睾丸扭转误诊分析并文献复习

目的提高临床医师睾丸扭转的诊治水平,减少误诊。方法报道2例因延迟就诊的睾丸扭转患者的诊治资料,结合文献对其病因、临床表现、超声诊断及误诊原因进行复习与分析。结果对2例患者均行手术探查,1例睾丸坏死者行睾丸切除,1例行复位及同侧睾丸固定术,术后睾丸萎缩失去功能。结论发病后及时就诊、准确诊断和及时正确的治疗是避免睾丸丢失的关键,彩色多普勒超声为睾丸扭转的首选检查方法,及时的手术探查可以提高睾丸的挽救率。     

睾丸扭转9例分析

目的：提高对睾丸扭转的认识及诊治水平,早诊断,早治疗。方法：回顾9例睾丸扭转患者的病历资料,复习相关的文献。结果：所有诊断均术前经彩色多普勒超声（CDFI）证实;左侧睾丸扭转7例,右侧2例;发病至就诊时间3.5 h至6 d;8例手术治疗,1例手法复位成功后自行出院;8例手术证实均为鞘膜内扭转,其中7例睾丸已坏死,行睾丸白膜内切除术;睾丸存活1例,行睾丸固定术。结论：睾丸扭转不容忽视,睾丸扭转应早期诊断,及时手术治疗是避免睾丸坏死的关键。     

睾丸急性扭转3例治验

患者3例,年龄18～26岁,平均22岁,1例为剧烈活动后发生,2例在早晨发生,3例均以疼痛、恶心、呕吐为为主要症状就诊,仅1例初诊考虑为睾丸急性扭转,余2例误诊为“急性睾丸炎”、经严密观察下手术探查,3例扭转均为18O度,复位后,睾丸精索血运恢复,将睾丸固定在阴囊肉膜内、随访年余无异常变化。睾丸急性扭转并非罕见,扭转原因:①睾丸横位;②附睾附着在睾丸一极;③睾丸系膜过     

飞行学员急性睾丸扭转诊治体会

目的：总结飞行学员急性睾丸扭转的诊治体会。方法一旦诊断明确，立即手术探查，实施睾丸复位并固定术治疗。结果3例病人手术治愈后，随访1～2年无复发。结论急性睾丸扭转病人及早实施手术复位并固定术治疗，操作简便，创伤性小，效果可靠。飞行学员患者治愈后应改做其他专业工作。     

睾丸扭转9例分析

目的:提高对睾丸扭转的认识及诊治水平,早诊断,早治疗.方法:回顾9例睾丸扭转患者的病历资料,复习相关的文献.结果:所有诊断均术前经彩色多普勒超声(CDFI)证实；左侧睾丸扭转7例,右侧2例；发病至就诊时间3.5 h至6 d;8例手术治疗,1例手法复位成功后自行出院；8例手术证实均为鞘膜内扭转,其中7例睾丸已坏死,行睾丸...     

武警部队战士精索扭转12例诊治体会

精索扭转的诊断与治疗一直是泌尿外科最具挑战性的急症之一,因易误诊为急性附睾炎及嵌顿疝而延误治疗.一旦延误诊治,可导致睾丸坏死、切除,甚至引发医疗诉讼,值得医务人员高度重视.尽管多普勒超声使得诊断日臻完善,但继发于精索扭转的睾丸损害仍然十分常见.通常认为,诊断精索扭转的患者行睾丸固定术后并无复发风险,但是仍有少数患者再次发生鞘膜内精索扭转.笔者就我科2005年1月以来收治的12例精索扭转病例进行回顾性分析,以提高对本病的诊治水平,同时探讨外科处置与疾病预后的关系.     

睾丸扭转误诊5例原因分析

1985～1993年，共收治睾丸扭转8例。但入院前8例全部误诊，入院后误诊5例，现就误诊原同分析如下。一、误为急性＊九炎例119岁。因阴囊疼痛3d，于1985年9月161河入院。3d前患者于睡眠中突然出现阴囊疼痛，曾在卫生队拟诊为急性睾丸炎而用青霉素等治疗3d无好转，遂送本院。体检：体温375℃，阴囊右侧皮肤水肿，宰九肿大约scmX3．scmX3cm，触痛明显，附率未能触及，诊所急性举九炎继续消炎治疗。4d后肿胀不退而行右率九探查，见精京顺时钟方向扭转36O”，率九坏死，予以切除。讨论军丸扭转容易误诊的急性睾丸炎、附睾炎。丁崇标”’报告率九…     

