切换至 "中华医学电子期刊资源库"
高级检索
中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (06) : 759 -764. doi: 10.3877/cma.j.issn.1674-3253.2025.06.012

临床研究

单侧睾丸部分切除术在青春期前男孩生育力保存中的应用探索
李俊涛1, 刘贵华2, 何子勤1, 马朦惠2, 赵阳杰1, 肖楚天1, 张翼飞1, 颜禄斌1, 梁晓燕2, 王德娟1,†()   
  1. 1510655　广州，中山大学附属第六医院（生物医学创新研究院）小儿外科
    2510655　广州，中山大学附属第六医院（生物医学创新研究院）生殖中心
  • 收稿日期:2025-01-22 出版日期:2025-12-01
  • 通信作者: 王德娟
  • 基金资助:
    广东省基础与应用基础研究基金(2024A1515010266)

Application of unilateral partial orchiectomy for fertility preservation in prepubertal boys

Juntao Li1, Guihua Liu2, Ziqin He1, Menghui Ma2, Yangjie Zhao1, Chutian Xiao1, Yifei Zhang1, Lubin Yan1, Xiaoyan Liang2, Dejuan Wang1,†()   

  1. 1Department of Pediatric surgery, the Sixth Affiliated Hospital of Sun Yat-sen University (Biomedical Innovation Center), Guangzhou 510655, China
    2Center of Reproductive Medicine, the Sixth Affiliated Hospital of Sun Yat-sen University (Biomedical Innovation Center), Guangzhou 510655, China
  • Received:2025-01-22 Published:2025-12-01
  • Corresponding author: Dejuan Wang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李俊涛, 刘贵华, 何子勤, 马朦惠, 赵阳杰, 肖楚天, 张翼飞, 颜禄斌, 梁晓燕, 王德娟. 单侧睾丸部分切除术在青春期前男孩生育力保存中的应用探索[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(06): 759-764.

Juntao Li, Guihua Liu, Ziqin He, Menghui Ma, Yangjie Zhao, Chutian Xiao, Yifei Zhang, Lubin Yan, Xiaoyan Liang, Dejuan Wang. Application of unilateral partial orchiectomy for fertility preservation in prepubertal boys[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(06): 759-764.

目的

探讨重度β地中海贫血（β-TM）、尤文肉瘤、神经母细胞瘤等青春期前男性患儿生育力保存的方法。

方法

中山大学附属第六医院2023年10月至2024年4月小儿外科48例男性患儿（其中46例重度β-TM、1例尤文肉瘤、1例神经母细胞瘤）为保存生育力行单侧睾丸部分切除术，均为右侧睾丸部分切除（切除体积为20%~30%）。切除的睾丸组织采用慢速程序化冷冻方法进行睾丸组织冷冻保存。并行2例青春期前食蟹猴睾丸组织冷冻实验，验证复苏冷冻睾丸组织与新鲜睾丸组织精原干细胞数量变化情况。

结果

48例男性患儿平均年龄为（9.63±3.00）岁，BMI为15.29（14.37，16.41）kg/m2。48例患者顺利完成手术，住院时间为2（2，3）d；术中出血量为2（2，5）ml，手术时间为70.0（50.0，99.5）min。其中3例患儿合并隐睾，术中行睾丸固定术。1例患儿出现术后阴囊血肿，予以抗生素对症治疗后好转，无患儿伤口出现活动性出血。采用慢速程序化冷冻方法分别成功为48例男性患儿保存睾丸组织，冷冻过程顺利。2例青春期前食蟹猴复苏冷冻睾丸组织与新鲜睾丸组织相比，精原干细胞数量无明显变化。

结论

对拟行造血干细胞移植的重度β-TM，尤文肉瘤、神经母细胞瘤青春期前男性患儿，行单侧睾丸部分切除并保存患儿睾丸组织，是保存其生育力的一种方法。

关键词: β地中海贫血, 尤文肉瘤, 神经母细胞瘤, 睾丸组织冷冻, 慢速程序化冷冻, 男性, 精原干细胞, 生育力保存
Objective

To explore methods for fertility preservation in prepubertal boys with severe β-thalassemia (β-TM), Ewing's sarcoma, and neuroblastoma.

