睾丸扭转的早期诊断和治疗(附26例临床报告)

目的分析睾丸扭转的早期诊断和治疗方法 ,提高其早期诊断及治疗水平。方法回顾性总结分析26例睾丸扭转患者的临床资料。结果 3例发病<6 h者手法复位成功;5例6~12 h手术者,睾丸均得以保存;5例12~24 h手术者,3例睾丸得以保存;13例超过24 h手术者,仅4例睾丸得以保存。结论睾丸扭转所致睾丸缺血坏死与睾丸扭转持续时间和睾丸扭转程度密切相关,彩色多普勒超声检查是诊断睾丸扭转的理想手段,早期迅速明确诊断、及时手术复位固定治疗才能最大限度提高睾丸的挽救率,临床上怀疑为睾丸扭转的患者应及早进行手术探查治疗,睾丸扭转持续时间越短,睾丸获救机会越大。     

睾丸扭转的诊治

目的探讨睾丸扭转的诊断及治疗方法,以提高本病患者睾丸存活率。方法分析30例睾丸扭转患者的临床资料。结果30例中,初诊确诊为睾丸扭转者18例,误诊为急性附睾炎12例,均行彩色多普勒超声检查以明确诊断,彩超诊断符合率100%;30例患者均行手术探查,16例因扭转时间短,扭转程度轻,行睾丸复位、固定手术,14例行患侧睾丸切除术,所有病例均行对侧睾丸探查、固定术,30例均痊愈出院。结论彩超是该疾病的首选检查方法,早期诊断,及时手术探查是患侧睾丸存活关键,睾丸扭转12h以内均应行睾丸复位固定术,12～24h者应尽量保留睾丸。>24h者应手术切除。     

基层医院对睾丸扭转的诊治体会

目的提高基层医院睾丸扭转的诊治水平,降低误诊率,提高睾丸存活率。方法回顾分析22例睾丸扭转患者的临床资料。结果 3例患者就诊时间〈6 h,行手法复位成功;19例患者就诊时间〉12 h,手术探查,18例患者睾丸坏死,行睾丸切除。结论基层医院睾丸扭转误诊率高;早期诊治,及时手术探查是治疗睾丸扭转的有效方法。     

睾丸扭转15例分析

目的：总结睾丸扭转的诊治经验。方法；回顾性总结15例睾九扭转患者的诊治资料，结合文献进行分析。结果：3例12h以内手术者睾丸均存活，4例12-24h手术者，3例睾丸存活，8例超过24h手术者仅2例睾丸存活。结论：彩超对睾九扭转的早期诊断很有帮助，及早手术是避免睾丸坏死的关键。     

睾丸扭转诊治体会(附9例报告)

目的提高睾丸扭转的诊治水平。方法对9例睾丸扭转患者的临床资料进行总结。9例均有睾丸绞痛症状,及PREHN征阳性。9例患者均经彩超检查确诊为睾九扭转,彩超显示睾丸、附睾在阴囊内位置改变,睾丸内血流减少或消失。结果5例12h以内手术者,睾丸均存活；4例超过24h手术者,行睾丸切除。结论彩超能反映扭转睾丸的血流变化,为首选的辅助检查方法,尤其对睾丸扭转早期诊断很在帮助。确诊后宜积极行手术探查,早期诊断、及时手术治疗是提高疗效的关键。     

睾丸扭转诊疗分析

目的提高对睾丸扭转的认识及诊治水平。方法回顾总结我院12例睾丸扭转患者的诊治资料,复习相关的文献。结果左侧睾丸扭转9例,右侧睾丸扭转3例。12例均接受手术治疗,8例睾丸已坏死,行睾丸切除术;睾丸存活4例,行睾丸复位固定术;12例均行健侧睾丸固定术。结论疑为睾丸扭转时,应首选彩色多普勒检查,彩色多普勒血流动态显像是诊断睾丸扭转的最佳方法,治疗上应尽早手术探查,避免睾丸切除的发生。早期诊断和手术探查是避免睾丸坏死、切除的关键。     

