39例睾丸扭转的诊断与治疗并文献复习

目的 提高睾丸扭转的诊断与治疗水平.方法 回顾性分析2007年1月～ 2013年10月间39例睾丸扭转患者的住院病例资料.结果 30例患者早期被误诊为睾丸附睾炎.39例均行阴囊彩超检查,其中9例提示睾丸血供明显减少,30例提示睾丸血供消失.并急诊行阴囊探查术,术中发现30例患侧睾丸坏死,行患侧睾丸切除+对侧睾丸固定术;9例复位扭转睾丸后血供好转或者恢复,行睾丸复位固定术+对侧睾丸固定术.术后35例获随访,随访时间3 ～72个月,其中3例复位睾丸出现不同程度萎缩,所有患侧睾丸及健侧睾丸未再次发生扭转.结论 睾丸扭转早期容易误诊为睾丸、附睾炎,阴囊彩超有助于诊断.一旦明确或者高度怀疑睾丸扭转,应急诊行阴囊探查术,挽救扭转的睾丸.     

睾丸扭转32例诊治分析

目的提高睾丸扭转的诊断和治疗水平。方珐回顾性分析32例睾丸扭转患者的临床资料，32例经手术探查，患侧行睾丸切除或睾丸复位固定、健侧睾丸固定。结果29例患者经彩色多普勒超声确诊为睾丸扭转，23例初诊误诊。19例患侧睾丸切除。13例睾丸保留，其中4例萎缩。站论对于青少年患者阴囊急症，首诊医生应高度警惕睾丸扭转，可疑时立即行彩色多普勒血流显像检查，避免延误诊治。及时手术探查是提高睾丸成活率的关健。     

儿童睾丸扭转的诊治探讨

目的:探讨如何早期发现儿童睾丸扭转。方法:回顾性分析24例睾丸扭转的临床资料。结果:年龄4个月~15岁,平均8.5岁。左睾丸17例,右睾丸7例。发病到手术时间1 h~4个月。初诊确诊为睾丸扭转16例,延误诊断8例。术前均行彩超检查,1例4个月患儿拒绝治疗,手术探查23例,6例保留睾丸,17例行睾丸切除。结论:睾丸坏死不仅与扭转度数和时间有关,还和扭转的松紧度有关;彩色多普勒超声对睾丸扭转的早期诊断具有重要的参考价值;小儿阴囊急症疑为睾丸扭转应早期手术探查。     

16例睾丸扭转的临床诊疗体会

目的探讨睾丸扭转的早期诊断和治疗体会。方法 16例睾丸扭转患者中,4例行睾丸切除术,12例行睾丸复位固定术。所有患者均行对侧睾丸探查固定术。回顾性分析患者的临床资料。结果鞘膜内型睾丸扭转13例,鞘膜外扭转3例。睾丸扭转180°以内者6例,180°～270°4例,270°～360°3例,360°以上者3例。彩超诊断符合率为100%。8例发病12 h以内的患者,均得以保留睾丸。4例发病12～24 h的患者,保留睾丸3例,1例睾丸坏死行切除术。4例发病24 h以上的患者,均因睾丸坏死而行睾丸切除术。随访1～5年,11例保留睾丸的患者中,7例彩超显示睾丸形态和血流正常。3例患侧睾丸轻微萎缩,1例患者患侧睾丸明显萎缩,但对侧睾丸均血流正常。5例切除睾丸者彩超显示对侧睾丸血流正常。结论彩超是睾丸扭的转首选检查方法,早期诊断、及时手术探查对提高患者睾丸成活率具有重要意义。     

睾丸扭转的诊治体会

目的探讨睾丸扭转的诊治方法。方法回顾总结18例睾丸扭转患者的诊治资料,结合文献进行分析。结果18例经手术证实与术前彩色多普勒超声检查(CDS)诊断一致。8例行手术复位、固定,10例行患侧睾丸切除,所有病例均行对侧固定术。14例随访6～12个月,其中8例手术复位、固定者,1例睾丸萎缩。7例成年人精液分析,4例生精正常,3例生精低下。结论考虑睾丸扭转时,应首选CDS检查;治疗上应尽快手术探查;扭转360°、10h者应切除患侧睾丸。     