Methods

To preserve fertility, 48 cases of boys (46 with severe β-TM, 1 with Ewing sarcoma, and 1 with neuroblastoma) who underwent right partial orchiectomy (removing 20-30% of the volume) in the pediatric surgery department of the Sixth Affiliated Hospital of Sun Yat-sen University from October 2023 to April 2024. The excised testicular tissue was preserved using slow programmable cryopreservation. Two parallel experiments of testicular tissue freezing in prepubertal crab-eating macaques were conducted to verify the changes in the number of spermatogonia stem cells in resuscitated frozen testicular tissue and fresh testicular tissue.

Results

The average age of 48 patients was (9.63±3.00) years, and BMI was 15.29 (14.37, 16.41) kg/m2. All 48 patients successfully completed the surgery with a hospital stay of 2 (2, 3) days, intraoperative blood loss 2 (2, 5) ml,and operation time 70.0 (50.0, 99.5) min. Among them, 3 children had cryptorchidism and underwent orchiopexy during the surgery. One child developed postoperative scrotal hematoma, which improved after antibiotic treatment. Slow programmable cryopreservation was successfully used to preserve testicular tissue for all 48 boys, and the freezing process was uneventful. Compared with fresh testicular tissue, there was no significant change in the number of spermatogonia stem cells in the resuscitated frozen testicular tissue of two prepubertal crab-eating macaques.

Conclusion

For prepubertal boys with severe β-TM, Ewing sarcoma, and neuroblastoma who are candidates for hematopoietic stem cell transplantation (HSCT), partial orchiectomy is performed on one side and the testicular tissue of the child is preserved, leaving hope for them to have offspring in adulthood.

