单侧睾丸扭转术后健侧睾丸功能的研究

目的研究睾丸扭转患者术前和术后不同时间性激素、抑制素B及精液参数的动态变化，探讨健侧睾丸的损伤与修复代偿功能。方法10例睾丸扭转患者（16～45岁），睾丸扭转病程3～6d，平均4．7d；左侧9例，右侧1例，术中探查示患侧睾丸坏死，全部行患侧睾丸切除。全自动化学发光法检测血清中FSH、LH、T的值；ELISA法定量检测患者血清中抑制素INHB的浓度；WLJY-9000分析精液参数。结果INHB水平在术后3周水平最低，12周时恢复正常，术前与术后3周、6周之间有显著差异；术后26周血LH和INHB水平相对术后6周时显著升高；精液常规检测示，术后3周时精液中精子数、精子活率、精子活力较正常标准明显降低，12周时有好转，26周时基本恢复正常：FSH与INHB呈显著负相关P〈0．05，R=-0．900，INHB与精子数量及精子存活率呈显著正相关P〈0．01，R=1．000。结论睾丸扭转者患侧睾丸切除后，健侧睾丸有一个损伤和修复的过程；血清INHB和T变化是睾丸功能的敏感指标，能较准确地反映睾丸损伤和修复程度。     

睾丸扭转长期随访分析(附16例报告)

目的通过回顾性临床资料分析,进一步提高急性睾丸扭转的诊疗水平。方法分析16例(其中2例为双侧睾位扭转)睾丸扭转患者经诊治后随访3~15年的临床资料。结果 7例行患侧睾丸复位固定术及对侧睾丸预防性固定术,7例行患侧睾丸切除术及对侧睾丸预防性固定术,1例双侧睾丸扭转行双侧睾丸切除术,1例双侧睾丸扭转行左侧睾丸切除术及右侧睾丸复位固定术。手术切除标本病理检查均为睾丸坏死。16例随访3年~15年,随访期间1例无睾丸患者血清睾酮偏低;其余15例患者未见明显血清睾酮异常。未切除睾丸的15例中有8例8侧(其中7例患侧睾丸行复位固定术,另1例是双侧睾丸扭转,1侧睾丸行复位固定术)患者患侧睾丸复位固定术后未再次发生患侧睾丸扭转,l例术后出现患侧复位固定的睾丸较同龄人轻度缩小;14例14侧(其中7例患者行睾丸切除术,7例患侧行睾丸复位固定术)患者对侧睾丸预防性固定术后未发生预防侧睾丸的扭转,l例术后出现对侧预防性固定的睾丸较同龄人轻度缩小。16例中,除了1例无精子症外,2例为少精子症,l例为弱精子症,l例为少弱精子症,余11例精液检查均正常。1例无睾丸患者为无精子症,未见明显阴茎晨间勃起,为重度阴茎勃起功能障碍,2例患者(其中1例为弱精子症,1例为少弱精子症)出现轻度阴茎勃起功能障碍,13例患者无勃起功能障碍;随访期间11例生育下一代。结论彩色多普勒血流显像是诊断急性睾丸扭转的可靠方法,早期手术探查对提高睾丸成活率及保护其功能有重要意义。     

灯盏花素对青春前期大鼠睾丸扭转复位双侧睾丸的保护作用

目的:探讨灯盏花素青春前期大鼠睾丸扭转复位双侧睾丸的远期保护作用。方法:对建立左侧睾丸扭转复位动物模型,将32只4周龄健康SD雄性大鼠随机分为4组:假手术组、生理盐水组(腹腔内注射生理盐水2 mg/kg)、灯盏花素单次给药组(睾丸复位前30 min,腹腔缓慢注入灯盏花素2 mg/kg,给药体积为0.5 ml/100 g体重)和灯盏花素连续给药组(在单次给药组的基础上,于术后每天注射同等剂量灯盏花素注射液1次,连续7 d),每组8只。术后6周处死大鼠,取双侧睾丸和附睾,检测睾丸组织总抗氧化能力(T-AOC)、超氧化物歧化酶(SOD)、一氧化氮合酶(NOS)活性与丙二醛(MDA)含量,测定精子浓度、存活率和活动率,行睾丸组织病理学观察。结果:与同侧生理盐水组比较,两给药组双侧SOD、T-AOC、NOS活性、精子浓度、精子存活率和精子活动率均升高,MDA含量下降,其中各检测指标除单次给药组健侧T-AOC活性、精子浓度、精子活动率、双侧NOS活性及连续给药组健侧NOS活性外差异均显著(P0.05);与同侧单次给药组比较,连续给药组双侧SOD、T-AOC、NOS活性、精子浓度、精子存活率和精子活动率均升高,MDA含量下降,其中各项指标除健侧NOS活性外差异均显著(P0.05)。生理盐水组可见双侧生精小管退变,间质水肿,且患侧受损明显大于健侧;两给药组使双侧睾丸扭转复位后损伤的组织学改变明显改善。结论:灯盏花素可通过有效清除氧自由基,减轻脂质过氧化损伤,对青春前期大鼠睾丸扭转复位双侧睾丸有明显的保护作用,且连续给药明显优于单次给药。     

