SEED CORD [funiculus spermaticus (PNA)] — the pair anatomic education suspending a small egg and relating to internal men's generative organs.
S.'s embryogenesis to. it is connected with differentiation of a mezonefralny channel and process of lowering small egg (see) from an abdominal cavity in a scrotum (see. Urinogenital system, ontogenesis ).
Page to. lasts from top end of a small egg to a deep abdominal ring (see. Pakhovy channel ). It represents round tyazh (fig. 1) 150 — 200 mm long. S.'s diameter to. newborns and babies have about 14 mm, at the age of 15 years apprx. 18 mm, and at adults can reach 20 — 25 mm.
In S.'s structure to. enter: deferent duct (ductus deferens), yaichkovy artery (. testicularis), artery of a deferent duct (. ductus deferentis), venous pampiniform texture (plexus pam-piniformis), yaichkovy vein (v. testicularis), veins of a deferent duct (vv. ductus deferentis), neuroplexes (plexus testicularis et deferentialis) and limf, vessels (vasa lymphatica). In the thickness of S. to. meets also thin fibrous tyazh (vestigium processus vaginalis) — the rest of the obliterated vulval shoot of a peritoneum.
At boys till 1 year the vulval shoot is not obliterated completely in 54% of cases, and at adults in 5% of cases. Between elements C. to. and around it there is a friable connecting and fatty tissue. Deferent duct (see) — the main education of S. to., and also vessels and S.'s nerves to. are surrounded with covers, to-rye proceed in covers of a small egg. The most outside cover shrouding all S. to., the outside seed fascia (fascia spermatica externa) is. It serves as continuation of a superficial fascia of a stomach (see. Abdominal wall ). More deeply the fascia of the muscle lifting a small egg (fascia cremasterica), departing from edges of a superficial abdominal ring is located. Under this fascia the muscle lifting a small egg (m. cremaster) lies, edges till the period of puberty it is poorly developed, and then considerably increases; it is presented by bunches of the muscle fibers which separated from cross and an internal braid of muscles of a stomach. Under the muscle lifting a small egg the internal seed fascia (fascia spermatica interna) lies, edges is continuation of a cross fascia (fig. 2).
S.'s blood supply to. and its covers the kremasterny artery (a. cremasterica) from the lower epigastriß artery carries out (a. epigastrica inf.). Outflow of a venous blood happens on the veins of the same name in veins of a scrotum. Limf, S.'s vessels to. fall into lumbar limf, nodes (nodi lymphatici lumbales). S. innervate to. femoral and sexual and sexual nerves (n. genitolemoralis et n. pudendus).
Methods of inspection
by the simplest method of inspection of S. to. its palpation in inguinal area and a scrotum is. It is normal of S. to. it is probed as roundish formation of uniform density, in depth to-rogo is defined dense tyazh — a deferent duct. For a research of part C. to., passing in to a scrotum (see), apply a dpafanoskopiya of a scrotum (see. Gidrotsele ). In some cases carry out rentgenol. a research of a deferent duct (see. Vezikulografiya ), ultrasound examination of S. to. (see. Ultrasonic diagnosis ).
Distinguish malformations, damages, diseases and S.'s tumors to.
Malformations. Most often an edema of covers of S. meets to. (funikulotsela). It the delay of an obliteration of a gleam of a vulval shoot is the reason peritoneums (see), the small egg which is formed in the course of lowering. There are several types of an edema of covers of S. to. At not fusion of the proximal site of a vulval shoot of a peritoneum the vodyanochny cavity is reported with a peritoneal cavity — the reported edema (fig. 3, a), and at an obliteration of this site the edema which is not reported with a peritoneal cavity — the isolated edema develops (fig. 3, b). The combination of an edema of covers of S. is possible to. with an edema of covers of a small egg. At the same time vodyanochny cavities can be reported among themselves and with a peritoneal cavity (fig. 3, b), only among themselves (fig. 3, d) or to be isolated from each other (fig. 3, e). At children S.'s edema meets more often to., reported with a peritoneal cavity, at a cut diameter of an anastomosis with a peritoneal cavity does not exceed 5 mm.
