56例小儿睾丸扭转的诊断与治疗

目的提高对小儿睾丸扭转的临床诊断和治疗水平。方法回顾性分析56例睾丸扭转患儿的临床资料,左侧扭转32例,右侧扭转24例。初诊时间<6h20例,6～24h28例,>24h8例。初诊确诊为睾丸扭转34例,延误诊断22例(本院8例,外院14例)。结果12例发病后<6h就诊者手法复位成功,其余44例手术探查,16例手术探查发现睾丸已坏死而行睾丸切除,其中>24h者7例。结论提高首诊诊断正确率将有助于扭转睾丸的救治。彩色多普勒超声是首选的辅助检查方法。主张尽早手术及预防性对侧睾丸固定。     

睾丸扭转26例临床分析

目的：总结睾丸扭转的诊断及治疗。方法：对26例睾丸扭转的临床资料作回顾性分析。结果：8例扭转时间短或扭转＜180度者经手术复位，保留睾丸；18例睾丸因扭转时间长或完全旋转而坏死予以切除。结论：Doppler超声听诊仪和彩色Doppler超声成像是诊断急性睾丸扭转的可靠依据，治疗是应及时诊断、及时复位、切除坏死睾丸，并将双侧睾丸同时作预防性固定，以免复发或对侧再发。     

小儿睾丸扭转的诊断与治疗

目的提高对小儿睾丸扭转的临床诊断和治疗水平。方法回顾性分析42例睾丸扭转的临床资料,年龄4～15岁,平均8.5岁。左睾丸27个,右睾丸15个。初诊时间<6h10例,6～24h26例,6例超过24h。初诊确诊为睾丸扭转24例,延误诊断18例(本院7例,外院11例)。结果8例发病后6h就诊者,给予手法复位成功;34例发病时间>6h者手术探查,18例手术探查睾丸已坏死,而行睾丸切除。结论彩色多普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。主张尽早手术及预防性对侧睾丸固定。     

小儿急性睾丸扭转的诊断与治疗

报道小儿急性睾丸扭转１１例，２例手法复位成功，９例手术治疗，其中４例行睾丸切除。结合文献，对该病诊断及治疗进行讨论．     

新生儿睾丸扭转临床回顾与分析

目的 探讨新生儿睾丸扭转的治疗措施选择.方法 回顾性分析11例新生儿睾丸扭转的诊治资料.分析评估内容包括临床表现、体格检查、辅助检查、治疗方法的选择以及术后随访情况等.结果 11例新生儿睾丸扭转,左侧6例,右侧5例;顺产8例,剖宫产3例;足月产10例,早产1例.产前睾丸扭转5例;产后睾丸扭转6例.产前睾丸扭转5例均行患侧睾丸切除,1例行对侧睾丸预防性固定术.所有产后睾丸扭转均行患侧睾丸切除+对侧睾丸预防性固定术.术后病理检查提示睾丸组织大部分出血伴坏死,其中5例产前睾丸扭转病例中4例病理检查提示睾丸组织有钙化灶.术后随访对侧睾丸未见明显异常.结论 对产前睾丸扭转,需切除患侧睾丸并同时行对侧睾丸固定.对双侧产前睾丸扭转,建议手术探查行睾丸扭转矫正术后保留睾丸.对产后睾丸扭转则需尽早安排手术探查并行预防性睾丸固定.     

小儿急性睾丸扭转的诊断与治疗

报道小儿急性睾丸扭转１１例，２例手法复位成功，９例手术治疗，其中４例行睾丸切降，结合文献，对该病诊断及治疗进行讨论。     

睾丸扭转23例

目的探讨儿童睾丸扭转的诊治方法。方法回顾分析23例睾丸扭转患儿临床资料。患儿年龄3 d~12岁,病程3 h~5 d。入院后立即急诊行睾丸探查术。其中7例睾丸血运不恢复予切除,余行睾丸固定术。结果7例6 h内手术或扭转小于360度复位后血运恢复好,16例超过6 h且扭转超过360度均有不同程度的血运障碍,其中720度以上者7例均呈坏死改变。患儿均治愈出院。结论及早手术是提高儿童睾丸扭转疗效的关键。     

小儿隐睾扭转的诊治体会

目的：探讨小儿隐睾合并扭转的临床诊治经验。方法回顾性分析2008年7月至2013年12月我们收治的14例小儿隐睾合并睾丸扭转病例的临床资料,其中左侧9例,右侧5例;左侧9例中,2例为双侧隐睾;右侧5例中,1例术中及术后病理检查证实为隐睾合并睾丸成熟畸胎瘤。14例均为单侧隐睾扭转。患儿年龄4岁至11岁5个月,平均3．1岁。结果14例患儿中,11例行扭转坏死睾丸切除术,3例行扭转睾丸复位＋下降固定术,患儿均同期行健侧睾丸固定术或健侧睾丸下降固定术。术后经2个月至5年随访,11例睾丸切除患儿健侧睾丸发育良好,血清睾酮水平正常;3例睾丸下降固定术患儿中,2例睾丸发育良好,1例合并睾丸畸胎瘤患儿经保睾手术后患侧睾丸发育较小,无肿瘤复发。结论早期诊断和及时手术治疗是提高隐睾并扭转患儿睾丸存活率的关键。     