改良睾丸固定术的疗效观察

目的　探讨改良睾丸固定术临床应用价值。方法　将复位后的睾丸鞘膜切开翻转后直接与切开阴囊肉膜的边缘缝合固定 ,不做间窝。结果　全组 65例 ,其中 43例术后获得随访 1～ 5年 ,效果满意 ,复位后的睾丸发育良好 ,无回缩也无任何并发症。结论　改良后的睾丸固定术 ,更符合生理要求 ,且可避免其它术式引起的并发症或后遗症     

睾丸鞘膜间皮瘤成像研究

正摘要目的描述睾丸鞘膜间皮瘤病人的影像表现。方法回顾性分析10例病理证实睾丸鞘膜间皮瘤病人的临床数据、影像表现和随访信息(所有病人行超声检查,2例病人行MRI检查)。结果睾丸鞘膜间皮瘤影像表现有多种,最常见(5/10)表现为含实性、富血供结节的鞘膜积液;1例表现为有分隔、囊壁富血供的鞘膜积液;1例表现为多发实性结节,周围有少量、生理性的积液包绕;1例表现为厚壁囊性占位,睾     

彩色多普勒超声诊断睾丸扭转的价值

回顾分析自2006年～2007年超声提示睾丸扭转5例均经手术病理证实,4例患者均睾丸严重缺血坏死,手术切除.1例患者睾丸缺血,积极术中复位,睾丸康复.现报告如下.     

急性阴囊闭合性损伤的磁共振成像与彩色多普勒超声诊断

目的探讨磁共振成像（magnetic resonance imaging,MRI）与彩色多普勒超声在急性阴囊闭合性损伤中的诊断价值。方法收集急性阴囊闭合性损伤患者8例,所有病例全部经MRI及彩色多普勒超声检查,回顾性分析及比较MRI及彩色多普勒超声图像。结果8例急性阴囊闭合性损伤患者中,MRI示睾丸损伤出血8例（其中自膜下少量积血2例）,睾丸增大、阴囊肿大皮肤增厚、鞘膜积液8例,白膜毛糙3例,附睾增大5例（其中附睾损伤出血3例）,腹股沟区淋巴结肿大4例。彩色多普勒超声示睾丸损伤出血6例,睾丸增大6例,阴囊肿大、皮肤增厚8例,鞘膜积液6例,白膜异常未见,附睾增大2例,腹股沟区淋巴结肿大未见。结论MRI能清楚显示急性阴囊闭合性损伤,是目前诊断急性阴囊闭合性损伤的精确影像检查方法。     

Evaluation of testicular viability by power Doppler ultrasonography in experimentally induced acute testicular torsion

RATIONALE AND OBJECTIVE: We sought to determine whether torsed testis viability can be evaluated by ultrasonography (US) including power Doppler US in an experimental model of acute testicular torsion. METHOD: Eighteen rats underwent unilateral 540 degrees testicular torsion and contralateral orchiopexy. Gray-scale and power Doppler US were performed 24 hours later. We evaluated echogenicity, intratesticular vascular flow, and testis size. Echogenicity and intratesticular vascular flow were quantitatively analyzed by using a visual scale and computer-based analysis. After US, detorsion was performed in torsed testes, and 6 days after detorsion testes were excised to determine testicular viability, which was determined using gross and microscopic findings. US findings before detorsion were correlated with testicular viability. RESULTS: At US performed 24 hours after testicular torsion, all viable testes (n = 7) were homogeneous and isoechoic versus contralateral testes. In nonviable testes (n = 11), lower (82%) and heterogeneous (73%) echogenicities were seen on gray-scale US. Intratesticular vascular flow was preserved in 86% of viable testes. In nonviable testes, no intratesticular vascularity was observed in 82%, and intermittent, peripheral blood flow was detected in the remaining 18%. Intratesticular focal lesions were observed in 45% of nonviable testis. Quantitative analysis showed a statistically significant difference between viable and nonviable testes in terms of testicular echogenicity and intratesticular vascular flow. CONCLUSION: Preoperative US including power Doppler examination can predict testicular viability in testicular torsion. Echogenicity of nonviable testes was found to be hypoechoic and inhomogeneous. Power Doppler examination showed no or intermittent peripheral blood flow in nonviable testes.     

