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。     

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。     

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。     

小儿睾丸及睾丸附件扭转的诊治（附65例报告）

目的提高小儿睾丸及睾丸附件扭转的临床诊治水平。方法回顾分析我院近10年间65例小儿睾丸及睾丸附件扭转患者的临床表现、辅助检查以及诊断治疗方法。结果65例患儿中，睾丸扭转33例，睾丸附件扭转32例，58例（89％）患儿存在阴囊肿胀或疼痛表现，7例伴有恶心、发热等症状。63例进行手术治疗，行睾丸或睾丸附件切除54例（86％）。结论小儿睾丸及睾丸附件扭转是儿外科急症，早期正确的诊断和及时的手术治疗是保存睾丸的关键。     

146例小儿阴囊急症的诊治分析

目的:总结小儿阴囊急症的诊断及急诊手术探查治疗的经验。方法:回顾性分析10年来收治的146例小儿阴囊急症的临床资料。急性附睾炎68例(46.5%),睾丸扭转48例(32.8%),睾丸附件扭转19例(13%),其余为急性阴囊感染,急性睾丸炎,特发性阴囊水肿,阴囊血肿。前3种疾病共135例,占92.4%。结果:急诊手术探查95例(65%),急性附睾炎51.4%(35/68),睾丸扭转95.8%(46/48),睾丸附件扭转73.6%(14/19)。48例睾丸扭转者中,37例睾丸梗死,结论:小儿阴囊急症的正确诊断十分重要,对疑有睾丸扭转的应积极手术探查。     

睾丸精索扭转的诊断与治疗(附16例报告)

目的：总结睾丸精索扭转的诊断及治疗方法。方法：回顾性分析16例睾丸精索扭转患者的临床资料。患者年龄1～39岁,平均19岁,其中小于25岁者12例,占75％。左侧11例,占68％。发病至确诊时间6h～3周。结果：初诊误诊12例。16例均行手术治疗,4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。15例为鞘膜内扭转,1例为鞘膜外扭转。结论：彩色多普勒超声是急性精索扭转早期诊断的可靠方法;手术探查是提高睾丸存活率的重要手段。     

高频彩超对小儿阴囊急症的诊断及鉴别诊断价值

目的:分析小儿阴囊急症的高频超声图像特征,探讨高频彩超对小儿阴囊急症的诊断及鉴别诊断价值。方法:回顾分析我院2014年1月至2016年1月因阴囊急症而行彩色多普勒血流显像(CDFI)检查的256例患儿(起病时间2 h至3 d,年龄2 d至14岁)睾丸的形态、结构、内部回声及血供情况,并与临床手术及病理结果进行对照分析比较。结果:256例阴囊急症患儿中急性睾丸扭转23例,其中16例患儿行坏死睾丸切除术,有12例行对侧睾丸固定术;7例患儿行扭转睾丸复位,予保留并行睾丸固定术。超声特征:患儿患侧睾丸不同程度增大或缩小,内部回声不均匀,可见不规则片状低回声,可伴有睾丸鞘膜积液。CDFI:患侧睾丸内无明显血流信号,周围血流信号丰富。急性睾丸附件扭转116例,超声特征:睾丸上极上方或睾丸上极与附睾头间类圆形或椭圆形异常回声结节,早期为低回声,后逐渐增高,内部回声不均匀,呈"网格样"。附睾增大,可伴有患侧睾丸增大、阴囊壁增厚。CDFI:增大附睾或睾丸血流丰富,结节内未见血流信号。急性附睾炎103例,超声特征:患儿患侧附睾明显不同程度肿大,内部回声不均匀,CDFI:患侧附睾内血流信号丰富。急性睾丸炎6例,超声特征:患侧睾丸肿大,内部回声呈低回声,回声尚均匀。CDFI:患侧睾丸内部血流丰富。腹股沟嵌顿疝15例,超声特征:可见疝囊突入阴囊,阴囊明显增大,其内可见肠系膜及肠管。CDFI:可见血流信号。急性阴囊壁血肿及水肿8例。超声特征:阴囊壁均匀或不均匀增厚。CDFI;阴囊壁可见血流信号。结论:高频彩超对小儿阴囊急症具有较高敏感性及特异性,可为临床医生诊断及鉴别诊断提供可靠的诊断依据,是临床首选的影像学检查方法。     