Key words: β-thalassemia, Ewing sarcoma, Neuroblastoma, Testicular tissue cryopreservation, Slow programmable freezing, Male, Spermatogonia stem cells, Fertility preservation
图1 男性生育力保存患儿行右侧睾丸切除术注：a为睾丸鞘膜翻转状态，b为睾丸切除部分可吸收线悬吊，c为睾丸部分切除状态，d为睾丸缝合后状态
图2 青春期前食蟹猴睾丸组织实验验证注：a为食蟹猴新鲜睾丸组织及冷冻复苏睾丸组织HE染色图，b为食蟹猴新鲜睾丸组织及冷冻复苏睾丸组织UCHL1免疫组织化学染色图
[1]
Huleihel M, Lunenfeld E. Approaches and technologies in male fertility preservation[J]. Int J Mol Sci, 2020, 21(15): 5471. DOI: 10.3390/ijms21155471.
[2]
Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion[J]. Fertil Steril, 2019, 112(6): 1022-1033. DOI: 10.1016/j.fertnstert.2019.09.013.
[3]
Wyns C, Kanbar M, Giudice MG, et al. Fertility preservation for prepubertal boys: lessons learned from the past and update on remaining challenges towards clinical translation[J]. Hum Reprod Update, 2021, 27(3): 433-459. DOI: 10.1093/humupd/dmaa050.
[4]
Kanbar M, Delwiche G, Wyns C. Fertility preservation for prepubertal boys: are we ready for autologous grafting of cryopreserved immature testicular tissue?[J]. Ann Endocrinol (Paris), 2022, 83(3): 210-217. DOI: 10.1016/j.ando.2022.04.006.
[5]
Keros V, Rosenlund B, Hultenby K, et al. Optimizing cryopreservation of human testicular tissue: comparison of protocols with glycerol, propanediol and dimethylsulphoxide as cryoprotectants[J]. Hum Reprod, 2005, 20(6): 1676-1687. DOI: 10.1093/humrep/deh797.
[6]
Ehrhardt MJ, Krull KR, Bhakta N, et al. Improving quality and quantity of life for childhood cancer survivors globally in the twenty-first century[J]. Nat Rev Clin Oncol, 2023, 20(10): 678-696. DOI: 10.1038/s41571-023-00802-w.
[7]
Rives N, Courbière B, Almont T, et al. What should be done in terms of fertility preservation for patients with cancer? The French 2021 guidelines[J]. Eur J Cancer, 2022, 173: 146-166. DOI: 10.1016/j.ejca.2022.05.013.
[8]
Kolber MK, Cui Z, Chen CK, et al. Nutcracker syndrome: diagnosis and therapy[J]. Cardiovasc Diagn Ther, 2021, 11(5): 1140-1149. DOI: 10.21037/cdt-20-160.
[9]
Jensen CFS, Østergren P, Dupree JM, et al. Varicocele and male infertility[J]. Nat Rev Urol, 2017, 14(9): 523-533. DOI: 10.1038/nrurol.2017.98.
[10]
Chen J, Chen J, Fang Y, et al. Microbiology and immune mechanisms associated with male infertility[J]. Front Immunol, 2023, 14: 1139450. DOI: 10.3389/fimmu.2023.1139450.
[11]
广东省地中海贫血防治协会，《中国实用儿科杂志编辑委员会》. 造血干细胞移植治疗重型β地中海贫血儿科专家共识[J]. 中国实用儿科杂志, 2018, 33(12): 935-939. DOI: 10.19538/j.ek2018120602.
[12]
Kanbar M, de Michele F, Giudice MG, et al. Long-term follow-up of boys who have undergone a testicular biopsy for fertility preservation[J]. Hum Reprod, 2021, 36(1): 26-39. DOI: 10.1093/humrep/deaa281.
[13]
Borgström B, Fridström M, Gustafsson B, et al. A prospective study on the long-term outcome of prepubertal and pubertal boys undergoing testicular biopsy for fertility preservation prior to hematologic stem cell transplantation[J]. Pediatr Blood Cancer, 2020, 67(9): e28507. DOI: 10.1002/pbc.28507.
[14]
Valli-Pulaski H, Peters KA, Gassei K, et al. Testicular tissue cryopreservation: 8 years of experience from a coordinated network of academic centers[J]. Hum Reprod, 2019, 34(6): 966-977. DOI: 10.1093/humrep/dez043.
[15]
Duffin K, Neuhaus N, Andersen CY, et al. A 20-year overview of fertility preservation in boys: new insights gained through a comprehensive international survey[J]. Hum Reprod Open, 2024, 2024(2): hoae010. DOI: 10.1093/hropen/hoae010.
[16]
Fayomi AP, Peters K, Sukhwani M, et al. Autologous grafting of cryopreserved prepubertal Rhesus testis produces sperm and offspring[J]. Science, 2019, 363(6433): 1314-1319. DOI: 10.1126/science.aav2914.
[17]
马朦惠, 苏文龙, 吕林艳, 等. 玻璃化冷冻及慢速程序化冷冻对未成熟睾丸组织的保护效果分析[J]. 中华男科学杂志, 2023, 29(9): 776-782. DOI: 10.13263/j.cnki.nja.2023.09.002.