Clinically to a funikulodela it is characterized by existence in inguinal area of a swelling of oblong shape, an elastic consistence, painless, rather easily displaced, not connected with a small egg. When S.'s edema to. it is reported with a peritoneal cavity, the swelling in a prone position disappears, and in a standing position increases. If S.'s edema to. isolated, the swelling at change of position of a body does not change in volume. In nek-ry cases the message of a vodyanochny cavity with a peritoneal cavity stops, at the same time perhaps acute development of the isolated S.'s edema to., the cyst having an appearance. At sharply arisen S.'s edema to. the swelling in inguinal area becomes intense and painful, the wedge, a picture at the same time reminds a picture restrained inguinal hernias (see).
Diagnosis is based on a wedge, signs. At differential diagnosis with the restrained inguinal hernia (see) it is necessary to consider lack of symptoms of intestinal impassability and peritonitis, a positive symptom of raying at a diafanoskopiya. At children of younger age in these cases diagnosis presents certain difficulties in this connection there is justified an early operative measure.
Treatment operational. Planned operation is usually performed to children 1,5 years since to this age the vulval shoot of a peritoneum can independently be obliterated are more senior. Operation consists in allocation at a superficial abdominal ring of a vulval shoot of a peritoneum, underrunning and its bandaging, in the presence of S.'s cyst to. it is deleted. Forecast favorable.
To inborn defects of S. to. refer also lack of its separate elements at cryptorchism (see), S.'s shortening to. at partial lowering of a small egg, a cut does not cause almost any disturbances.
Damages Page to. can be closed (hypodermic) and open. The closed damages can arise at a bruise or blow, napr, a ball, and also at blow by the inguinal area about a solid. The wedge, a picture depends on weight of an injury. A characteristic sign is pain, hemorrhage. Blood infiltrirut fabrics C. to., sometimes hypodermic cellulose and skin. Page to. it is thickened, infiltrirovan, at a palpation painful. From the first days after an injury recommend a bed rest, cold for area C. to. Later apply thermal procedures, UF-radiation, sollyuks (see. Phototherapy ), what promotes a zatikhaniye of the inflammatory process which developed after an injury. At infection and S.'s suppuration to. the abscess is opened.
At S.'s bruises to., the sharp movements, physical tension there can be S.'s twisting to., combined with turn of a small egg round its pivot-center (torsion of a small egg). It is promoted by anatomic features: wide pakhovy channel, big mobility of a small egg, etc. S.'s twisting is possible to. at an arrangement of a small egg in the inguinal channel, i.e. at an inguinal form of a cryptorchism. At S.'s twisting to. venous stagnation, a vein thrombosis of S. develops to. Recognition of a disease is complicated, the differential diagnosis is carried out with the restrained inguinal hernia (see), infringement of a small egg, etc.
Treatment operational — S. to. untwist and fix in normal situation (funikulopekstsya), hemming S. to. to rings of the inguinal channel. In case of a gangrenosis of a small egg and S. to. make S.'s removal to. together with a small egg and its appendage.
Open damages of S. to. in peace time meet seldom, sometimes there are S.'s damages to. at operative measures in the field of the inguinal channel and a scrotum, during the carrying out novocainic blockade (administration of novocaine in S. to.). In wartime gunshot wounds are possible, to-rye usually are followed by a complete separation of S. to. or its separate elements and damage of other bodies. In all cases of open damages of S. to. timely primary surgical treatment of a wound, a stop of bleeding and the corresponding operational treatment is required. Treatment of a contaminated wound is carried out according to the practical standard (see. Wounds, wounds ). In the further ambassador of a rupture of S. to. the atrophy of a small egg develops.
Diseases. One of the most widespread diseases is the varicocele — to a varikotsela (see).
The inflammation of a seed cord (funiculitis) as an independent disease meets seldom, more often it is observed at orchitis (see), epididymite (see), deferentitis (see), vesiculitis (see). Development of a funiculitis after an adenomectomy is possible. The disease arises also at distribution of contagiums in the hematogenous way from other inflammatory center, napr, at a paratyphoid, sepsis, flu, epidemic parotitis, tuberculosis. Process usually happens unilateral. Page to. becomes reinforced, painful, the dermahemia over it sometimes appears. Body temperature increases, also the general condition of the patient can be broken.
