364例阴囊急症的诊疗分析

目的探讨小儿阴囊急症的鉴别诊断和治疗方法。方法回顾性分析作者于2006年3月至2010年12月收治的364例阴囊急症患儿临床资料。结果364例阴囊急症患儿中,急性附睾炎221例（占61%）,年龄3个月至5岁多见,症状出现较早,并以起病2~3 d最剧烈,实验室检查异常26例（11%）。彩色多普勒超声提示附睾增大、充血和睾丸反应性改变,检出率99%。3例超声检查诊断困难,后经手术证实。112例睾丸附件扭转中,痛性结节93例（83%）,蓝斑征26例（23%）,超声附件检出率100%。所有患儿初期症状较轻,逐渐加剧,保守治疗1~2周后疼痛逐渐减轻。11例睾丸扭转超声检查显示睾丸无血流予手术治疗。8例出现特发性阴囊水肿,12例出现阴囊感染。结论小儿阴囊急症中以急性附睾炎最常见,病史、体查和多普勒超声检查有助于阴囊急症的鉴别诊断。大多数小儿急性附睾炎可以保守治疗。     

小儿阴囊急症的鉴别诊断和手术治疗

目的探讨小儿阴囊急症的鉴别诊断及治疗方法。方法总结分析我院近7年收治的小儿阴囊急症病例资料。结果133例阴囊急症中睾丸附件扭转105例(79.0%),睾丸附睾炎16例(12.0%),睾丸扭转4例(3.0%),其他8例(6.0%)。附件扭转以6～12岁居多,其阴囊肿痛程度较睾丸附睾炎为轻(P<0.005)。在睾丸附件扭转中蓝斑征9例(8.6%),痛性结节23例(21.9%),超声附件检出率为90.5%。手术中发现不完全性坏死附件、哑铃状附件节间扭转、慢性附件扭转等特殊病例。睾丸附睾炎好发于6岁内,可双侧发病或反复发作。睾丸扭转其提睾反射均消失,超声显示睾丸无血流。结论小儿阴囊急症以睾丸附件扭转最常见,睾丸扭转发病最急。病史、体征及超声检查有助于鉴别诊断,主张积极探查手术。     

小儿阴囊急症的治疗体会(附50例报告)

小儿阴囊急症包括:急性睾丸扭转、睾丸附件扭转,阴囊内容物的炎症。在临床治疗过程中易造成误诊,延误治疗,严重者造成睾丸坏死,现将我院诊治的50例患儿分析如下。1临床资料我院从1996～2003年间共收治阴囊急症患儿50例,年龄6月～12岁,平均7.8岁;左侧35例,右侧15例,未见双侧者,其中3例为隐睾并发睾丸扭转。共有睾丸扭转17例,其中有8例为漏诊病例,包括1例来院时已有睾丸坏死;附件扭转与炎症33例。就诊时间:6h内有12例,6～10h有14例,11～24h为12例,25～48h为7例,49～72h3例。本组根据临床表现和彩色多普勒血流显像CD-FI诊断如表1。其中9例明…     

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。     

超声检查在儿童睾丸附件扭转和急性附睾炎鉴别诊断中的应用

目的 探讨超声检查在儿童睾丸附件扭转和急性附睾炎诊断及鉴别诊断中的应用价值.方法 回顾性分析39例睾丸附件扭转和14例急性附睾炎二维及彩色多普勒超声声像图特点,总结两者鉴别要点.结果 睾丸附件扭转超声表现为睾丸与附睾头之间或睾丸旁高回声或中等回声结节,常伴附睾增大、阴囊壁增厚、鞘膜积液,附睾或睾丸内血流轻度增多.急性附睾炎超声表现为附睾增大,回声减低或增高,常伴阴囊壁增厚、鞘膜积液.附睾内血供丰富,并发睾丸炎时,睾丸增大,回声减低,但是睾丸与附睾头之间或睾丸旁未探及高回声或中等回声结节.结论 超声检查在儿童睾丸附件扭转和急性附睾炎诊断及鉴别诊断中具有一定价值,其中睾丸与附睾头之间或睾丸旁出现高回声或中等回声结节是两种疾病的鉴别要点.     