手术治疗15例睾丸扭转的临床分析

目的提高睾丸扭转的诊断和治疗水平。方法回顾分析15例睾丸扭转患者的诊断和手术治疗过程。结果6例延误诊断者扭转睾丸均已坏死。行睾丸切除术；其余9例行复位固定术，术后扭转睾丸全部存活。结论积极的早期诊断、早期手术是挽救扭转睾丸的关键。     

40例睾丸扭转诊治分析

目的探讨睾丸扭转的临床诊断方法及治疗情况,以提高救治水平。方法对我院2009年8月至2011年3月收治的40例睾丸扭转患者临床诊治资料进行回顾性分析,观察其诊断特点及预后情况。结果 40例睾丸扭转患者,34例经彩超确诊,6例经手术探查确诊。其中发生左侧扭转22例,右侧扭转12例。其中8h以内就诊16例,经手术复位固定,术后睾丸全部成活;9～24h就诊者17例,手术复位后11例存活;24h以后就诊者7例,全部行睾丸切除术,并固定健侧睾丸。结论利用彩超进行检查睾丸扭转情况,并根据睾丸扭转时间积极手术探查能够提高睾丸生存机会。     

睾丸扭转56例临床诊治体会

目的提高睾丸扭转的临床诊治水平。方法对本院2001年1月至2012年9月确诊并治疗的56例睾丸扭转患者的临床资料进行了回顾性分析。结果 56例睾丸扭转患者均行彩色多普勒超声检查及手术治疗,其中51例提示睾丸血流信号减弱或消失。56例均为鞘膜内睾丸扭转,其中35例行患侧睾丸切除术加健侧睾丸固定术;21例行患侧睾丸扭转复位固定术加健侧睾丸固定术。15例发病后6h内就诊手术者,患侧睾丸均存活,6例发病后6～12h手术者仅3例可保留患侧睾丸,35例超过12h手术者均行患侧睾丸切除术。随访12个月,56例术后健侧无睾丸扭转发生,1例保留患侧睾丸者出现睾丸萎缩。结论彩色多普勒超声检查对确诊睾丸扭转十分重要,患者应在6h内手术,早期诊断、及时手术可显著提高睾丸存活率。     

睾丸精索扭转的临床诊疗分析

目的:探讨睾丸精索扭转的诊断及治疗方法.方法:回顾分析22例睾丸精索扭转患者的I临床资料.结果:初诊误诊13例.22例均行手术治疗,10例扭转时间短,睾丸血运良好者手术后保留睾丸,12例因睾丸已坏死,行睾丸切除术.加例为鞘膜内扭转,2例为鞘膜外扭转.结论:彩色多普勒血流动态显像检查(CDFI)是急性精索扭转早期诊断可靠方法;手术探查是提高睾丸存活率的重要手段.     

睾丸扭转46例的诊断与治疗

目的 提高睾丸扭转的诊治水平.方法 回顾睾丸扭转46例,结合文献进行诊治讨论.结果 患者年龄14～52岁,平均25.6岁,病程1h～8d,左侧35例,右侧11例.38例行彩色多普勒血流显像检查,33例与临床诊断相符(86.8%),显示同侧睾丸血流减慢或消失.46例均行手术探查,37例行睾丸切除术,其中对侧睾丸固定术29例,8例未行对侧睾丸固定术;9例保留睾丸,随访1～12年,1例发生睾丸萎缩.结论 睾丸扭转是青少年阴囊急症的常见病,彩超检查是睾丸扭转的首选方法,早期手术探查对提高睾丸存活率有重要意义.     

