睾丸扭转的诊断与治疗(附56例报告)

目的 提高对睾丸扭转的临床诊断和治疗水平.方法 回顾性分析56例睾丸扭转的临床资料,年龄4～18岁,平均8.5岁.左睾丸32个,右睾丸24个.初诊时间<6h10倒,6～24h36例,10例超过24h.初诊确诊为睾丸扭转34例,延误诊断22例.结果 其中8例发病后确诊时间<6h确诊者,给予手法复位成功:其余50例发病时间>6h者手术探查,16倒手术探查睾丸已坏死而行睾丸切除,其中>24h者10例.结论 彩色多瞢勒超声是首选辅助检查方法.提高首诊诊断正确率将有助于扭转睾丸的获救.     

睾丸扭转的急诊处理

目的　提高睾丸扭转的诊治水平。方法　回顾总结了 2 2例睾丸扭转的诊断和治疗经验。结果　本组 2 2例 ,5例有外伤史 ,17例无明显诱发病因 ,14例患者在基层医院以睾丸损伤或附睾炎保守治疗 3～ 30d ,因效果欠佳转本院就诊 ,均行睾丸切除。余 8例患者中 ,从发病至就诊本院 0 .5～ 4h 3例 ,4～ 10h 3例 ,10～ 2 4h 2例 ,手法复位 5例 ,成功 1例 ,手术 7例 ,保留睾丸 4例 ,切除睾丸 3例。 11例行彩色多普勒超声检查 ,4例显示睾丸血流减少 ,7例显示睾丸增大 ,血流消失。结论　应加强对睾丸扭转的认识 ,准确的诊断和果断的处理是挽救睾丸的关键。     

睾丸扭转的诊断和治疗

目的 总结睾丸扭转的早期诊断和治疗方法,提高睾丸扭转的诊疗水平.方法 回顾性分析36例睾丸扭转的发病及诊治等临床资料.结果 左例睾丸扭转22例,右侧睾丸扭转14例,发病至就诊时间3 h～14 d,36例均接受手术治疗.鞘膜内扭转34例,鞘膜外扭转2例,其中35个睾丸已坏死行手术切除及健侧睾丸固定术,睾丸存活1个,行双侧睾丸固定术.结论 睾丸扭转是泌尿外科急症,睾丸扭转的早期目的 总结睾丸扭转的早期诊断和治疗方法,提高睾丸扭转的诊疗水平.方法 回顾性分析36例睾丸扭转的发病及诊治等临床资料.结果 左例睾丸扭转22例,右侧睾丸扭转14例,发病至就诊时间3 h～14 d,36例均接受手术治疗.鞘膜内扭转34例,鞘膜外扭转2例，其中35个睾丸已坏死行手术切除及健侧睾丸固定术,睾丸存活1个,行双侧睾丸固定术.结论 睾丸扭转是泌尿外科急症,睾丸扭转的早期诊断及早期手术探查是避免睾丸坏死的关键.     

睾丸扭转的诊断与治疗

目的：探讨睾丸扭转的早期诊断和治疗,以提高患者的睾丸成活率。方法：对18例睾丸扭转患者的临床资料进行回顾性分析,18例患者行彩色多普勒超声检查和手术探查,其中8例患者行睾丸切除术,10例行睾丸复位固定术,所有病例均行对侧睾丸探查固定术。结果：18例中初诊确诊为睾丸扭转者11例,误诊为急性睾丸附睾炎7例,彩超诊断符合率为100％;18例患者均痊愈,发病〈12h6例均保留睾丸,术后睾丸均成活;发病12～24h5例,保留睾丸4例,1例睾丸坏死行切除术;发病〉24h7例均为睾丸坏死而行睾丸切除术。随访1～5年,10例保留睾丸的患者中,6例患者彩超显示睾丸形态和血流正常;3例出现患侧睾丸轻微萎缩,但对侧睾丸血流正常;1例患者患侧睾丸明显萎缩。8例切除睾丸患者彩超显示对侧睾丸血流正常。结论：彩超是睾丸扭转首选检查方法,早期诊断、及时手术探查是提高患者睾丸成活率的关键。睾丸扭转12h以内均应行睾九复位固定术,12～24h应尽量保留睾丸,超过24h应切除睾丸。     

Diagnosis and treatment of testicular torsion and analysis on contralateral testicular function