单侧睾丸扭转对大鼠两侧睾丸生精功能的损害

目的 研究单侧睾丸扭转对大鼠两侧睾丸精子发生的影响。方法 制作单侧睾丸扭转不同时间的大鼠模型，以乳酸脱氢酶X(LDH—X)为观测指标，分析附睾内的精子数量和活力，从而反映睾丸生成精子的能力。部分组别的动物在扭转复位前注射别嘌呤醇，观察药物对组织的保护作用。结果 单侧睾丸扭转后，患侧附睾管腔内的精子数量及活力明显降低；对侧改变出现于扭转6h以后；应用别嘌呤醇能改善扭转2h以内患侧的精子发生。结论 单侧睾丸扭转造成两侧睾丸生精功能下降，下降程度与先前扭转时间有关；早期手术复位加以别嘌呤醇的应用能对受损组织提供有限保护。     

小儿睾丸疾病外科急诊20例报告

小儿阴囊红肿、疼痛多见于睾丸扭转、附睾睾丸炎、睾丸附件扭转。提高对阴囊急诊的认识,以及彩色多普勒超声血流显像等辅助诊断技术的应用,对早期睾丸扭转的手术复位以挽救睾丸,和避免不必要的手术探查起了重要作用。     

西地那非对大鼠单侧睾丸扭转后对侧睾丸的影响及作用研究

目的 探讨大鼠单侧睾丸扭转后对侧睾丸的损伤以及西地那非（万艾可）的保护机理.方法 将72只健康雄性SD大鼠,随机分为假手术组、安慰剂组、西地那非组.3组分别在假手术/左侧睾丸扭转复位术后4 h、24 h、2周时,各组各处死8只大鼠.分别观察右侧睾丸组织病理学变化、测定右侧睾丸组织中MDA、NO/NOS含量.结果 术后4 h,各组间组织病理学变化、MDA、NOS含量无明显差异,睾丸组织未见损伤,但NO在两地那非组较假手术组、安慰剂组明显增加（P〈0.05）.术后24 h,假手术组右侧睾丸组织损伤最小,西地那非组较严重,安慰剂组最为严重;与假手术组比,其余两组MDA、NO/NOS含量明显升高（P〈0.05）;西地那非组NO/NOS含量与安慰剂组相比明显下降（P〈0.05）;术后2周时,睾丸组织损伤有不同程度恢复,但仍以安慰剂组最为严重;与假手术组比,其余两组MDA、NO/NOS含量仍然升高（P〈0.05）;西地那非组NO/NOS含量与安慰剂组相比明显下降（P〈0.05）.结论 大鼠单侧睾丸扭转复位后,对侧睾丸组织术后4 h时.睾丸组织未见损伤.12 h后睾丸组织明显损伤,并且持续至2周后.早期应用适量西地那非（万艾可）可促局部NO增加,扩血管作用加强,拮抗交感神经缩血管作用,进而保护对侧睾丸.     

Outcomes of Second Look Exploration in Testicular Torsion of Children

Background:

Testicular torsion (TT), or twisting of the testicle resulting in a strangulation of the blood supply, occurs in men whose tissue surrounding the testicle is not well attached to the scrotum. It is important to emphasize that testicular torsion is a medical emergency.

Objectives:

The aim of this study is to evaluate the second look exploration and outcomes in TT.

Patients and Methods:

Seventy boys out of 124 patients underwent early exploration and 48 hours later second look exploration due to TT. All patients were checked with preoperative color-doppler ultrasonography (CDU) and intraoperative bleeding test. Data included age at admission, side of pathology, relation of TT with season of year, duration of preoperative history, degree of testicular torsion, CDU findings, and degree of bleeding; results of second look exploration, follow-up, and outcomes were analyzed.

Results:

Totally 70 patients were included in this study within five years, of which mean age was 28.6 ± 32.9 months (range 1 to 144), 48% of our patients had nausea and vomiting. Preoperative CDU showed absent/weak flow in 50 (71%) cases. Winter showed most frequently (44%) referred cases of testicular torsion. Orchidopexy was performed in 44 (63%) and orchidectomy in 26 (37%) cases after second look exploration. Mean follow-up duration was 3.1 ± 1.4 years. 4 (9%) cases in orchidopexy group developed testicular atrophy during follow-up, all four cases had a history of longer than 12 hours and grade II testicular bleeding test intra-operatively. Other orchidopexy patients salvaged. 26 patients, who were in grade III, underwent orchidectomy in second look exploration.

Conclusions:

TT requires emergency attention. The ischemia time of the testis is traditionally after 6 hours, and imaging or other diagnostic modality should not be a cause of delay. Early surgical exploration is modality of choice, and second look exploration after 48 hours can be more effective and salvageable in these patients.     

