精索形态声像图在睾丸扭转诊断中的价值

目的分析睾丸扭转精索及睾丸内血流声像图表现，旨在强调精索二维图像在睾丸扭转中的价值。方法回顾性分析经手术证实的睾丸扭转患者精索超声和睾丸内血流CDFI检查的声像图特征。结果35例睾丸扭转患者，34例二维出现精索形态异常，31例CDFI出现睾丸内血流改变异常，敏感性分别为97．14％、80．00％；特异性分别为100％、96．70％。结论精索形态声像图改变在睾丸扭转诊断中具重要价值。     

睾丸扭转诊治现状

睾丸扭转为最重要的急性阴囊急症之一，早期就诊、诊断和治疗是挽救睾丸和功能的保证。本文就睾丸扭转的病因、诊断和治疗方法现状做一综述。     

睾丸扭转的诊治

睾丸扭转是泌尿外科的急症,发病率约为 1/4 000,如不及时诊断、治疗,可能造成睾丸缺血坏死而切除睾丸。我院自1990年至2002年共收治睾丸扭转18例,报告如下。1　资料与方法1.1　临床资料　本组18例,年龄 8~41 岁,平均 16.2 岁;左侧14例,右侧3例,双侧 1 例;有 11 例患者不能陈述明确的诱因,有2例有剧烈活动史。2 例发病 6 h内就医,3 例 24 h内就医,其余24 h~7 d就医。16 例阴囊及睾丸肿胀、疼痛并向同侧腹股沟放射,睾丸上抬、触痛,睾丸、附睾界限不清,提睾反射消失。14 例血象升高, 5 例发热(> 38 ℃)。18 例行CDFI检查,血流明显减少或…     

精索扭转误诊24例分析

目的：分析精索扭转误诊的原因及教训，提高临床医生对该病的认识水平与警惕性，以减少误诊的发生。方法：对24例外院误诊的精索扭转病例进行回顾性分析。结果：24例患者均经手术证实为精索扭转，因未能及时诊断，延误时机而切除缺血坏死的睾丸。结论：彩色多普勒血流动态显像应作为诊断该疾病的常规与首选检查方法，对精索扭转一旦确诊或疑有精索扭转的患者应及早行紧急复位，以期挽救睾丸。同时行睾丸固定术也十分必要，对于确诊毫无保留价值的睾丸需行切除。     

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。     

睾丸扭转的诊治体会

睾丸扭转是阴囊外科常见急症之一,发病率约1/4000,多发生于25岁以下,临床上极易被误诊误治,造成睾丸缺血坏死,而被迫行睾丸切除术。我科自1996年2月至2005年2月共收治9例该病患者。现报告如下。1临床资料1.1一般资料本组9例,年龄11~23岁,左侧5例,右侧4例。发病至就诊时间为4h~4     

彩色多普勒超声在睾丸扭转诊断中的应用

<正>睾丸扭转是泌尿外科较常见的急症,多因剧烈运动或暴力损伤阴囊时螺旋状附着于精索上的提睾肌强烈收缩,导致扭转并引起睾丸的急性血液循环障碍。好发于青少年。虽然发病率低,但误诊率较高,易被误诊为急性睾丸炎、附睾炎,延治误治可导致睾丸坏死或不可逆性睾丸萎缩。故早期诊断对于保留睾丸及减轻患者痛苦具有重要意义。2012-01—2015-02,我院共手术治疗13例睾丸扭转患者,现将其彩色     

12例睾丸扭转的诊治体会

报道睾丸扭转12例,3例因早期诊治使患睾获救。对睾丸扭转的诊断和治疗等问题进行了讨论,强调彩色B超是首选的辅助检查方法;积极的早期手术是提高扭转睾丸获救率的关键。     

睾丸扭转18例报告

目的 总结睾丸扭转的诊治体会。方法 报告18例睾丸扭转的临床诊治资料。结果 5例扭转时间短或不全扭转才经手术复位后保留了睾丸。13例（70％）坏死睾丸予以切除。结论 彩色多普勒超声成像是诊断急性睾丸扭转的可靠方法,治疗上主张作预防性睾丸固定,以免扭转复发或再发。     

