儿童附睾囊肿：治疗方法与临床结局的系统评价和荟萃分析。
完整摘要 · 中文译文
目的：系统整合目前关于男孩附睾囊肿（ECs）的流行病学、临床特征、自然病程以及不同管理方法下所报告结局的证据。 方法：采用符合PRISMA 2020标准的系统评价方法，检索PubMed、Embase和Scopus数据库，时间范围从建库至2026年8月31日。纳入标准为观察性研究，研究对象为18岁以下患有附睾囊肿的男性，并报告临床结局。对关键患病率结局进行了单臂比例的随机效应Meta分析。 结果：共纳入2002年至2025年间发表的9项回顾性研究，包含492例儿科患者。未发现对照比较研究。附睾囊肿最常在偶然检查或评估无痛性阴囊肿大时被发现。病变以单侧为主（79%-90%），多数位于附睾头部，报告的囊肿大小为2至40 mm。相关病变包括鞘膜积液、精索静脉曲张和睾丸微石症，未报告与恶性肿瘤相关。在当代队列中，保守管理是首选的初始策略，而早期系列研究报告了较高的手术率。手术主要用于持续疼痛或进行性增大，采用开放切除术，症状缓解率高，报告的并发症发生率低。Meta分析显示，双侧囊肿发生率为8%（95% CI 7-9%；I² = 12.5%），完全自行消退率为12.2%（95% CI 8.3-16.1%；I² = 88.1%），手术率为7.4%（95% CI 3 1.1%-11.7%；I2 = 94.7%）的儿童需要手术治疗。术后并发症少见（3.4%；95% CI 1.1-5.6%；I2 = 0%），报告的扭转事件罕见（1.6%；95% CI 0.7-2.5%；I2 = 0%）；现有数据并未证实附睾囊肿易导致睾丸扭转。 结论：儿童附睾囊肿为良性病变，自然病程良好。多数病变保持临床稳定，而少数可完全自发消退。在大多数情况下，保守优先的处理方式较为适宜，仅对伴有持续症状、临床意义明确的增大或诊断不明确的特定患者保留手术治疗。 已知信息：• 儿童附睾囊肿是睾丸外良性病变，通常被偶然发现，且常采用保守管理。• 各儿科研究中的手术指征和随访策略仍不一致。 新增信息：• 据我们所知，基于所进行的检索，这是首个专门评估儿童附睾囊肿的系统评价和荟萃分析。• 我们的研究结果支持保守优先的处理方式，手术率和报告并发症发生率均较低，并对常规长期超声监测的价值提出质疑。
完整摘要 · 英文原文
PURPOSE: To systematically synthesise current evidence on the epidemiology, clinical characteristics, natural history, and outcomes reported under different management approaches for epididymal cysts (ECs) in boys. METHODS: A PRISMA 2020-compliant systematic review was conducted using PubMed, Embase, and Scopus from inception through 31 August 2026. Observational studies including males younger than 18 years with ECs and reporting clinical outcomes were eligible. Random-effects meta-analyses of single-arm proportions were performed for key prevalence outcomes. RESULTS: Nine retrospective studies published between 2002 and 2025 were included, comprising 492 paediatric patients. No controlled comparative studies were identified. ECs were most frequently detected incidentally or during evaluation for painless scrotal swelling. Lesions were predominantly unilateral (79-90%), most were located in the epididymal head, and reported cyst size ranged from 2 to 40 mm. Associated conditions included hydrocele, varicocele, and testicular microlithiasis, with no reported link to malignancy. Conservative management was the preferred initial strategy in contemporary cohorts, whereas earlier series reported higher surgical rates. Surgery was mainly indicated for persistent pain or progressive enlargement and involved open excision, with high rates of symptom resolution and low reported morbidity. Meta-analysis showed that bilateral cysts occurred in 8% (95% CI 7-9%; I2 = 12.5%) of patients, complete spontaneous regression occurred in 12.2% (95% CI 8.3-16.1%; I2 = 88.1%), and 7.4% (95% CI 3.1-11.7%; I2 = 94.7%) of children required surgery. Postoperative complications were uncommon (3.4%; 95% CI 1.1-5.6%; I2 = 0%), and reported torsion events were rare (1.6%; 95% CI 0.7-2.5%; I2 = 0%); the available data did not establish that ECs predispose to testicular torsion. CONCLUSION: Paediatric ECs are benign lesions with a favourable natural history. Many lesions remain clinically stable, while complete spontaneous regression occurs in a minority. A conservative-first approach is appropriate in most cases, reserving surgery for selected patients with persistent symptoms, clinically meaningful enlargement, or diagnostic uncertainty. WHAT IS KNOWN: • Epididymal cysts in children are benign extratesticular lesions, usually detected incidentally and commonly managed conservatively. • Surgical indications and follow-up strategies remain inconsistent across paediatric studies. WHAT IS NEW: • To the best of our knowledge, and on the basis of the searches performed, this is the first systematic review and meta-analysis specifically evaluating paediatric ECs. • Our findings support a conservative-first approach, with low rates of surgery and reported complications, and question the value of routine prolonged ultrasonographic surveillance.