Bell-C1apper畸形与睾丸扭转

通过7例Bell-Clapper畸形病例的总结和文献复习,提高对间歇性睾丸扭转的认识,及早诊断及手术,减少睾丸扭转坏死的发生率。对4例间歇性睾丸扭转病例及3例睾丸扭转坏死或萎缩病例的解剖与治疗的回顾作出Bell-Clapper畸形与睾丸扭转的关系分析。结果发现7例病人解剖上均有Bell-Clapper畸形,4例间歇性睾丸疼痛病人行了双侧睾丸探查和固定,3例睾丸坏死和萎缩病例行病睾切除及对侧睾丸固定术。作者提示,对间歇性睾丸疼痛的病人应提高警惕,在睾丸未发生扭转坏死之前及时行双睾探查,及时固定,防患于未然。     

婴幼儿睾丸扭转的早期诊断和治疗方法选择

目的：探讨提高婴幼儿睾丸扭转疗效的方法。方法：对12例睾丸扭转患儿均行阴囊彩超检查,10例提示睾丸扭转。根据病情选择手法复位、睾丸复位 双侧睾丸固定术和切除扭转的睾丸同时固定对侧睾丸。结果：1例行手法复位成功,随访4个月～3年,3例保留睾丸者彩超显示双睾丸血流一致;9例切除睾丸者显示对侧睾丸血流正常。结论：阴囊彩超检查对婴幼儿睾丸扭转的诊断有较大的帮助;婴幼儿睾丸扭转后发生睾丸坏死的比率高,早期诊断、及时治疗是救活睾丸的关键,一旦明确或高度怀疑睾丸扭转,应立即行手术探查。     

单侧睾丸缺如37例报告

单侧隐睾患儿经查体及手术探查未能发现睾丸称为单睾畸形或单侧睾丸缺如[1] 。我院 1989至 2 0 0 1年手术治疗1172例隐睾患儿 ,发现单侧睾丸缺如 37例 ,发病率占隐睾的 3.17%。现报告如下。材料与方法　本组 37例。年龄 2～ 13岁。右侧 2 2例 ,左侧 15例。术前均经两位医师仔细检查下腹部、会阴部、大腿内侧 ,均未发现异位睾丸。 37例患儿健侧睾丸均较同龄正常儿童有不同程度增大 ,双侧阴囊发育较好者 19例 ,患侧阴囊发育欠佳者 12例 ,患侧阴囊发育较差者 6例。 2 1例行B超检查 ,18例未发现睾丸 ,3例于腹股沟处探及直径约0 .3～ 0 .5cm低回…     

成人精索扭转

作者从1970～1986年治疗13例成人精索扭转。均经手术证实。其中8例年龄20～30岁,5例年龄大于30岁(最大43岁)。7例有发作性睾丸疼痛病史,均自行缓解。左侧精索扭转9例(69%),右侧精索扭转4例(31%)。所有病人的患侧睾丸位于阴囊上部,8例患侧阴囊出现红癍或水肿,1例出现明显的阴囊化脓。 4例早期确诊者行阴囊探查,见睾丸活力尚好而作双侧睾丸固定术。9例未能早期确诊者阴囊探查术中见8例患侧睾丸缺乏活力,而作患侧睾丸切除,对侧睾丸固定。另1例患侧睾丸无明显缺血,也作双侧睾丸固定术。所以,共有5例睾丸得到救治,占38%。     

睾丸扭转导致睾丸切除原因分析(附13例报告)

