The laparoscopic management of intersex patients:: the preferred approach
The laparoscopic management of intersex patients:: the preferred approach
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DOI：
10.1111/j.1464-410x.2005.05417.x
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发表时间：
2005-04-01
影响因子：
4.5
通讯作者：
Arap, S
中科院分区：
文献类型：
--
作者：
Dénes, FT;Cocuzza, MAS;Arap, S
目的：介绍可能是最大的一系列使用腹腔镜治疗双性患者的研究。（34例男性，2例女性假两性畸形，9例性腺发育不全，4例真两性畸形，1例复杂性尿道下裂），年龄0.5-46岁（平均18.3），接受腹腔镜手术切除性腺和/或导管结构不符合社会性别，或性腺肿瘤或恶性肿瘤的潜在风险。在腹腔镜检查中，6例患者的10个性腺缺失，4例被确定为“消失”; 72个性腺（46个发育不良，17个正常睾丸，1个正常卵巢，1个卵睾丸，7个性腺母细胞瘤或无性细胞瘤）被切除; 2个卵睾丸在切除卵巢段后被替换在阴囊中，一个正常睾丸也被替换。12例尿生殖窦患者的阴道部分切除，11例包括子宫切除术。其中3例患者采用会阴联合入路完成切除，同时行男性化生殖器成形术。有没有术中并发症或转换; 2例术后并发症。CONCLUSIONSLaparoscopy允许直接识别和性腺切除。所有异常的导管结构必须切除，因为这会增加切除不明性腺的机会。切除男性社会性别患者的子宫和尿生殖窦阴道部分是可行的，发病率低。根据社会性别，可以在同一程序中进行生殖器成形术。
OBJECTIVETo present possibly the largest series of the use of laparoscopy for treating intersex patients.PATIENTS AND METHODSFifty intersex patients (34 with male and two with female pseudohermaphroditism, nine with gonadal dysgenesis, four with true hermaphroditism, and one with complex hypospadias), aged 0.5-46 years (mean 18.3), underwent laparoscopy to remove gonads and/or ductal structures incompatible with the social gender, or for gonadal tumour or a potential risk for malignancy. When necessary, genitoplasty was performed concomitantly.RESULTSAt the laparoscopic evaluation, 10 gonads of six patients were absent, while four were identified as 'vanishing'; 72 gonads (46 dysgenetic, 17 normal testes, one normal ovary, one ovotestis, seven gonadoblastomas or dysgerminomas) were removed; two ovotestes were replaced in the scrotum after removing the ovarian segment, as was one normal testis. Twelve patients with a urogenital sinus had its vaginal component removed, 11 including a hysterectomy. Three of these patients had a combined perineal approach to complete its removal, together with masculinizing genitoplasty. There were no intraoperative complications or conversions; two patients had complications after surgery.CONCLUSIONSLaparoscopy allows the straightforward identification and removal of gonads. All abnormal ductal structures must be removed, as this increases the chance of resecting unidentified gonads. Removing the uterus and vaginal component of the urogenital sinus in patients with male social sex is feasible, with low morbidity. Genitoplasty, according to the social sex, can be performed in the same procedure.