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。     

睾丸附件扭转33例

目的 分析小儿睾丸附件扭转的临床特点和治疗方法.方法 回顾性分析本院1999年8月-2007年8月收治的33例小儿(3.2～14.0岁)睾丸附件扭转临床治疗.20例于治疗前行彩色多普勒超声(CDFI)检查,记录检查结果.33例分为手术组23例和保守治疗组10例,记录手术组术中所见睾丸附件情况及切除福建的病理检查结果,比较二组患儿平均住院时间、平均阴囊红肿消退时间.结果 睾丸附件扭转以阴囊肿痛为主要表现,CDFI检查表现为睾丸上极附近无血流回声团.手术组和保守治疗组均取得满意疗效.手术组阴囊红肿消除时间为(5.0±1.0)d,保守组为(9.1±5.2)d;住院时间分别为(5.2±2.3)d和(8.9±6.6)d,二组比较,均有显著性差异(t=2.26, 3.12 P<0.05).对病程长、症状轻的病例,在阴囊红肿消退时间和住院时间等方面手术组均优于保守组,术后B超显示睾丸附件可恢复正常.结论 CDFI检查哈在小儿睾丸附件扭转的诊断中具有重要意义,早期手术治疗睾丸附件扭转有利于睾丸及附睾炎性反应得吸收.     

儿童阴囊急症的诊治分析

阴囊急症是小儿泌尿外科常见急症,临床诊断与鉴别有一定困难,延误诊断及治疗可能发生睾丸坏死及其他并发症。现将我院自1998年1月至2 0 0 2年1月收治的6 0例阴囊急症患儿的诊断及治疗情况,总结分析如下。1　临床资料1.1　一般资料6 0例阴囊急症患儿,其中外伤4例、睾丸扭转18例(其中4例为隐睾)、睾丸(附睾)附件扭转2 2例、睾丸炎14例、自发性阴囊肿胀2例。1.2　年龄与类型4例外伤均为学龄儿童,平均年龄8岁;睾丸扭转18例,<1岁5例,2～6岁9例,8～10岁4例;隐睾伴睾丸扭转者年龄分别为4月、8月、2岁和8岁。多在发病2 4h内就诊,最长为发病后7d就诊…     

小儿睾丸附件扭转的保守治疗探讨

睾丸附件扭转是小儿常见的阴囊急症,治疗上分手术治疗和保守治疗两种方法.本文对我院2002至2010年间门诊治疗并随诊的56例睾丸附件扭转的病例进行回顾性研究,探讨睾丸附件扭转的保守治疗效果.     

小儿睾丸附件扭转的保守治疗探讨

睾丸附件扭转是小儿常见的阴囊急症,治疗上分手术治疗和保守治疗两种方法.本文对我院2002至2010年间门诊治疗并随诊的56例睾丸附件扭转的病例进行回顾性研究,探讨睾丸附件扭转的保守治疗效果.     

The tender scrotum

Although scrotal pain and swelling are rarely life threatening, a patient who presents with a tender scrotum should be considered a surgical emergency until the etiology is uncovered. The loss of a testicle and even sterility may occur if the diagnosis of testicular torsion is delayed. In most cases, a careful history and thorough physical examination are all that are needed in making the diagnosis. In the equivocal case, a Doppler ultrasound is helpful in distinguishing surgical versus nonsurgical problems. This chapter will cover the most common causes of a tender and nontender scrotum; testicular torsion, epididymitis, torsion of appendage testis, trauma, incarcerated hernia, hydrocele, reducible hernia, nephrotic syndrome, Henoch-Schönlein purpura, and Kawasaki disease. This chapter will also discuss the appropriate workup and diagnostic tests for each of these entities and when immediate surgical consultation is necessary.     