彩色多普勒超声在睾丸扭转诊断中的作用

目的探讨彩色多普勒超声诊断睾丸扭转的临床意义。方法回顾分析15例经手术病理证实的睾丸扭转患者的术前彩色多普勒超声表现,并与手术病理对比分析。结果15例患者中,13例的彩色多普勒超声显示血流消失或明显减少提示睾丸扭转,有2例初次超声检查误诊,1例误诊为睾丸炎,另1例误诊为正常。后经复查超声,诊断为睾丸扭转。结论彩色多普勒超声能准确地显示睾丸内血供情况,判断睾丸缺血的不同阶段,因而它是诊断睾丸扭转首选的、可靠的检查方法。     

Hodentorsion: Diagnose, Differenzialdiagnose und Therapie im Kindesalter

Acute scrotum represents an emergency situation although testicular torsion is present in less than 20% of the cases. Sonography has meanwhile become the definitive modality for diagnosis. Its increasing use before surgical intervention has led to technical improvements in ultrasound diagnostics and critical assessment of ultrasound criteria to exclude testicular torsion as well as standardization of examination procedures. Central arterial and venous perfusion shown to be bilaterally equal on Doppler sonography is the most important criterion for excluding torsion.This article discusses other criteria such as the "resistance index," comparison of parenchymal structure of both testes, evidence for spermatic cord torsion, or differences between the sides in perfusion of the testicular parenchyma and highlights the difficulties involved in partial and intermittent testicular torsion. Alternative investigative methods and the significance of sonography in the differential diagnosis of other underlying causes are addressed. In summary, the combination of interpreting B-mode imaging, color Doppler, and power Doppler sonography and analyzing Doppler flow curves after clinical examination results in successful and conclusive evaluation of the testes in cases of acute scrotum in boys.     

Acute testicular torsion in children: the role of sonography in the diagnostic workup

Acute testicular torsion in children is an emergency and has to be diagnosed urgently. D oppler sonography is increasingly used in imaging the acute scrotum. Nevertheless, in uncertain cases, surgical exploration is required. In this study, we attempted to define the role of Doppler sonography in the diagnostic workup of the acutely painful scrotum. All patients admitted between 1999 and 2005 with acute scrotal pain were included. After clinical assessment, patients were imaged by Doppler sonography with a ‘‘high-end’’ instrument. In cases of absent arterial perfusion of the testis in Doppler sonography, surgical exploration was carried out. Patients with unaffected perfusion were followed clinically by ultrasound for up to 2 years. Sixty-one infants and children aged 1 day to 17 years (median: 7.9 years) were included. In 14 cases, sonography demonstrated absent central perfusion, with abnormal parenchymal echogenicity in six. Absence of venous blood flow together with reduction of central arterial perfusion was found in one infant. In these 15 patients, surgical exploration confirmed testicular torsion. Among the other 46 patients, we found four cases with increased testicular perfusion and 27 with increased perfusion of the epididymis. In one infant, a testicular tumour was found sonographically, and orchiectomy confirmed diagnosis of a teratoma. Follow-up examinations of the conservatively treated patients showed good clinical outcome with physiologic central perfusion as well as normal echogenic pattern of both testes. No case of testicular torsion was missed. By means of Doppler sonography, an unequivocal statement regarding testicular perfusion was possible in all cases. The initial Doppler diagnosis was confirmed by operative evaluation and follow-up ultrasound. Testicular torsion can therefore be excluded by correctly performed ultrasound with modern equipment. Patrick Gunther and Jens-Peter Schenk contributed equally to this work     

The normal and abnormal scrotum in children: evaluation with color Doppler sonography.