23例睾丸扭转诊疗分析

目的提高睾丸扭转的诊疗水平和睾丸的挽救率。方法回顾性分析对23例睾丸扭转患者的诊断及治疗资料,20例经彩超确诊,3例经手术探查确诊,19例Prehn,s征阳性,发生左侧扭转16例,右侧扭转7例。结果8 h内就诊9例,经手术复位固定,术后睾丸全部成活。9～24 h就诊6例,其中扭转〈360°4例,手术复位固定后3例睾丸存活,〉360°2例,手术后仅一例存活;超过24 h就诊8例,全部行睾丸切除术,并经阴囊纵隔固定健侧睾丸。结论睾丸扭转8 h内应保留睾丸,手术复位固定。9～24 h内就诊的,手术者应尽可能复位保留睾丸,按扭转程度酌情处理;超过24 h,应手术切除睾丸。     

睾丸扭转的诊断与治疗

目的:探讨睾丸扭转的诊断及治疗方法,以提高本病患者睾丸存活率.方法:分析28例睾丸扭转患者的临床资料.结果:28例中初诊确诊率仅11%(3例),25例复诊时行彩色多普勒超声(彩超)检查明确诊断,并经手术证实为睾丸扭转,彩超诊断符合率100%;28例患者均行手术探查,13例因扭转时间短(10 h内10例,24 h内3例),行睾丸复位、固定术,15例行患侧睾丸切除术(24 h内5例,＞24 h 10例),所有病例均行对侧睾丸探查、固定术,28例均痊愈出院.结论:彩超是该疾病的首选检查方法;早期诊断、及时手术探查是患侧睾丸存活的关键;睾丸扭转10 h以内的均应行睾丸复位固定术, 10～24 h者应尽量保留睾丸,＞24 h者应手术切除.     

Methylene blue increases contralateral testicular ischaemia-reperfusion injury after unilateral testicular torsion

1. Testicular ischaemia-reperfusion injury is commonly seen in childhood. Infertility occurs in 25% of patients after unilateral testicular ischaemia. It is has been reported that methylene blue has a positive effect in the reparation of ischaemia-reperfusion injury in different tissues. Therefore, we hypothesized that methylene blue may prevent the hazardous effects of ischaemia-reperfusion injury in testicular tissue after unilateral testicular torsion. 2. Thirty-two prepubertal Wistar-albino rats were divided into four groups. Testicular torsion was created by rotating the right testis 720 degrees in a clockwise direction for 5 h in all groups except for Group C, which was the sham control group. In Group T, bilateral orchiectomy was performed following the torsion period. In Group TD, both testes were removed 5 days after the torsion period. In Group MB, methylene blue (1 mg/kg, i.p.) was administered 40 min before detorsion and once daily over 5 days; then, both testes were harvested. Tissue levels of malondialdehyde (MDA), serum levels of creatine kinase (CK), mean testicular biopsy score (MTBS) and mean seminifer tubule diameter (MSTD) were determined. 3. There was a significant difference in MTBS between Groups T and TD (P < 0.05) in both ipsilateral and contralateral testes. In the contralateral testis, treatment with methylene blue decreased MTBS and MSTD (P < 0.05) and increased MDA levels (P < 0.05). In Group T, mean serum CK concentrations were higher than in any of the other groups (P < 0.05). 4. After 5 h of unilateral testicular torsion and a 5 day reperfusion period, serious tissue damage occurred on both the ipsilateral and contralateral sides. Serum CK concentrations may be an indicator for ischaemia, but not for ischaemia-reperfusion injury. Contrary to our hypothesis, methylene blue increased contralateral testicular damage after unilateral testicular torsion and exacerbated oxidative events.     

Protective Effects of the Nuclear Factor Kappa B Inhibitor Pyrrolidine Dithiocarbamate on Experimental Testicular Torsion and Detorsion Injury