目的 探讨降低睾丸扭转导致的失睾率的有效方法.方法 回顾性总结13例睾丸扭转患者的诊治资料,结合文献进行分析.结果 本组中有10例扭转时间>24h且扭转角度>360.,其中9例术前证实无生机,直接切除睾丸;1例因家属拒绝睾丸切除而予以睾丸复位且固定,术后3个月随访发现患睾明显萎缩.本组另3例中,1例扭转时间>24h,但仅扭转270°,2例扭转时间<24h,这3例均术中复位,判断血供恢复良好予以睾丸固定,经随访患侧睾丸与健侧睾丸基本对称,发育正常.患侧睾丸萎缩或切除致失睾率为76.9%(10/13).结论 睾丸扭转后存活的关键因素是首诊时间、及时诊断和处理;扭转度数也是重要因素.     

Prenatal testicular torsion: Ultrasonographic features, management and histopathological findings

AIM: To highlight the ultrasonographic features of prenatal torsion of the testis in utero (IUTT) at presentation, the neonatal management and the histological findings postorchiectomy or biopsy. METHODS: Seven newborns underwent emergency exploration for IUTT. All patients underwent a sonography and real-time color Doppler ultrasound study of the scrotum before any surgical procedure. A histological examination was performed in the removed specimens. RESULTS: Sonography of the scrotum revealed enlarged, heterogeneous testes. In all cases the color and power Doppler did not reveal any flow signal on the affected side. Four newborn with unilateral testicular torsion underwent orchiectomy and contralateral orchidopexy. In one neonate after detorsion and with the absence of gangrenous changes and a reassuring biopsy, a twisted testis could be treated conservatively with orchidopexy. In another case, the parents, acknowledging the inviability of the affected testis, gave consent only for a biopsy of the testis. In the neonate with bilateral IUTT, bilateral testicular biopsies were performed. Histology of the removed testes variably showed interstitial red cell extravasion and coagulation or hemorrhagic necrosis. Light microscopy of the preserved testis highlighted surviving seminiferous tubules, with gonocytes, spermatogonia and fetal Sertoli cells. CONCLUSIONS: An early diagnosis and treatment in IUTT is essential. Surgical exploration should be always performed through the inguinal route. In bilateral IUTT testes should be left to try to assure, as long as possible, a residual Leydig cell function.     

Torsion of an intra-abdominal testis

To present a case of torsion of a nonneoplastic intra-abdominal testis with an unusual clinical presentation.A 26-year-old active duty Navy Petty Officer presented to the emergency department on 3 occasions over a 5-day period with lower abdominal pain. Physical examination demonstrated acute tenderness in the left lower quadrant with sugestion of a normal spermatic cord and atrophic testis in the left scrotum. Computed tomography scan demonstrated an intra-abdominal lesion near the internal inguinal ring. The patient underwent surgical exploration through an inguinal incision. Torsion of a nonviable intra-abdominal testis was present. The scrotum contained only the vas deferens and cremasteric muscle. An orchiectomy was performed with removal of the vas deferens and other cord structures.The unusual clinical finding of acute torsion of an intra-abdominal testis, associated with an apparent atrophic scrotal testis, presented a confusing clinical picture. Computed tomography scan did not clarify the issue sufficiently to establish a definite preoperative diagnosis. Clinical suspicion prompted early surgical intervention. Review of the current literature produced 60 reported cases of torsion of an intra-abdominal testis. Two thirds of these involved testicular neoplasm, usually seminoma. Although the clinical presentation varied, most patients had recent onset of lower abdominal pain associated with tenderness and, in half the cases, a mass. Patients almost always presented with an absent scrotal testis on the involved side, and not infrequently reported previous surgery thought to be an orchiectomy.Diagnosis of an intra-abdominal testicular torsion is rare, particularly when no neoplasm is present. A high index of suspicion must be maintained whenever there is abdominal pain and undescended testis. The surgical history and imaging studies may not clarify a confusing clinical picture.     