无精子症患者睾丸组织病理分型与血清抑制素B关系的研究

目的:探讨无精子症患者睾丸组织病理分型与血清抑制素B(INH B)水平间的关系,了解血清INH B在评估无精子症患者睾丸生精功能状态的敏感性和特异性。方法:对83例无精子症患者进行睾丸活组织病理检查诊断,根据病理形态的不同分为:唯支持细胞综合征组(n=21)、生精功能低下组(n=20)、生精阻滞组(n=24)和生精功能基本正常组(n=18)。患者睾丸活检前分别测定其血清INH B、卵泡刺激素(FSH)、黄体生成素(LH)及睾酮(T)水平。结果:上述4组血清INH B水平分别为(20.85±18.78)、(67.25±40.98)、(73.63±25.54)和(149.48±27.92)ng/m l。INH B水平在生精阻滞组与生精功能低下组之间差异无显著性(P>0.05),其他各组间以及与上述两组血清INH B水平间差异均有极显著性(P<0.001);FSH水平在生精阻滞组与基本正常组间差异无显著性(P>0.05),其他各组间以及与上述两组血清FSH水平间差异均有显著性(P<0.05);4组血清LH及T水平之间无相关性。结论:血清INH B水平在生精小管生精功能受损时明显降低,唯支持细胞综合征者下降最为显著。血清INH B水平可直接反映睾丸生精功能的总体状态,是判断无精子症患者睾丸生精功能更有效的诊断指标。     

睾丸扭转的临床分析

目的探讨睾丸扭转的疾病特征、发病因素、手术方法/时机,以及预后因素。方法回顾性分析我院自2010年1月1日至2017年1月1日收治的36例睾丸扭转患者的临床资料,对患者的疾病特征、扭转类型、治疗过程及预后情况进行统计分析。结果 36例患者中Prehn征阳性者33例,阳性率91.7%。扭转角度≤90°的患者11例,术后患侧睾丸100.0%存活;扭转角度90°~360°的患者17例,术后患侧睾丸存活13例,存活率76.5%;扭转角度≥360°者8例,术后患者睾丸只有1例存活,存活率12.5%。发病6h内手术干预组18例,术后患者睾丸存活17例,存活率94.4%;6~24h组患者13例,术后患者睾丸存活8例,存活率61.5%;发病24h以上组患者5例,全部切除患侧睾丸,睾丸存活率为0。结论 Prehn征阳性者应高度考虑睾丸扭转。患者睾丸是否能够成功保留,主要取决于发病时间和睾丸扭转角度,因此早期诊断和治疗能有效提高患侧睾丸的存活率。     

腹腔镜完全腹膜外腹股沟疝修补术对睾丸的影响

目的:探讨成年男性腹股沟疝患者行腹腔镜完全腹膜外疝修补术(totally extraperitoneal,TEP)的治疗效果及对患者睾丸的影响。方法:选取并随访2014年1月至2016年12月行腹腔镜TEP的87例男性患者,统计手术时间、术中出血量、住院时间等围手术期指标,彩超观察手术前后患者睾丸血流、睾丸体积等指标,并与健侧进行对比分析。结果:本组87例患者均成功完成腹腔镜TEP,无一例中转开腹。手术时间44~79 min,平均(58.4±15.0)min;术中出血量9~28 ml,平均(17.6±6.2)ml;术后住院4~6 d,平均(5.0±1.0)d;术后发生血肿4例,半年后复发1例。术前及术后3个月、6个月,患者睾丸动脉收缩期峰值血流速度、舒张末期血流速度健侧与患侧差异无统计学意义(P0.05);术前,患侧睾丸动脉阻力指数大于健侧(P0.05);术后3个月、6个月,两侧睾丸动脉阻力指数差异均无统计学意义(P0.05)。术前及术后3个月患侧与健侧的睾丸动脉管径、睾丸体积差异均无统计学意义(P0.05)。结论:腹腔镜TEP治疗成年男性腹股沟疝的疗效肯定,对患者睾丸血流灌注水平有一定的改善作用。     

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.     