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。     

睾丸扭转误诊113例分析

目的 :提高睾丸扭转 (精索扭转 )诊治水平。　方法 :回顾分析 1994～ 2 0 0 4年总计 113例睾丸扭转误诊的临床资料。　结果 :首诊误诊率 84 .3%。误诊为急性附睾、睾丸炎 81例 (71.7% ) ;鞘膜积液 10例 (8.8% ) ;急性肠炎 7例 (6 .2 % ) ;泌尿系结石 5例 (4.4 % ) ;腹股沟疝 5例 (4.4 % ) ;睾丸肿瘤 3例 (2 .7% ) ;附睾结核 2例 (1.8% )。发病至误诊时间 2h～ 2个月 ,平均 6 .3d。手法复位成功 3例 ;92例行手术探查 ,睾丸、附睾切除 6 4例 ,睾丸萎缩 2 6例 ,总计睾丸毁损率 79.6 %。　结论 :提高首诊医生对睾丸扭转的诊治水平是减少误诊的关键 ,诊断流程采用病史、体征、彩超 3者结合 ,治疗的最佳方法是积极开展阴囊急诊的手术探查。     

睾丸扭转33例报告

报告３３例睾丸扭转病例,均系单侧发病,２０岁以下占２３例。３例施行手法复位,其余３０例行手术探查,１３例睾丸复位后血供恢复正常行睾丸固定,１７例睾丸已坏死予以切除。睾丸坏死与病史长短有关联,６小时之内者无一例坏死,而超过１２小时的１８例中则有１６例发生坏死。提高本病疗效的关键是做到尽早诊断和治疗,对睾丸扭转可疑者主张积极手术探查。     

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.     

症状不典型睾丸扭转7例并文献复习

目的:提高症状不典型睾丸扭转的早期诊断和治疗水平。方法:回顾分析7例症状不典型睾丸扭转确诊病例并文献复习。结果:7例患者均以腰痛为首发症状来诊,后均经彩色多普勒超声确诊为睾丸扭转,5例手术复位成功,睾丸存活;1例行患侧睾丸切除;另1例因家人及本人拒绝而放弃手术。结论:对首先主诉腰痛的男性患者,首诊医师一定要检查睾丸,以免漏诊;对疑为睾丸扭转者,应急诊手术探查。     

Torsion of the cryptorchid testis--can it be salvaged?

PURPOSE: The literature concerning undescended testis mainly concentrates on the increased risks of infertility and development of germ cell tumors. Yet the UDT also appears to be at higher risk for torsion compared to the normally descended testis, and this issue is relatively poorly addressed. We reviewed all cases of torsion of UDTs operated on at our hospital during the last 20 years in an attempt to characterize better this condition and its salvageability. MATERIALS AND METHODS: In this retrospective clinical study we reviewed and analyzed all cases of testicular torsion involving UDT operated on at our hospital between 1984 and 2004. RESULTS: A total of 11 children were operated on at our hospital for torsion of undescended testis between 1984 and 2004. Patient age ranged from 1 month to 18 years (median 7.5 months). In all cases unilateral torsion of undescended testis was diagnosed, with 73% of cases involving the left side. Clinical symptoms included inguinal swelling and erythema associated with a tender, firm mass palpated in the groin area and an empty ipsilateral hemiscrotum. Doppler ultrasound examination was routinely performed in the last 7 patients to confirm the diagnosis. During inguinoscrotal exploration severe ischemia or overt necrosis of the testis was found in 5 of 11 cases. Three of these 5 cases were managed by orchiectomy, while in the other 2 cases the testis subsequently vanished. In the 6 patients who exhibited some improvement following detorsion and warming of the tissue the testes were preserved and orchiopexy was performed. Followup was available in only 5 patients, with vanishing of the torsed testis observed in 4 and a normal testicle detected 21 years postoperatively in 1 patient who was diagnosed early. CONCLUSIONS: This series clearly demonstrates poor rates of surgical salvage, which we mainly attribute to delays in parental response and in primary physician referral to the hospital. Parents, who have a pivotal role in early diagnosis, were usually unaware of this urological emergency, and some were surprisingly unaware of the presence of cryptorchidism. By increasing the awareness regarding this entity among members of the medical community and parents, we hope that torsion of the cryptorchid testis (literally, "hidden testis") will no longer necessarily be synonymous with "crypt-torsion" ("hidden torsion").     