Recurrent torsion after previous testicular fixation

Background : Occasionally patients present with acute testicular pain having undergone a previous testicular fixation for torsion. The aim of this article is to review the literature and determine whether recurrent torsion of the testis is possible and whether the technique used at initial fixation is relevant. Methods : A literature search was performed using MEDLINE, Pre‐MEDLINE, EMBASE and CIANHL databases using the terms ‘spermatic cord torsion’ and ‘testicular torsion’ in combination with ‘treatment failure’, ‘re‐operation’ or ‘recurrence’. Results : Twenty cases of recurrent testicular torsion after fixation are described. Fifteen of the 17 that specified the type of suture used at initial fixation had used absorbable suture. Animal models suggest that to produce dense adhesions at testicular fixation, the tunica vaginalis must be everted behind the testis with or without fixation, before the testis is returned to the scrotum. Without this eversion, the adhesions around the testis are fine and only located at the site of fixation suture. The use of non‐absorbable suture led to abscess formation in 30% of testes in animal models. Conclusions : The higher incidence of recurrent torsion after fixation using absorbable rather than non‐absorbable sutures in the literature may be caused by a greater number of fixations being carried out using absorbable suture. Use of non‐absorbable suture is limited by the high rate of abscess formation. The most important factor for adhesion formation would appear to be the eversion of the tunica vaginalis and it is recommended that this is carried out at all testicular fixations.     

Adult testicular torsion

PURPOSE: Testicular torsion in adulthood is thought to be relatively unusual. We compared a series of men 21 years old or older with testicular torsion with a concurrent series of younger patients with torsion. MATERIALS AND METHODS: We reviewed the medical records of patients admitted with testicular torsion in a 9-year period to hospitals affiliated with our institution. Data included patient demographics, history, physical findings, radiographic results if any, operative findings and outcome (testicular salvage versus loss). RESULTS: The charts of 48 patients were evaluated. Excluded from study was a neonate with torsion and 3 males who underwent delayed surgery for presumed missed torsion. Of the remaining 44 patients we compared 17 who were 21 years old or older (range 21 to 34) with 27 younger than 21 (range 8 to 20). The salvage rate differed in the 2 age groups with 70.3% of testes salvaged in the younger group versus only 41% in the older group. A factor affecting salvage in each group was time to presentation. In the older age group patients in whom the testis was lost had a significantly higher mean delay in presentation than those in whom it was salvaged (102 versus 11 hours). A similar pattern was noted in the younger group with a mean time to presentation of 108 and 6.5 hours in those with testicular loss and salvage, respectively. Mean time between presentation and operation was 7.1 hours in the older and 4.8 in the younger group, which was not statistically different. A significant difference was noted in the degree of spermatic cord twisting. The cord was twisted a mean of 585 degrees in the adults versus 431 in the younger group. CONCLUSIONS: Testicular torsion in adults was more common in our series than expected. Salvage of the affected testis was better in younger patients, presumably due to less twisting of the cord.     

高频彩色多普勒超声对睾丸扭转的诊断价值

目的 探讨高频彩色多普勒超声对睾丸扭转的诊断价值.方法 对经手术证实的32例睾丸扭转患者的超声诊断结果及其彩色多普勒声像图特点进行回顾性分析.结果 超声首诊符合31例,诊断符合率96.88%.二维超声和彩色多普勒血流成像相结合,有助于对睾丸扭转的正确诊断.结论 高频彩色多普勒超声对睾丸扭转的诊断具有重要价值.     

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。     

睾丸扭转和精索扭转的诊断与治疗(附68例报告)

目的:探讨睾丸和精索扭转的诊断与治疗方法,提高睾丸和精索扭转的治疗水平。方法:对68例睾丸和精索扭转的临床资料进行总结,68例平均年龄21岁,<20岁者占84%,左侧55例占80.8%.发病至确诊时间6h～30天,12h以上者占90.2%。结果:53例术前彩色多普勒血流动态显象(CDFI)应作为诊断疾病的常见与首选检查方法。诊断并经手术证实,符合率100%,经手术探查;41例行手术复位、固定,睾丸获救。27例行患侧睾丸切除术,所有病例均行对侧探察,固定。结论:阴囊X核素显象,B超对睾丸精索扭转早期诊断有帮助。早期诊断,及时治疗是提高疗效的关键。彩色多普勒血流动态显象应作为诊断该疾病的常见及首选检查方法,对睾丸精索一旦确诊或疑有精索扭转的患者应及早行紧急复位,以期挽救睾丸,同时行睾丸固定术也十分必要。对于确诊毫无保留价值的睾丸需行切除术。     