一氧化氮在一侧睾丸扭转对侧睾丸损伤中的作用

目的 研究总抗氧化能力(T-AOC)和一氧化氮(NO)在一侧睾丸扭转对侧睾丸损伤中的作用。方法 SD雄性大白鼠建立左侧睾丸扭转模型，于扭转后6h再分为扭转睾丸复位及切除组，分别于术后1h、1d、1周、2周和4周处死4—5只，取出睾丸用于一氧化氮合酶(NOS)活性、NO、T-AOC及细胞凋亡的检查。结果 UTT复位后对侧睾丸组织NOS活性、NO含量明显升高，T—AOC显著降低。结论 NO过量产生及T-AOC的下降是UTT对侧睾丸损伤的重要原因。     

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.     

大鼠一侧睾丸扭转对侧睾丸改变的实验研究

目的 :研究一侧睾丸扭转 (UTT)后对侧睾丸组织学及生精细胞凋亡的改变 ,以明确UTT后对侧睾丸是否存在损伤。　方法 :SD雄性大鼠 6 0只 ,随机分为实验组 (n =4 8)及对照组 (n =12 )。实验组采用Turner方法建立左侧睾丸扭转模型 ,于扭转后 6h处死 4只 ,其余 4 4只再分为扭转睾丸复位及切除组 ,分别于术后 1d、1周、4周处死7～ 8只 ,取睾丸组织进行组织学及生精细胞凋亡的检测。　结果 :UTT复位后对侧睾丸组织学发生明显改变 ,生精细胞凋亡指数明显高于对照组 (P <0 .0 5 )。扭转睾丸切除后对侧睾丸变化不明显。　结论 :UTT可引起对侧睾丸损伤 ,其机制可能与再灌注有关 ,扭转睾丸切除可防止或减轻对侧睾丸的损伤     

未成熟大鼠睾丸单侧扭转后对健侧血流和组织学的影响

目的:观察未成熟大鼠睾丸单侧扭转后对健侧睾丸血流供应和组织学的影响,并比较不同处理方法的疗效。方法:建立Wistar3周龄大鼠左侧睾丸扭转模型,分别建立对照组、扭转组、扭转复位组和扭转切除组,每组10只。彩色多普勒测量各组术前、术后8h(即扭转复位或切除术后2h)、12h、24h、72h右侧睾丸动脉收缩期最大血流速度,并于对照组和扭转组术后2h,扭转复位组和扭转切除组第1次术后12h各取2只大鼠右侧睾丸进行组织病理学观察。各组喂养至9周龄时分别取右侧睾丸进行组织学观察及检测各组大鼠右侧睾丸的生精小管直径(STD)、生精上皮细胞计数(CMSE)和睾丸活检评分(TBS)。结果:①未成熟睾丸左侧扭转后,右侧睾丸的血供呈持续性增加。②扭转组、扭转复位组和扭转切除组右侧睾丸均有不同程度的间质水肿和超微结构改变。③9周龄时扭转组、扭转切除组右侧睾丸重量均较对照组显著增加(P<0.01);各组大鼠STD、CMSE、TBS均无显著性差异(P>0.05)。结论:未成熟大鼠睾丸单侧扭转后可引起对侧睾丸的血供增加和组织学改变,轻微损伤后扭转复位和睾丸切除预后效果相似。     