Prenatal bilateral extravaginal testicular torsion—a case presentation

A newborn male presented at birth with findings consistent with bilateral testicular torsion. Preoperative ultrasound demonstrated no flow to either testicle, and he underwent surgery, during which bilateral extravaginal testicular torsion was confirmed. The right testicle was grossly necrotic and orchidectomy was performed, whereas the left testicle was indeterminate and underwent detorsion and orchidopexy. At 6-month follow-up, the left testicle remained within normal clinical limits with good flow on ultrasound examination.     

小儿睾丸附件扭转的彩色多普勒超声诊断意义

目的探讨彩色多普勒超声检查在诊断小儿睾丸附件扭转中的意义。方法回顾性分析我院1999年2月～2005年11月收治的小儿睾丸附件扭转病例的临床资料及超声检查结果。结果在所有病人中,发现蓝斑征9例(8.6%),痛性结节23例(21.9%),74例超声检查资料完整的病例中,超声检查在睾丸上极发现无血流回声结节67例,均经手术证实。结论彩色多普勒超声检查若发现睾丸上极附近无血流回声团,则提示睾丸附件扭转。超声检查在小儿睾丸附件扭转的诊断中具有重要的意义。     

Testicular torsion following torsion of a hydatid of Morgagni

The acute scrotum is one of the commonest surgical emergencies in pediatric practice. Early diagnosis, prompt treatment, and preventive measures are important to avoid testicular infarction. Occurrence of torsion has been previously reported following orchidopexy for undescended testis and for previous torsion of the testis. We report a case of intravaginal torsion of the testis in a patient who had previously undergone exploration and excision of a torted hydatid of Morgagni without formal orchidopexy. As exploration of the scrotum does not confer protection against subsequent torsion, orchidopexy should be routinely performed in patients who are found to have high investment of the tunica vaginalis or separation of the epididymis and testis on scrotal exploration for any reason. Correspondence to: E. J. Guiney     

Acute scrotum -etiology,clinical presentation and seasonal variation

Objective  The aim of the present study was to evaluate the etiology, history, physical examination findings, and seasonal variation of acute scrotal problems in children. Methods  A retrospective review of all boys, presenting with acute scrotum to the Pediatric Surgery Clinic of the University Hospital Heraklion between January 1989 and December 2006 was performed. Results  A total of 140 boys presented with scrotal pain were included. Overall the commonest cause of acute scrotum was epididymo-orchitis (35%, 95%CI: 27%–43%), followed by torsion of appendages. In contrast the most common cause in boys of preschool age was spermatic cord torsion (P<0.020). All cases of spermatic cord torsion were characterized by severe testicular pain and an absent cremasteric reflex. The interval between pain initiation and presentation to our clinic was 11.4 hours (SD:3.07) when the testis was salvaged by detorsion, and 19.0 hours (SD:6.32) when the testis was removed. The difference between means was statistical significant (p<0.001). The incidence of torsion of appendages (p<0.036) and/or spermatic cord (p<0.047) was increased in winter. Conclusion  The absence of cremasteric reflex in association with testicular tenderness strongly suggests testicular torsion. The low temperatures during winter may account for the increased incidence of the torsion of both the spermatic cord torsion and the appendages.     

Preoperative manual detorsion of the spermatic cord with Doppler ultrasound monitoring in patients with intravaginal acute testicular torsion

Objective. To assess the effectiveness of preoperative manual detorsion in acute testicular torsion.¶Materials and methods. Between June 1998 and March 1999, seven patients presenting with testicular torsion underwent manual manipulation under US monitoring in order to restore the flow to the testis prior to surgery (orchidopexy). All detorsions were lateral in direction. The success of the manoeuvre was assessed both clinically and sonographically and confirmed at surgery.¶Results. Six manoeuvres were successful in restoring flow to the testis. The failed attempt in the seventh patient was due to failure to manipulate beyond an initial 1 1/2 rotations (540 °).¶Conclusions. Preoperative detorsion is the fastest way to relieve testicular ischaemia. However, manual detorsion of the spermatic cord is not a substitute for surgical exploration and bilateral orchidopexy is still necessary.     

Neonatal testicular torsion – a lost cause?

Twenty-four neonates presented with signs of testicular ischaemia over a 13-year period. They had a mean birth weight of 3.706 kg. The right testicle was affected in 13, the left in 9 and there was bilateral torsion in 2 babies. Two babies had no twist in the cord, but the testicles were nonviable macroscopically and microscopically. Twenty-one babies had primary exploration revealing necrotic testes in all patients and they underwent orchidectomies. The other three babies had conservative management and the affected testes had atrophied on follow-up. Sixteen babies had contralateral orchidopexy. Doppler ultrasound scans were reported as normal in 2 of 13 babies who had scans. No testes were salvaged following surgery.
Conclusion: The incidence of testicular torsion in the neonatal period was calculated as 6.1 per 100 000 live births. No testis was salvaged following surgery in our series of 24 patients. This dismal outcome underlines that immediate surgical exploration, although commonly performed, rarely saves torted testes.