目的 分析睾丸扭转的诊断及治疗方法及对健侧睾丸功能变化的影响.方法 对我科2006年1月至2010年6月收治的49例(平均年龄18.65岁)睾丸扭转患者的临床资料进行回顾性分析总结,术前行血清性激素检查,术中行健侧睾丸活检术.结果 患者均给予手术探查:行睾丸复位固定术12例,睾丸切除术37例,均行对侧睾丸固定术.发病＜12h的3例患者行手术治疗复位成功,术后1例睾丸萎缩；发病12～24 h的7例患者行手术治疗复位成功,5例复位后睾丸存活,2例睾丸萎缩；发病24h以上的2例患者行手术治疗复位成功,术后均睾丸萎缩.对侧睾丸活检术12例,10例患者生精细胞、精子细胞及成熟精子有不同程度减少表现.术前行内分泌检查12例,9例FSH升高,8例LH升高,4例T下降.结论 睾丸的挽救率与扭转持续的时间和扭转的程度密切相关,延迟就诊是睾丸丢失的重要原因.应首选彩色多普勒超声检查.扭转时间大于24h并扭转360°以上者,直接行患侧睾丸切除术可减轻对健侧睾丸的损害.     

睾丸扭转诊治66例分析

目的 分析睾丸扭转的诊断和治疗方法 .方法 对66例睾丸扭转患者的临床资料进行回顾性分析.结果 66例患者中,首诊时间＜10 h者 32例(48.5%),首诊确诊24例(36.4%).彩色多普勒血流显像(CDFI)误诊8例,该8例睾丸毁损.对未行预防性对侧睾丸固定的33例患者随访6月～20年,1例发生对侧睾丸扭转.结论 对于阴囊病变急诊患者,应高度警惕睾丸扭转可能.睾丸毁损与扭转的时间密切相关,延迟就诊是睾丸丢失的重要原因.CDFI检查存在假阴性,临床高度怀疑时应及早手术探查.建议常规预防性固定健侧睾丸.     

睾丸扭转诊治14例分析

目的探讨睾丸扭转的诊断与治疗,提高睾丸扭转的诊治水平。方法回顾性分析14例睾丸扭转患者临床资料,患者年龄13-48岁,平均24.5岁。左侧11例,右侧3例。发病到确诊时间4h-10d。首诊确诊者10例。结果 14例患者全部行手术探查,均确诊为睾丸扭转,其中8例行睾丸切除,6例行睾丸复位固定术。结论睾丸丢失与扭转的时间密切相关,延迟就诊是睾丸切除的重要原因,彩色多普勒超声（CDFI）是诊断睾丸扭转的可靠方法,对睾丸扭转的早期诊断和治疗有重要价值。一旦怀疑或确诊为睾丸扭转,应及时行手术探查。     

睾丸扭转14例诊治分析

目的 探讨睾丸扭转的诊断及治疗要点.方法 回顾性分析14例睾丸扭转患者临床资料,并结合文献进行总结.结果 14例患者均行彩色多普勒超声检查,提示睾丸血流减少,高度怀疑睾丸扭转,所有患者均急诊行手术探查.其中睾丸切除8例,术后病理报告均为睾丸缺血性坏死;6例保留睾丸患者行睾丸复位固定术,随访1年,睾丸均发育正常.结论 临...     

儿童睾丸扭转103例诊治经验回顾总结

目的提高儿童睾丸扭转的诊治水平。方法回顾分析1990-2006年总计103例年龄〈14岁的睾丸扭转患儿诊治的临床资料。结果6例患儿（扭转〈6h）行手法复位成功;手术探查94例,保留睾丸25例,行睾丸固定术23例（19例扭转〈6h,3例扭转12~24h,1例扭转〉24h）,睾丸坏死切除69例。其中,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例患儿病理报告为睾丸附睾缺血坏死。38例患者获随访1~5年,未发现再发睾丸扭转,4例患侧睾丸萎缩。结论提高对睾丸扭转的重视,加强儿童睾丸扭转的早期诊治。早诊断、及时手术治疗是睾丸成活的关键。     

28例睾丸扭转超声诊断及临床治疗分析

目的分析早期睾丸扭转诊断及诊治效果,提高睾丸扭转存活率。方法选取我院2011年2月～2017年4月28例睾丸扭转患者,入院前均行彩色多普勒超声检查,观察患者睾丸实质回声及血流情况,并对扭转患者的临床治疗情况进行回顾分析。结果 28例患者中,左侧16例,右侧12例;超声诊断睾丸完全无血流信号15例,12例睾丸血流明显减少,1例睾丸血流无改变。4例早期睾丸扭转,行手法复位,预后良好;中期患者18例,采用手术复位,复位成功14例,失败4例,后期行手术切除4例;晚期患者6例,手术切除患侧睾丸6例。术后随访6个月～1年,保留睾丸的18例中,有3例出现患侧睾丸萎缩;10例行睾丸切除者身体状况良好。结论超声能有效诊断睾丸扭转,并能有效评估睾丸复位成功率。睾丸扭转患者及早治疗,疗效越好,可以提高扭转睾丸的存活率。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.