Perinatal testicular torsion: a unique strategy

Background/Purpose

Perinatal testicular torsion (PTT) is defined as testicular torsion occurring prenatally or within the first 30 days of life. The aim of this study was to evaluate the data obtained from patients with PTT and propose principles of management based on clinical, surgical, and histologic findings.

Methods

A retrospective analysis of 27 boys seen between 1990 and 2005 with surgically documented PTT was conducted. Patients were divided into 2 groups: A, prenatal testicular torsion; B, postnatal testicular torsion. The presence of acute scrotal inflammatory signs defined the urgency to operate.

Results

There were 4 clinical pictures in group A: A1, patients with a nubbin testis (n = 3); A2, patients with a small and hard testis (n = 12); A3, patients with a normal-sized and hard testis (n = 8); and A4, patients with an acute scrotum (n = 2). Group B (n = 2) presented no sign after birth and later developed an acute scrotum. Surgical exploration and histologic examination showed clear signs of a long-standing testicular torsion in groups A1, A2, and A3 or a recent-onset testicular torsion in groups A4 and B. Only one testis could be salvaged (group B).

Conclusions

Clinical signs correlated very well with surgical and histologic findings and can define the need and the urgency to operate. Although testicular salvage rate is very low, the affected side always should be explored to confirm the diagnosis and to fix or remove the affected testicle. The contralateral scrotum also should be explored because of the risk of asynchronous contralateral testicular torsion.     

A rare simultaneous presentation of testicular mixed germ cell tumor with a contralateral testis torsion

We report a rare case of a 27-year-old man presenting with an acute scrotum with simultaneous occurrence of testicular tumor and contralateral torsion. Preoperative imaging demonstrated the testicular missed torsion, yet findings were equivocal with regard to the testicular tumor. On scrotal exploration the left testis was found to be ischemic due to threefold rotation. The right testis was not identifiable, being composed of numerous necrotic lesions. Frozen section suggested malignancy, hence high right orchiectomy was performed. Histologic examination of the right testis showed mixed germ cell tumor, containing all the subtypes. To our knowledge no similar case has been reported.     

A case of bilateral neonatal testicular torsion

We report a case of bilateral synchronous testicular torsion in a newborn. A male neonate was referred one day after birth because his left testis was firm and enlarged. We found that the scrotum was firm bilaterally and suspected it to be bilateral testicular tumor. Surgical exploration which was performed at 2 days after birth revealed testicular torsion on both sides. Left orchiectomy, right detorsion biopsy and orchiopexy were performed. Histopathological examination confirmed hemorrhagic necrosis of bilateral testes.     

Synchronous bilateral malignant mesothelioma of tunica vaginalis testis: early diagnosis

We report a case of bilateral synchronous malignant mesothelioma of the testis. A 21-year-old man presented with an acute scrotum after 3 months of recurrent pain on the right side. Ultrasonography demonstrated an irregular thickening of the tunica vaginalis testis, scrotolyths, and an increased blood flow to the right epididymis testis. Bilateral exploration revealed torsion of the hydatid and a bilateral malignant mesothelioma of the tunica vaginalis. One year later, elective bilateral exploration showed one minute area on the parietal tunica vaginalis of malignant mesothelioma. After 2 years of follow-up, the patient had no signs of distant disease.     

精索扭转的循证诊断与治疗

目的:系统评价精索扭转的诊断及处理方法。方法:计算机检索Cochrane图书馆、PubMed、维普资讯、CNKI,查找有关精索扭转的随机对照研究,检索时限均为1990~2012年,研究者对文献质量进行严格评价和资料提取,采用盲法分析。结果:共纳入27篇文献,3 541例患者纳入研究。结果表明:多普勒彩超在诊断阴囊急症明显优于常规超声,成为阴囊急症的首选影像学诊断方法;对任何年龄段的急性阴囊疼痛的患者均应行手术探查,没有足够的证据支持单侧精索扭转行对侧睾丸固定;精索扭转对于患侧睾丸生育功能的影响会随着患者年龄的增长而增加,对于健侧睾丸的影响尚存在争议。结论:对于有阴囊症状的患者应及时行阴囊多普勒彩超筛查,对于已确认精索扭转患者及阴囊急症患者应立即行阴囊手术探查,根据具体情况以决定是否行双侧睾丸固定术,对患者生育功能应加强随访。     