[18]
Mitchell RT, Ives J. Testicular tissue re-implantation and the 'hostile testis’[J]. Hum Reprod, 2024, 39(2): 282-284. DOI: 10.1093/humrep/dead258.
[19]
Hutka M, Smith LB, Mitchell RT. Xenotransplantation as a model for human testicular development[J]. Differentiation, 2017, 97: 44-53. DOI: 10.1016/j.diff.2017.09.001.
[20]
Younis N, Caldeira-Brant AL, Chu T, et al. Human immature testicular tissue organ culture: a step towards fertility preservation and restoration[J]. Front Endocrinol (Lausanne), 2023, 14: 1242263. DOI: 10.3389/fendo.2023.1242263.
[21]
Oktay KH, Marin L. Comparison of orthotopic and heterotopic autologous ovarian tissue transplantation outcomes[J]. Fertil Steril, 2024, 121(1): 72-79. DOI: 10.1016/j.fertnstert.2023.10.015.
[22]
Dolmans MM, von Wolff M, Poirot C, et al. Transplantation of cryopreserved ovarian tissue in a series of 285 women: a review of five leading European centers[J]. Fertil Steril, 2021, 115(5): 1102-1115. DOI: 10.1016/j.fertnstert.2021.03.008.
[23]
Braye A, Delgouffe E, van der Werff Ten Bosch J, et al. Gonadal development and function after immature testicular tissue banking as part of high-risk gonadotoxic treatment[J]. Pediatr Blood Cancer, 2023, 70(8): e30370. DOI: 10.1002/pbc.30370.
[24]
Condorelli M, Demeestere I. Challenges of fertility preservation in non-oncological diseases[J]. Acta Obstet Gynecol Scand, 2019, 98(5): 638-646. DOI: 10.1111/aogs.13577.
[25]
Antonouli S, Di Nisio V, Messini C, et al. A comprehensive review and update on human fertility cryopreservation methods and tools[J]. Front Vet Sci, 2023, 10: 1151254. DOI: 10.3389/fvets.2023.1151254.
[26]
Eeltink C, Embaby A, Incrocci L, et al. Sexual problems in patients with hematological diseases: a systematic literature review[J]. Support Care Cancer, 2022, 30(6): 4603-4616. DOI: 10.1007/s00520-021-06731-7.
[27]
刘贵华, 马朦惠, 苏文龙, 等. 中国首次青春期前男孩睾丸组织冷冻保存3例报道并文献复习[J]. 中华生殖与避孕杂志, 2023, 43(1): 84-89. DOI: 10.3760/cma.j.cn101441-20221108-00490.
[1] 张睿超, 杨诗源, 李况蒙, 蒋洁, 刘畅, 崔立刚. 男性生殖超声质量控制经验分享[J/OL]. 中华医学超声杂志（电子版）, 2025, 22(05): 434-443.
[2] 石珍, 杨小红, 赵胜, 伍玉晗, 王玉波, 陈诺. 先天性囊性神经母细胞瘤的产前及产后超声表现[J/OL]. 中华医学超声杂志（电子版）, 2025, 22(01): 25-30.
[3] 张旭, 徐建平, 苏冬明, 王彩芬, 王大力, 张文智. 男性乳腺肿块的超声造影特征[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(08): 854-859.
[4] 孙世强, 方琦, 邰亦成, 岳文杰, 杨澜. 单孔腔镜皮下乳腺切除术治疗男性乳腺发育症的效果及术后满意度评估[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(05): 282-286.
[5] 屈文静, 陈畅, 茅枫. 男性乳腺纤维瘤病一例[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(03): 190-191.
[6] 刘岩, 李梦竹, 胡扬喜, 董星, 孟化, 刘宝胤. 男性乳腺发育症经腋窝单孔腔镜皮下腺体切除七步法[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(03): 182-184.
[7] 朱洪宇, 曹越, 赵鑫洋, 周毅. 三孔全腔镜手术治疗中重度男性乳房发育症[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(03): 152-157.
[8] 孙云, 侯海涛, 聂存伟, 马凯丽. 家族性青春期男性乳腺发育症一例[J/OL]. 中华乳腺病杂志(电子版), 2023, 17(01): 53-54.
[9] 王秋毅, 黄薇. 妇科恶性肿瘤年轻患者生育力保存的临床实践与挑战[J/OL]. 中华妇幼临床医学杂志(电子版), 2025, 21(03): 266-270.
[10] 高梅娟, 董素贞. 多模态影像学新技术在儿童腹部常见恶性肿瘤中的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2025, 21(01): 15-20.
[11] 郭新宇, 李林强, 杨广超, 张成鹏, 陆朝阳. 无张力疝修补术对男性生殖功能影响的研究进展[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(03): 251-254.
[12] 王霞, 张雯, 廖菲, 高上兰. 肺尤文肉瘤并发免疫相关性肾炎救治成功一例[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(01): 165-167.
[13] 张秋月, 张雨, 王杰, 李丽雅, 徐解关玄, 陈香美, 蔡广研. 男性是老年IgA 肾病患者预后不良的危险因素[J/OL]. 中华肾病研究电子杂志, 2025, 14(01): 1-6.
[14] 葛友涛, 蒋秋子, 卞廷松, 肖倩倩. 中药复方治疗男性迟发性性腺功能减退症的组方规律及分子机制[J/OL]. 中华老年病研究电子杂志, 2023, 10(03): 43-50.
[15] 吴晓明, 翟仰魁, 王娟, 张硕, 许杰, 潘从清. 男性2 型糖尿病患者空腹C 肽和定量胰岛素敏感性检测指数与血浆致动脉粥样硬化指数的相关性[J/OL]. 中华肥胖与代谢病电子杂志, 2024, 10(04): 288-294.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号

AI
小
编
AI小编
你好！我是《中华医学电子期刊资源库》AI小编，有什么可以帮您的吗？