view). All examinations were performed using the same ultrasound system model at the same hospital, and images were independently reviewed by two qualified sonographers with consensus adjudication. TM rates were compared across strata of age at surgery (≤24 months vs >24 months), preoperative position (suprascrotal vs inguinal or higher) (note: in this study, “high scrotal” refers to a testis located relatively high in the scrotum that had not reached the normal position and required surgical treatment), and laterality (unilateral vs bilateral) using the chi-square test or Fisher’s exact test, and crude odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: TM was detected in 24 of 300 boys (8.0%) during follow-up, and all cases were classified as limited TM. The TM rate was higher in boys operated on after 24 months than in those operated on at or before 24 months (12.26% vs 3.45%; P = 0.005; OR = 3.91, 95% CI 1.42~10.77). TM was more frequently detected in testes located in the inguinal canal or higher preoperatively than in suprascrotal testes (11.24% vs 3.82%; P = 0.019; OR = 3.19, 95% CI 1.16~8.79). Unilateral cases had a higher TM rate than bilateral cases (10.53% vs 3.64%; P = 0.045; OR = 3.12, 95% CI 1.04~9.37). Conclusions: Postoperative detection of TM on follow-up ultrasonography in boys with cryptorchidism was associated with older age at orchiopexy and a higher preoperative testicular position. The association with laterality should be interpreted cautiously due to the limited number of events and warrants validation in larger cohorts.