精索形态观察在睾丸扭转早期诊治中的意义

目的:提高睾丸扭转早期的诊断和治疗水平。方法:回顾性分析49例睾丸扭转的临床资料及睾丸内血流声像图和精索超声特征。结果:49例睾丸扭转患者,彩色多普勒血流显像出现睾丸血流改变42例,其中血流增加3例,睾丸血流无明显改变7例;二维超声检查发现精索形态异常47例。手术复位固定21例,睾丸存活12例。结论:彩色多普勒超声扫描精索形态与睾丸血流变化对睾丸扭转的早期诊断有重要价值,尽早手术探查有助于挽救存活睾丸。     

新生儿睾丸扭转8例诊治分析

目的 探讨新生儿睾丸扭转临床特点及诊治方法.方法 回顾性分析我院近5年收治的8例睾丸扭转新生儿的临床资料并复习相关文献.结果 新生儿睾丸扭转共8例;年龄7h~8d;左侧3例,右侧5例;入院查体均发现阴囊肿大呈暗红色或黑紫色,内可及质硬包块,触痛阳性;超声检查示患睾增大、密度不均、血流信号减少或消失;均行阴囊探查术,术中均发现精索睾丸扭转并已坏死,7例行患睾切除;病理结果示睾丸大片出血坏死,5例择期行对侧睾丸固定术.所有患儿随诊3~12月,1例家长拒绝切除患睾的患儿3月时B超复查已经萎缩,超声检查均未发现对侧睾丸异常.结论 新生儿睾丸扭转的睾丸坏死率极高;当发现新生儿阴囊色泽改变、肿大触痛等改变,在不能除外睾丸扭转时应尽早行阴囊探查术.     

Clinical study on acute scrotum]

Between April 1986 and July 1990, we experienced 13 cases of acute scrotum with surgical exploration. Six of the patients had torsion of the spermatic cord; three had torsion of an appendix of the epididymis, one had torsion of a testicular appendix, one had testicular rupture, one had acute epididymitis and one was normal. Their ages ranged from 3 months to 55 years (mean: 17.7 years), and the patients with torsion of the spermatic cord ranged from 5 to 25 years in age (mean: 16.3 years). No specific symptoms, signs, or laboratory findings were noted in patients with torsion of the spermatic cord. In the majority of cases, scrotal swelling and redness of the scrotal skin were present, and we could not distinguish parts of the scrotal contents. From 2 to 92 hours had passed before the patients presented, and patients who first attended other clinics tended to be treated in an inappropriate manner. Orchidopexy was performed in all patients with torsion of the spermatic cord. At present, only one testis which was treated after a delay of 92 hours has proven to be atrophic. Early consultation of a urological clinic and early surgical exploration are important in the treatment of the acute scrotum.     

Intra-uterine testicular torsion: early diagnosis and treatment.

OBJECTIVE: To review the incidence and treatment of intra-uterine torsion of the testis which although rare is being recognized with increasing frequency. PATIENTS AND METHODS: From 1988 to 1997, five newborns (mean birth weight 3.62 kg, range 3.15-4.12) with unilateral torsion of the testis were treated; all underwent emergency exploration. The right testis was affected in three and the left in two boys. RESULTS: In all except one child, the affected testis was enlarged, firm to hard, tender, the overlying skin dark red and the affected testis higher than the contralateral testis. In one child the right testis was enlarged and higher, but soft to firm, and the overlying skin was oedematous and red. The exploration revealed extravaginal torsion of the testis which was gangrenous in four; in one after detorsion there was haemorrhage and haematoma of the cord and the tunica, and the testis was slightly congested but not gangrenous. This testis was preserved and bilateral orchidopexies performed; at 18 months both testes are palpable and of normal size. In the remaining four children the testes were frankly necrotic; they underwent orchidectomy and contralateral orchidopexy. Histology in all four revealed a totally infarcted testis with extensive haemorrhage and vascular congestion. CONCLUSION: The early diagnosis and treatment of intra-uterine torsion of the testis is essential.     

精索扭转（附4例报告并文献复习）

目的探讨精索扭转的早期诊断,以降低误诊率,提高睾丸的救治率。方法报告精索扭转4例,结合国内献20年报告的293例,对其临床资料进行了回顾性分析。结果误诊率为54．8％。自行复位3例,手法复位22例,手术治疗263例(265侧),拒绝手术3例,治疗方法不明6例。睾丸损失率69．3％。结论加强对精索扭转的认识,首选彩色多普勒血流显像(CDFI)检查,早期诊断和及时治疗,可提高睾丸的救治率。     

小儿服囊急症

目的：总结小儿阴囊急症手术或非手术治疗的可行性。方法：回顾性研究５２６例小儿阴囊急症患者的临床资料和诊疗经验。睾丸附件扭转３６８例（７０．０％）,急性鞘膜炎４９例（９．４％）,睾丸扭转４２例（８．０％）,急性附睾炎１９例（３．５％）,急性阴囊感染１８例（３．４％）,阴囊血肿１８例（３．４％）,睾丸炎６例（１．１％）,特发性阴囊水肿６例（１．１％）。前４种常见疾病共４７８例,占９０．９％。住院前误诊