Treatment consists in impact on primary center. Heat, effectively physiotherapeutic treatment is locally shown. Forecast, as a rule, favorable. The disease comes to an end with a full rassasyvaniye of infiltrate, cicatricial changes in area C. sometimes develop to.
Funikulodele (acquired) has an appearance of a cyst and develops most often as a result of an injury or a funiculitis. At the same time in the area C. to. fluctuating tumorous education is probed plotnoelastichesky, with a smooth surface, skin over the Crimea is mobile and is not changed. At a diafanoskopiya the positive symptom of raying is noted. When S.'s covers to. are sharply thickened, the symptom of raying can be negative.
Treatment conservative (rest, antibiotics, physiotherapeutic procedures, resorptional means). At unsuccessfulness of these an action operational treatment — excision of a cyst is shown.
Tumors. S.'s tumors to. meet seldom. They proceed from covers, vessels, and also from the friable connecting and fatty tissue located between elements C. to. As a rule, hemilesion is observed. Distinguish benign and malignant tumors of S. to.
To benign tumors of S. to. carry a lipoma (see), fibroma (see), myoma (see), a hemangioma (see), a lymphangioma (see) etc. In the beginning in inguinoscrotal area small, painless consolidation appears. In process of growth of a tumor there is a feeling of weight in this area and the dull non-constant ache amplifying during the walking and an exercise stress. Further pain becomes more intensive and constant. Benign tumors grow slowly, more often their size does not exceed 3 — 4 cm in the diameter, sometimes tumors reach the big sizes. For the purpose of differential diagnosis with an edema of covers of S. to. carry out a diafanoskopiya — at S.'s tumors to. symptom of raying negative. Treatment operational. During operation aim to depart from a vascular bundle not to break blood supply of a small egg. Forecast favorable.
From malignant tumors meet cancer (see) and sarcoma (see). They are characterized by rapid growth with infiltration of surrounding fabrics and bodies, is frequent with metastasises in pelvic and lumbar limf, nodes, and in late stages and in the remote bodies. The diagnosis is established at morfol. research. Treatment of hl. obr. operational. The orkhifunikulektomiya is shown (removal of a small egg and S. to.) with simultaneous removal regional limf, nodes. In the postoperative period according to indications carry out radiation therapy and chemotherapy. The forecast depends on timeliness and radicalism of the carried-out treatment.
Bibliography: Opel V. D. and Alexandrov A. V. Zavorot of a small egg and a seed cord at children, Vestn. hir., t. 115, No. 7, page 116, 1975; B y t to and P. F. and Krip G. M. Proksimalny fathers-in-law-kulo-safenny an anastomosis at the varikotsel, Urol. and nefrol., No. 4, page 59, 1976; D au-letsky S. Ya. and Isakov Yu. F. Children's surgery, p. 2, M., 1970; D at - A. Ya. Urologiya's khans of children's age, page 173, L., 1961; Zack B. I. and Ozyorsk A. N. Gemangioperitsi-toma of a seed cord, Urol. and nefrol., No. 2, page 67, 1977; Isakov Yu. F. and Yerokhin A. P. The comparative characteristic of results of operations of Ivanis-sevich and Palomo at children, in the same place, No. 5, page 30, 1979; L opatkin N. A. Pathogenetic justification of a new way of operational treatment to a varikotsela, in the same place, No. 5, page 31, 1973; Lopatkin N. A., etc. Varikotsele, diagnostic tactics, synchronous damages of kidneys, in the same place, No. 5, page 3, 1981; Operational surgery and topographical anatomy, under the editorship of V. V. Kovanov, page 216, M., 1978; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 13, page 351, M., 1955; Pappus D. and M about l of N e r Y. Changes spermatogram-we after operational treatment to a varikotsela, Urol. and nefrol., No. 4, page 46, 1979; Chukhriyenko D. P. and Lyul-k about A. V. The atlas of operations on bodies of urinogenital system, M., 1972; Campbell M. F. Clinical pediatric urology, Philadelphia, 1951; Molnar I. Andro-logische Bedeutung der Anomalien und Erkrankungen der Samenwege, Z. Urol. Nephrol., Bd 70, S. 511, 1977.
Yu. D. Glukhov, T. V. Krasovekaya; V. Ya. Bocharov (An.).