Early scrotal exploration in all cases is the investigation and intervention of choice in the acute paediatric scrotum

The acute scrotum in the paediatric population is a clinical dilemma where a definitive diagnosis can only truly be made at surgical exploration. We postulate that surgical exploration in all cases allows truly accurate diagnoses, treats the torted appendage testes and enables the validity of clinical signs associated with scrotal pathology to be assessed. We retrospectively reviewed all boys less than 15 years old who presented to our institution with scrotal pain over a 2 year period. A total of 121 patients attended of whom 113 had exploratory surgery, 31 (27%) had testicular torsion, 64 (57%) had a torted appendage testis, 12 (11%) had epididymitis, 1 (1%) had fat necrosis and 5 (4%) had no abnormality detected. On exploration 9 (29%) of the torted testis were unsalvageable and thus required excision. The initial clinical impression was frequently demonstrated to be flawed. Two patients with testicular torsion presented with a painless swelling and two further patients had necrotic testes despite a history of pain for less than 4 h. A normal cremasteric reflex and a visible blue dot were detected in boys with testicular torsion. Doppler ultrasound scans were not reliable with 50% sensitivity to clearly differentiate between torsion of the testis and that of the appendage testis. Absolute dependence on clinical features can lead to a misdiagnosis of testicular torsion. The surgical treatment of torted appendage testis is safe, allowing accurate diagnosis and pain relief with minimal morbidity. Early scrotal exploration of all cases with testicular pain ensures maximal testicular salvage.     

Gray-scale sonography in torsion of the testicular appendages

The reliability of gray-scale ultrasonography in diagnosing torsion of the testicular appendages was studied in a series of 54 boys with acute non-traumatic scrotal pain. All boys were operated upon, and the appendages extirpated irrespective of their appearance at exploration; the final diagnosis was based on histological examination. Forty-two boys had appendicular torsion, 2 had testicular torsion and 10 had other diagnoses. Using the sign of appendicular torsion — an echogenic extratesticular structure situated between the head of the epididymis and the upper pole of the testis — as the criterion, 37 displayed a true positive, 9 a true negative, 3 a false positive and 5 a false negative diagnosis. Thus, the sensitivity was 88%, the specificity 75% and the positive predictive value 93% respectively. The echogenic mass varied in size from 3 to 17 mm in diameter. In 34 of the 42 cases of appendicular torsion extratesticular fluid was present, and 19 patients showed enlargement of the head of the epididymis. It is concluded that gray-scale sonography is an accurate and valuable tool in diagnosing torsion of the testicular appendages.     

Acute scrotum — Etiology and management

Objective: Acute scrotal pain is a common urological emergency. Urgent exploration is the standard means of management, since no investigation can confidently exclude torsion of testis from the differential diagnosis.Methods: A review of all boys presenting with acute scrotal pain who underwent emergency scrotal exploration between January 1983 and March 2003 was performed.Results: 195 boys were included in this study. They were divided into 3 groups: group 1–73 with epididymo-orchitis, group 2–63 with torsion of testicular appendages and group 3–57 with spermatic cord torsion. The patients in group 2 were older than group 1, also patients in group 1 were older than group 3. During neonatal period the most common pathology was spermatic cord torsion, whereas in prepubertal period torsion of appendages was more common. In all boys, mean duration of pain at presentation was 2.11 days. Epididymo-orchitis was diagnosed in 37% of patients, with torsion of the appendages being the next most common entity. Testicular torsion was diagnosed in 29% of patients. In the group with testicular torsion salvage rate of testis was 37% because of late admission. The perioperative morbidity and mortality was not seen in any of the groups.Conclusion: We believe that any boy with acute scrotal pain and any suspicion of testicular torsion in physical examination must be applied routine surgical exploration.     

Color Doppler sonography in the diagnosis of acute scrotum in boys.