低温联合地塞米松对大鼠睾丸扭转复位后eNOS表达及生精细胞凋亡的影响

目的:探讨低温联合地塞米松对睾丸扭转复位后的保护作用,以及对eNOS表达及生精细胞凋亡的影响。方法:将80只青春期SD大鼠随机分为4组,每组20只。4组大鼠分别扭转左侧睾丸720°2 h,建立单侧睾丸扭转模型,随后各组做如下处理,A组:常温+生理盐水、B组:低温+生理盐水、C组:低温+地塞米松、D组:常温+地塞米松;术后48 h采集睾丸,通过HE染色光镜观察睾丸组织病理学改变、免疫组化法检测eNOS表达、TUNEL法检测睾丸生精细胞凋亡。结果:HE染色光镜下见4组大鼠扭转侧睾丸组织均有不同程度损伤,其中A组睾丸损伤最明显,其余3组扭转侧睾丸得到不同程度保护;睾丸组织eNOS免疫组化检测结果:A组扭转侧(左侧)睾丸组织阳性细胞数及阳性细胞着色强度明显强于B、C、D 3组,差异具有显著性(P<0.05、P<0.01、P<0.01);凋亡细胞染色:细胞核呈深棕黄色或棕褐色,A组扭转侧(左侧)睾丸可见大量生精细胞凋亡,凋亡指数AI(31.12±4.68)明显高于B组(16.58±6.22)(P<0.05)及C(8.60±1.15)、D组(13.52±3.06)(P<0.01)。结论:睾丸扭转复位后的缺血再灌注损伤可导致生精细胞凋亡增加、睾丸生殖能力下降;应用低温联合地塞米松能显著增强睾丸组织的抗损伤能力,较好地保护了扭转复位后睾丸的生精功能。     

低温对大鼠睾丸扭转后睾丸抗氧化能力影响的研究

目的:探讨低温对睾丸扭转后其抗氧化能力的影响。方法:24只健康青春期SD雄性大鼠随机分为3组:A组为睾丸扭转组,B组为睾丸扭转加低温组,C组为对照组,每组8只。建立单侧睾丸扭转模型。术后第14d采集睾丸。化学比色法测定其总抗氧化能力(T-AOC)和丙二醛(MDA)的含量。光镜观察睾丸组织学变化。结果:B组T-AOC明显高于A组(P<0.01),而低于C组(P<0.01);B组MDA含量低于A组(P<0.01),而高于C组(P<0.05)。结论:低温可抑制睾丸扭转复位后氧自由基的产生及其引发的脂质过氧化反应,提高扭转睾丸的生存力。     

Blood perfusion of the contralateral testis evaluated with contrast-enhanced ultrasound in rabbits with unilateral testicular torsion

The changes of blood perfusion of contralateral testis after unilateral testicular torsion remain controversial. In this study, 28 New Zealand white male rabbits were randomly divided into five groups. Group A (n = 8), the control group, underwent a sham operation on the unilateral testis without inducing testicular torsion. In groups B, C, and D (n = 5 each), unilateral testicular torsion was induced, and, after 3, 6 or 24 h, respectively, detorsion was performed. In group E (n = 5), permanent unilateral testicular torsion was applied. Contrast-enhanced ultrasound was used to observe the blood perfusion of the contralateral testis at the following stages: pre-torsion (preopration), immediately post-torsion (postopration), pre-detorsion, immediately post-detorsion, and late-stage post-detorsion (6–12 h post-detorsion in groups B–D) or at a similar time point (15–21 h post-torsion in group E). Time-intensity curves were generated, and the following parameters were derived and analyzed: arrival time, time to peak intensity, peak intensity, and half-time of the descending peak intensity. The analysis revealed that blood perfusion of the contralateral testis increased immediately after testicular torsion on the opposite side (P < 0.05), which increased with prolonged testicular torsion of the other testis. This research demonstrated that contrast-enhanced ultrasound was valuable in evaluating blood perfusion of the contralateral testis after unilateral testicular torsion.     

精索扭转37例误诊分析

目的：提高精索扭转诊治水平。方法：对52例精索扭转患者首诊误诊37例(71．2％)的临床诊治资料进行回顾性分析。结果：37例患者中，误诊为急性附睾、睾丸炎30例(81．1％)，睾丸肿瘤3例(8．1％)，泌尿系结石2例(5．4％)，附睾结核及慢性结肠炎各1例(2．7％)。28例行B超检查，21例诊断符合(75．0％)，漏诊3例(10．7％)，误诊为急性附睾、睾丸炎及睾丸占位各2例(7．1％)。22例行彩色多普勒血流显像(CDFI)检查，20例诊断符合(90．9％)，误诊为附睾炎及睾丸占位各1例(4．5％)。2例入院时患侧睾丸已萎缩未手术。35例探查手术，其中26例睾丸切除，病理报告均为睾丸缺血性梗死；余9例保留睾丸并予固定(5例血运完全恢复，4例已不可逆性坏死，家属坚决要求保留)。因为首诊误诊，86．5％(32／37)患者睾丸切除或萎缩。结论：对于阴囊急症患者。尤其是青少年，首诊医生应高度警惕精索扭转可能性，可疑时立即行B超、CDFI检查，尽早手术探查，是降低误诊率、提高诊治水平、挽救睾丸功能的关键。     

