青春期精索扭转的诊治分析（附67例报告）

黄黎明; 廖勇彬; 庞健; 吴荣海; 程洲平; 林绮平; 余新立; 孙明; 曹嘉正; 林伟光; 卢剑; 袁丹; 林智

doi:10.13201/j.issn.1001-1420.2014.06.025

青春期精索扭转的诊治分析（附67例报告）

- 江门市中心医院泌尿外科(广东江门, 529030)

详细信息

通讯作者: 黄黎明,E-mail:huangdayspring@163.com

中图分类号: R697

收稿日期: 2013-12-26

Clinical study of pubertal males with spermatic cord torsion（Report of 67 cases）

- Department of Urology, Jiangmen Central Hospital, Jiangmen, Guangdong, 529030, China

More Information

Corresponding author: HUANG Liming, E-mail: huangdayspring@163.com

Received Date: 26 December 2013

摘要

摘要: 目的:提高精索扭转的早期诊断和治疗水平,减少睾丸丧失。方法:回顾性分析2003年8月~2011年12月收治的67例青春期精索扭转的临床资料:患者年龄13~16岁,平均14.6岁。发病6小时内就诊23例,6~24小时39例,24小时以上5例。本组彩超检查53例;手术治疗63例,非手术治疗4例。并分析其确诊、误诊及睾丸挽救率。结果:首诊确诊率72%(48/67),误诊率28%(19/67)。误诊病种包括附睾-睾丸炎52%(10/19),鞘膜积液16%(3/19),腹股沟疝16%(3/19),输尿管结石11%(2/19),睾丸血肿5%(1/19)。67例中,外科干预63例,均为鞘膜内360°~1 080°扭转,其中发病6小时内手术探查19例,睾丸挽救率84%(16/19);6小时以上手术探查44例,睾丸挽救率23%(10/44),两组间差异有统计学意义(P<0.05,两组睾丸中位扭转角度540°)。挽救及健侧睾丸行阴囊肉膜下固定术。切除睾丸病理检查结果为出血坏死性改变。非手术治疗4例中,2例手法复位成功,1例就诊睾丸已萎缩,1例自发缓解。挽救睾丸26例,其中16例随访6~18个月,睾丸萎缩11例。结论:精索扭转误诊率较高,青春期突发阴囊剧痛首先要考虑精索扭转的可能。彩超为一线检查方法。扭转程度及缺血时间是影响睾丸结局的重要因素,及时手术探查可降低睾丸切除率。因此,早期确诊和治疗是避免睾丸丧失的关键。
- 精索扭转 /
- 诊断 /
- 治疗
Abstract: Objective:To improve the level of early diagnosis and treatment in patients with spermatic cord torsion and to prevent testicular loss.Method:The clinical data of 67 male adolescents with spermatic cord torsion from August 2003 to December 2011 were analyzed retrospectively. The average age of the patients was 14.6 (range, 13-16) years. During of symptoms was less than six hours in 23 cases, less than 24 hours in 39 cases and more than 24 hours in five cases. Fifty-three patients underwent color Doppler ultrasonography. Surgical treatments were performed for 63 patients, and the rest underwent non-surgical treatment. We calculated rate of diagnosis, misdiagnosis and testicular salvage.Result:The initial diagnosis rate of the disease was 72% (48/67) and the initial misdiagnosis rate was 28% (19/67). Misdiagnosed diseases included epididymis-orchitis 52% (10/19), hydrocele 16% (3/19), inguinal hernia 16% (3/19), ureteral calculi 11% (2/19) and testicular hematoma 5% (1/19). Sixty-three of 67 patients whose testes with a range of 360° to 1 080° intrathecal torsion were performed open surgery. The rate of salvage testes was 84% (16/19) within six hours period of disease, but it was 23% (10/44) for during of symptoms more than six hours. The difference between two groups was statistically significant (P<0.05, the median degree of testicular torsion in two groups was 540 °). All 63 patients underwent contralateral orchiopexy and ipsilateral orchiectomy for testicular torsion with necrosis intraoperatively. The resected testes in pathology demonstrated haemorrhagic necrosis. On the other hand, four patients received non-surgical treatment (two patients with successful manual detorsion, one patient with testicular atrophy and one patient with spontaneous remission). There were 16 patients in all 26 salvaged testes who followed up for 6 to 18 months. Testicular atrophy was found in 11 patients.Conclusion:The rate of misdiagnosis of testicular torsion is high. Sudden, severe scrotal pain in pubertal males should be considered as possible testicular torsion. Doppler ultrasonography should be used as the first-line examination. The degree of testicular torsion and ischemic time are significant factors affecting testicular function. Orchidectomies can be reduced by timely surgical exploration. Therefore, early diagnosis and treatment are crucial to avoid testicular loss.
- spermatic cord torsion /
- diagnosis /
- treatment

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参考文献(12)

[1]	Ringdahl E, Teague L.Testicular torsion[J].Am Fam Physician, 2006, 74 (10):1739-1743.
[2]	Arda I S, Ozyaylali I.Testicular tissue bleeding as an indicator of gonadal salvageability in testicular torsion surgery[J].BJU Int, 2001, 87 (1):90.
[3]	Eaton S H, Cendron M A, Estrada C R, et al.Intermittent testicular torsion:diagnostic features and management outcomes[J].J Urol, 2005, 174 (4 Pt 2):1535.
[4]	Chan J L, Knoll J M, Depowski P L, et al.Mesorchial testicular torsion:case report and a review of the literature[J].Urology, 2009, 73 (1):83-86
[5]	Favorito L A, Cavalcante A G, Costa W S.Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion[J].Int Braz J Urol, 2004, 30 (5):420-424.
[6]	吴忠标, 陈柏君, 张大宏.睾丸钟摆畸形与睾丸扭转22例报告[J].中华泌尿外科杂志, 2005, 26:710.
[7]	Kyriazis I D, Dimopoulos J, Sakellaris G, et al.Extravaginal testicular torsion:a clinical entity with unspecified surgical anatomy[J].Int Braz J Urol, 2008, 34 (5):617.
[8]	Prando D.Torsion of the spermatic cord:the main gray-scale and doppler sonographic signs[J].Abdom Imaging, 2009, 34:654-658.
[9]	Hod N, Maizlin Z, Strauss S, et al.The relative merits of doppler sonography in the evaluation of patients with clinically and scintigraphically suspected testicular torsion[J].Isr Med Assoc J, 2004, 6 (1):13-15.
[10]	Trojian T H, Lishnak T S, Heiman D.Epididymitis and orchitis:an overview[J].Am Fam Physician, 2009, 79 (7):583-587.
[11]	Sahni D, Jit I, Joshi K, et al.Incidence and structure of the appendices of the testis and epididymis[J].J Anat, 1996, 189:341-348.
[12]	Ruiz Montes A M, Jiménez Alvarez C, Núnez Núnez R, et al.The clinical characteristics of patients with torsion of the testicular and epididymal appendages[J].Cir Pediatr, 1994, 7 (3):140-142.