The use of color Doppler sonography to evaluate the symptomatic testes in children with scrotal pain or swelling was prospectively studied with a fourth-generation color sonographic unit with a 7-MHz linear transducer. The 32 patients were 1 day to 18 years old (mean age, 8.6 years). Results were correlated with scintigraphic findings in 23 patients, with the final diagnosis established by surgery in 12 patients, and with clinical follow-up in all patients. Eight cases of testicular torsion, including two of acute torsion and six of late torsion, were correctly detected by color Doppler sonography and confirmed surgically. In the remaining patients, perfusion of the testis was correctly detected by color Doppler examination. The final diagnoses in these patients included torsion of the appendix testis (15 patients), epididymitis (five patients), epididymo-orchitis (one patient), yolk sac tumor of the testis (one patient), hydrocele (one patient), and local reaction to an insect bite (one patient). The ability to detect blood flow in the normal contralateral testis was also evaluated in 28 patients. Blood flow was demonstrated in normal testes larger than 1 cm3. Detection of flow in the very small normal prepubertal testis was often difficult, and no flow was identified in one testis. Flow was identified in central arteries in only six of 13 testes smaller than 1 cm3. We conclude that color Doppler sonography is helpful in the initial evaluation of pediatric testes, providing accurate evaluation of the involved hemi-scrotum in our patients and also providing the benefit of both structural and flow information. Until our sensitivity to low-velocity flow improves, we would not suggest the exclusive use of color Doppler sonography in the evaluation of testicular perfusion in the prepubertal patient. We advocate the addition of testicular scintigraphy to corroborate the presence of testicular perfusion when flow in intratesticular arteries cannot be established with certainty by color Doppler sonography.     

Prenatal testicular torsion: sonographic appearance in the newborn infant

The prenatal diagnosis of spermatic cord torsion is often really difficult and the diagnosis is usually retrospective. Herein, we report a case of a male newborn baby who presented at delivery with an enlarged, swollen and tender scrotum. US showed an enlarged right testis, with dishomogeneous texture, fluid collection between the testis and the tunica vaginalis and large hydrocele. Differential diagnosis included hydrocele complicated by infection or hemorrhage, testicular tumor or postnatal testicular torsion. Color and power Doppler did not reveal any flow signal, and the diagnosis of antenatal torsion with initial necrosis was made. The role of color Doppler US is emphasized in directing the patient to emergency surgical exploration, when testicular salvage may be possible. Delayed surgical treatment can be proposed, when the diagnosis of antenatal torsion has a high degree of certainty. However, the Doppler examination of a newborn baby's testis is a very difficult challenge even for an experienced radiologist. Electronic Publication     

Suspected testicular torsion and ischemia: evaluation with color Doppler sonography

Color Doppler sonography was performed in 32 patients with a painful scrotum in whom testicular ischemia from torsion or postherniorrhaphy was clinically suspected. Surgical correlation was available in 15 patients, and scintigraphic correlation was available in 17 patients. Seven of the 32 patients were diagnosed as having testicular ischemia from torsion. Color Doppler flow imaging demonstrated a lack of intratesticular flow in six of the seven testes with torsion and relatively normal intratesticular flow in one of the patients with acute torsion. Normal or increased intratesticular flow was demonstrated by color Doppler in all 57 of the nonischemic testes. Using the single criterion of presence or absence of identifiable intratesticular flow, the authors found that color Doppler was 86% sensitive, 100% specific, and 97% accurate in the diagnosis of torsion and ischemia in the painful scrotum. Color Doppler sonography is an accurate, noninvasive means of rapidly assessing perfusion of the testis in the painful scrotum.     

彩色多普勒超声在小儿睾丸扭转诊断中的价值

目的探讨彩色多普勒超声对小儿睾丸扭转的诊断价值。方法对44例临床疑诊睾丸扭转男孩(年龄1岁～15岁,平均8岁)首先用二维超声显示双侧睾丸附睾形态、结构及内部回声,再用彩色多普勒观察血流情况,所有病例经手术证实。结果44例中的41例睾丸扭转患者患侧睾丸血流减少或消失。结论彩色多普勒诊断睾丸扭转有很高的特异性,简便无创,应作为诊断睾丸扭转的首选方法。     

彩色多普勒超声在急性阴囊肿痛诊断中的应用

目的评价彩色多普勒超声(CD)在急性阴囊肿痛诊断及鉴别诊断中的应用价值。方法应用CD对53例急性阴囊肿痛患者进行急诊检查。观察阴囊内容物的形态、回声、结构及血流变化。经手术或临床治疗随访证实诊断。结果53例阴囊急症中,37例经非手术治疗及超声随访证实诊断,16例经手术及病理确诊。CD诊断准确率98%(52/53)。其中,睾丸扭转92%(12/13),睾丸、附睾炎100%(28/28),阴囊外伤100%(9/9),阴囊皮肤感染100%(3/3)。结论CD不仅能够区别睾丸扭转和炎症,并能鉴别肿瘤与炎症,还可评价阴囊外伤的程度及预后,因而它可作为诊断急性阴囊肿痛的首选方法。