Testicular torsion–detorsion and potential therapeutic treatments: A possible role for ischemic postconditioning

Testicular torsion is a common urological emergency among adolescent boys and young men. Rotation of the testis and twisting of the spermatic cord rapidly leads to ischemia, resulting in a loss of germ cells. Thus, prompt diagnosis and urgent surgical intervention are required, but the subsequent release of the torsion induces reperfusion injury, which causes further damage to the ischemic testis. Testicular torsion–detorsion (ischemia–reperfusion) injury triggers the generation of reactive oxygen species, pro‐inflammatory cytokines, neutrophil recruitment, lipid peroxidation, anoxia and apoptosis, which carry a significant risk of subsequent infertility. Previously, the effects of numerous pharmacological agents and treatments have been evaluated to prevent testicular ischemia–reperfusion injury in animal models. We propose a new treatment, especially postconditioning, to prevent adverse effects of ischemia–reperfusion injury after testicular torsion–detorsion.     

Experimental testicular torsion: Effect on endocrine and exocrine function and contralateral testicular histology

Summary In order to investigate whether unilateral testicular torsion exerts a negative influence on the previously undisturbed contralateral side, exocrine and endocrine testicular function were evaluated before and two months after torsion. A rat model with 6 hours', 12 hours' or permanent extravaginal 540° torsion of the right testis was used; a sham operated group of animals served as controls. Ejaculates were collected by electrostimulation; LH, FSH and testosterone serum levels were determined by radioimmunoassays. Eight weeks after torsion sperm output had decreased by half in the experimental groups, and LH levels increased significantly, whereas the other hormone levels, as well as the controls, remained unchanged. Morphometry of the contralateral testis revealed no alterations except a significant increase of the Leydig cells and interstitial cells in some subgroups. All observed changes correlate with the functional loss of one testis; definite evidence for contralateral damage was not observed.     

Protective effects of trapidil in ischemia–reperfusion injury due to testicular torsion and detorsion: An experimental study

OBJECTIVE: We aimed to detect the preventive effects of trapidil in ischemia-reperfusion (IR) injury due to testicular torsion and detorsion. METHODS: Forty prepubertal albino rats were used. In the IR group, torsion was created by rotating the left testis over 2 h, and detorsion was done by untwisting the testis. Bilateral orchiectomies were performed after 4 h. In study group, 2-h torsion was performed and trapidil was administered as a single dose 1 h before detorsion. Bilateral orchiectomies were performed after 4 h. In the sham group, a sham operation was done. In the sham plus trapidil group, a sham operation was done and trapidil was administered as a single dose. Testicular tissue malondialdehyde (MDA), nitric oxide (NO) and total sulfhydryl (T-SH) levels were determined for each group. The grades of interstitial injury were determined in histopathologic examination. RESULTS: The NO and MDA levels in the IR group were significantly higher than the study, sham and sham plus trapidil groups in the left testis (P<0.05, P<0.001 and P<0.001, respectively). A statistical difference was not found among study, sham and sham plus trapidil groups in the left testis in NO and MDA levels (P>0.05). The T-SH level in the study group was significantly higher than in the IR, sham and sham plus trapidil groups in left testis P<0.05). In the IR group (left testis), grade 1 interstitial injury was 30% (3/10), grade 2 injury was 60% (6/10) and grade 3 injury was 10% (1/10). In the study group (left testis), grade 1 interstitial injury was 30% (3/10) and there was no injury in 70% (7/10). CONCLUSION: Trapidil decreased free oxygen radical formation in testicular torsion and detorsion, and attenuated histopathological damage in the ipsilateral twisted testis.     

Testicular function after torsion

A group of 20 patients with torsion was investigated. The study indicated that immediate surgical intervention with a period of torsion of the testis of less than 6 h will prevent impairment of testicle function. The histology of testicular biopsies taken from such patients revealed only interstitial oedema and, at the most, partial necrosis. If torsion time exceeded 6 h testicular histology revealed severe alterations, and surgical correction could not prevent atrophy of the testis. Patients with pathological spermiograms showed FSH values over or at the upper limit of the normal range. As far as can be concluded from one single basal hormone determination, the testosterone secretion remained unaltered. Libido, potency and virilization remained normal.