慢性睾丸痛的诊断治疗进展附光盘简

慢性睾丸痛定义为间断或持续性单侧或双侧睾丸疼痛不适、病程超过3个月的慢性疼痛综合征。慢性睾丸痛是个棘手的临床难题,因缺乏有效的诊断和治疗手段,给泌尿外科和男科医生带来了强有力的挑战。慢性睾丸痛的治疗选择多依据病因,但其病因繁多,而且很多无法找到确切病因。精索显微去神经术是治疗慢性睾丸痛的有效方法,术前精索封闭呈阳性反应对预测手术成功率有帮助。本文对慢性睾丸痛的发病率、发病机制、病因、诊断和治疗的最新进展进行了复习。     

Immunohistopathology of the contralateral testis of rats undergoing experimental torsion of the spermatic cord

Aim:To evaluate the immunohistopathological changes in the contralateral testis of rats after an experimental sper-matic cord torsion.Methods:Male Sprague-Dawley rats of 45-50 days old were subjected to a 720° unilateralspermatic cord torsion for 10,30 and 80 days(experimental group,E),respectively or sham operation(controlgroup,C).Histopathology of the contralateral testis as well as germ cell apoptosis were studied using the TerminalDeoxynucleotidyl Transferase Biotin-dUTP Nick End Labeling(TUNEL)technique.The number of testicularlymphocytes,mast cells and macrophages,and the expression of tumor necrosis factor-α(TNF-α)and its receptor(TNFR1)in testicular cells of the contralateral testis were quantified by histochemistry and immunohistochemistry.TNF-α concentration in testicular fluid was determined by ELISA.Results:In the contralateral testis of rats fromthe E group,the maximal degree of damage of the germinal epithelium was seen 30 days after torsion.At this time weobserved in the E group vs.the C group increases:(i)the number of testicular T-lymphocytes;(ii)the number oftesticular mast cells and macrophages;(iii)the percentage of macrophages expressing TNF-α:(iv)TNF-α concen-tration in testicular fluid;(v)the number of apoptotic germ cells;and(vi)the number of TNFR1~ germ cells.Conclusion:Experimental spermatic cord torsion induces,in the contralateral testis,a focal damage of seminiferous tubulescharacterized by apoptosis and sloughing of germ cells.Results suggest humoral and cellular immune mediatedtesticular cell damage in which macrophages and mast cells seem to be involved in the induction of germ cell apoptosisthrough the TNF-α/TNFR1 system and in the modulation of the inflammatory process.(Asian J Andro12006 Sep;8:576-583)     

Serum creatine kinase enzyme levels in the early diagnosis of spermatic cord torsion

Delay in the diagnosis of spermatic cord torsion (SCT) is still a significant cause of testicular loss in children. The aim of this experimental study was to assess the diagnostic value of serum creatine kinase (CK) in the early period following SCT. Forty male rats were assigned randomly into five similar groups: group A, control; group B, sham, right testis exposed, manipulated, and blood sampling at 6th h; group C, right SCT, blood sampling at 2nd h; group D, right SCT, blood sampling at 4th h; and group E, right SCT, blood sampling at 6th h. CK and its isoenzymes were measured in the sera of all animals. All testes were removed and examined histopathologically. Significant increases in serum CK levels compared to control and sham groups were observed at 4 and 6 h following SCT. The major increase in CK was observed in the CK-MM isoenzyme fraction. Histologic pictures showed varying degrees of edema, vascular congestion, and hemorrhage in the testicular tissue, but no necrosis in any of the study groups. These results showed that serum CK levels in rats in the early period following SCT increase significantly before necrosis of testicular tissue. This may be of value as a diagnostic test, to corroborate findings from clinical studies.