Evaluation of acute painful scrotum is difficult and imaging studies have been reported to be unreliable in detecting testicular torsion. In order to assess the value of color Doppler sonography in acute scrotal disease, the authors reviewed 65 consecutive boys, ranging in age from 1 to 16 years. The study demonstrated absent or diminished flow signals in 11 patients. All of them had a surgical intervention, and in 8 of them, a testicular torsion was confirmed. 54 boys had a symmetrical or increased flow signal on the affected side. Just 5 boys among this group underwent surgical exploration. On follow up, none of the 54 patients with good flow signals proved to have a testicular torsion. Sonography and color Doppler sonography helped to differentiate epididymitis and torsion of a testicular appendage as a basis for further investigations and correct conservative therapy. In detecting a testicular torsion, color Doppler sonography yielded a positive predictive value of 73%, a sensitivity of 100% and a negative predictive value of 100%. We therefore conclude, that Doppler sonography can reliably rule out testicular torsion so that routine scrotal exploration in cases of acute scrotum is no longer necessary. By reducing the number of emergency operations and hospitalization days, color Doppler sonography can cut down the total cost of managing acute painful scrotum in boys.     

Spiral twist of the spermatic cord: a reliable sign of testicular torsion

Background. Colour Doppler sonography (CDS) has become the procedure of choice in evaluating testicular perfusion but false negative findings have been reported. Objective. To determine if direct visualisation of the twisted spermatic cord using high resolution US is a reliable sign to assess testicular torsion. Material and methods. Thirty patients (aged 2–26 years) with equivocal diagnosis of testicular torsion prospectively underwent high resolution and CDS. The results were correlated with surgical findings. Serial transverse and longitudinal scans were performed to compare the scrotal contents on each side and study the complete spermatic cord course, from inguinal canal to testis, to detect a spiral twist. Results. In 14 of the 23 cases of torsion, the diagnosis was based on the colour Doppler findings in the scrotum because blood flow was absent in the symptomatic testis and detectable without difficulty on the normal side. In nine cases, CDS was unreliable; in six cases intratesticular perfusion was present in a twisted testis and in three small boys, no colour signal was obtained in either testis. In all cases of torsion, the spiral twist of spermatic cord was detected at the external inguinal ring. The twist induced an abrupt change in spermatic cord course, size and shape below the point of torsion. It appeared in the scrotum as a round or oval, homogeneous or heterogeneous extratesticular mass with or without blood flow, that could be connected cephalad with the normal inguinal cord. In the other seven cases (three late torsions of the appendix testis, one epididymo-orchitis and three torsions with spontaneous reduction), no spiral twist was detectable. Conclusion. The detection of spermatic cord spiral twist appears a reliable US sign of torsion whatever the testicular consequences. Received: 1 December 1997 Accepted: 17 June 1998     

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.     

Scrotal Exploration for Testicular Torsion and Testicular Appendage Torsion: Emergency and Reality

Background:

Scrotal exploration is considered the procedure of choice for acute scrotum.

Objectives:

We evaluated the importance of early diagnosis and testicular salvage on the therapeutic outcomes of patients with pediatric testicular torsion (TT) and testicular appendage torsion (TAT) in our geographic area.

Patients and Methods:

We performed a retrospective database analysis of patients who underwent emergency surgery for TT or TAT between January 1996 and June 2009. Patient history, physical examination findings, laboratory test results, color Doppler sonography (CDS) results, and surgical findings were reviewed.

Results:

A total of 65 cases were included in our analysis. Forty-two cases were followed up for at least 3 months. Testicular tenderness was identified as the major clinical manifestation of TT, while only a few patients with TAT presented with swelling. CDS was an important diagnostic modality. The orchiectomy rate was 71% in the TT group.

Conclusions:

Cases of acute scrotum require attention in our area. Early diagnosis and scrotal exploration could salvage the testis or preserve normal function without the need for surgery.