睾丸钟摆畸形与睾丸扭转22例报告

目的 提高对睾丸钟摆畸形（bell-clapper deformity，BCD）的认识，探讨鞘膜内睾丸扭转的解剖和发病特点。方法 回顾性分析22例间歇性睾丸疼痛病例，年龄7～23岁，平均17岁。左侧18例、右侧4例。其中睾丸扭转坏死16例、睾丸大小正常4例、左侧睾丸萎缩2例。结果 22例解剖上均有钟摆畸形即睾丸缺乏正常鞘膜的包裹，睾丸引带缺如，缺乏与壁层鞘膜的粘连，鞘膜腔大，鞘膜在精索上的止点较高，精索活动度较大。16例睾丸坏死或萎缩者行病侧睾丸切除，对侧睾丸固定；6例间歇性睾丸疼痛患者作双侧睾丸探查及固定。22例随访6个月～10年，平均4年9个月，均无睾丸疼痛症状。结论 应高度重视间歇性睾丸疼痛患者，提高间歇期或扭转早期的诊断率，在睾丸未发生扭转坏死之前及时行双侧睾丸探查及固定术，减少睾丸坏死率。     

Color Doppler ultrasonography in the diagnosis of the acute scrotum

PURPOSE: To determine the value of color Doppler ultrasonography (CDUS) in the diagnosis of acute scrotum. MATERIALS AND METHODS: 10 patients referred to our hospital with acute scrotal pain were included in this study. All patients were evaluated with CDUS after the initial clinical examinations. Blood flow of the involved testis was compared semiquantitatively to that of the opposite testis. Patients with a diagnosis of testicular torsion by CDUS underwent surgical exploration. Patients with CDUS diagnosis of epididymitis were treated with intravenous antibiotics. RESULTS: Of the 10 patients evaluated, CDUS diagnosed 5 patients with testicular torsion and 5 patients with epididymitis. All cases of torsion were confirmed intraoperatively. 2 cases with no intratesticular blood flow on CDUS had necrotic testes and underwent orchiectomy with orchiopexy of the contralateral testes. A case with absent flow and 2 cases with decreased flow had bilateral orchiopexy. CDUS findings of normal or increased flow were present in all patients with epididymitis. No cases of testicular atrophy were encountered on long-term follow up in patients with epididymitis. CONCLUSION: CDUS is helpful in detecting the perfusion of the testis as well as in getting anatomical information. CDUS is a very useful device which causes a minimal burden to the patient with acute scrotum. In most cases it will rapidly provides us the correct information although it may not be regarded as the definitive adjunct.     

儿童睾丸扭转103例诊治分析

目的提高儿童睾丸扭转的诊治水平。方法回顾分析1993年1月-2008年1月总计103例14岁以下睾丸扭转患儿的诊治临床资料。砖果年龄1．5d～14岁（平均4．8岁）。睾丸扭转部位：左侧64例,右侧34例,双侧5例。9例（8．74％）患儿（扭转〈6h）行手法复位成功;手术探查94例（91．26％）,保留睾丸行睾丸固定术25例（21例扭转〈6h,3例扭转12～24h,1例扭转〉24h）。睾丸坏死切除69例。右侧睾丸扭转而左侧精索明显长者19例行对侧睾丸固定术。52例（50．49％）患儿病理报告为睾丸附睾缺血性坏死。38例（36．89％）患儿随访1～6年,未发现再发睾丸扭转,5例患侧睾丸萎缩。结论儿童睾丸扭转的早诊断、及时手术治疗是睾丸成活的关键。