Testicular torsion results with the damage of the testis and it is a surgical emergency. Pyrrolidine dithiocarbamate (PDTC) is a low-molecular-weight antioxidant and potent inhibitor of nuclear factor kappa B (NF-κB) activation. In this study, we aimed to investigate the effects of PDTC to testicular torsion-detorsion (T/D) injury. Forty adult male Sprague-Dawley rats were separated into four groups. A sham operation was performed in group I. In group II, torsion is performed 2 hours by 720 degree extravaginally testis. In group III, 4 h reperfusion of the testis was performed after 2 h of testicular torsion. In group IV, after performing the same surgical procedures as in group III, PDTC (100 mg/kg, intravenous''s) was administered before 30 min of detorsion. The testes tissue malondialdehyde (MDA), superoxide dismutase (SOD) catalase (CAT) level was evaluated. Histological evaluations were performed after hematoxylin and eosin staining. Testicular tissue MDA levels were the highest in the T/D groups compared with treatment group. Administration of PDTC prevented a further increase in MDA levels. Significant decrease occurred in CAT and SOD levels in treatment group compared with the control group. The rats in the treatment group had normal testicular architecture. The results suggest that PDTC can be a potential protective agent for preventing the biochemical and histological changes related to oxidative stress in testicular injury caused by testis torsion.     

睾丸扭转19例诊治体会

目的提高睾丸扭转的诊治水平。方法回顾性分析19例睾丸扭转患者的诊治资料,结合文献进行分析。结果19例患者均经彩色多普勒超声检查确诊为睾丸扭转。7例(32％)经手术复位保留了睾丸,12例(68％)坏死睾丸予以切除。结论彩色多普勒超声检查为诊断睾丸扭转的首选辅助检查方法。确诊后应积极手术探查,以期挽救睾丸。     

Rosiglitazone, an agonist of peroxisome proliferator-activated receptor-gamma, prevents contralateral testicular ischaemia-reperfusion injury in prepubertal rats

1. Rosiglitazone plays a positive role in the reparation of ischaemia-reperfusion (I/R) injury in different tissues. Thus, we examined its biochemical and histological effects on the contralateral testes to determine whether exogenous rosiglitazone affords any protection against testicular damage. 2. Forty-eight prepubertal male Wistar-Albino rats were divided into six groups. Testicular torsion was created by rotating the right testis 720 degrees in a clockwise direction for 5 h in all groups except group I, which was the sham-control group. In group II, bilateral orchiectomy was performed following the torsion period. After detorsion both testes were removed in the fifth hour in group III and on the seventh day in group IV. In group V, one-shot rosiglitazone (4 mg/kg) was administered 40 min before detorsion and both testes were removed following the torsion period. In group VI, rosiglitazone was administered (4 mg/kg) 40 min before detorsion and for 7 days, and then both testes were harvested. The tissue levels of malondialdehyde (MDA) were measured and mean testicular biopsy score (MTBS) and mean seminiferous tubule diameter (MSTD) were examined. Immunoexpression of endothelial nitric oxide synthase (eNOS) in testes tissues was investigated by immunohistochemical studies. 3. In the contralateral testis, the MTBS and MSTD values of group VI were significantly higher than those in group IV. Immunohistochemically, mild eNOS immunostaining was present in the germ cells of the contralateral testes in group IV after I/R. In group VI, intense eNOS immunoreactivity was seen in the contralateral testes. 4. Rosiglitazone reduces contralateral testicular damage formed after unilateral testicular torsion and alleviates the oxidative events.     

睾丸扭转的诊治46例分析

目的 分析睾丸扭转的诊断和治疗方法。方法对46例睾丸扭转患者的临床资料进行回顾性分析。结果 46例患者中,初诊确诊为睾丸扭转者19例(41.3%),延误诊断27例(58.7%)。病程<6 h者14例(30.4%),6~12 h者11例(23.9%),>12 h者21例(45.7%)。46例患者均施行手术探查,其中30例(65.2%)行睾丸切除术,行睾丸保留固定术16例(34.8%),同时行预防性对侧睾丸固定术。彩色多普勒血流显像(CDFI)确诊43例(93.5%)。41例患者随访6月~12年,未发生睾丸扭转。结论 CDFI是诊断睾丸扭转的重要检查方法。睾丸扭转的早期诊断尤其重要,及时手术探查是减少睾丸丢失的关键。建议常规预防性固定对侧睾丸。