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。     

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。     

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

自1897年Tylor 第一次报告1例2天新生儿的睾丸扭转以来,将近100年的历史中,见之于文献报道的新生儿睾丸扭转也仅只100多例,可见新生儿睾丸扭转是比较罕见的。截至1988年5月底,本院33例经手术证实的睾丸扭转中,3例为新生儿。兹予报道。病例简介例1,入院时6个月。第一胎第一产,足月顺产,生后即见阴囊右侧红肿,未作任何处理。50天时第一次来院就诊,当时发现右侧阴囊内有一硬块,拟诊为睾丸扭转梗死机化。家属不愿接受手术而出院。3个月后,该肿块逐渐缩小变硬,于6个月时再次入院,右侧睾丸为1×0.6×0.6cm     

睾丸扭转48例

我院 1991年 1月～ 2 0 0 1年 12月收治睾丸扭转患儿 4 8例 ,现总结报告如下。资料与方法一、一般资料　本组 4 8例 ,均为男性 ,年龄 2个月～ 14岁。睾丸扭转均为单侧 ,左侧 2 6例 ,右侧 2 2例。二、临床特点　临床均表现为睾丸急性疼痛 ,阴囊水肿、发红、触痛。恶心、呕吐 16例 ,腹痛、发热各 2例。体检患侧阴囊皮肤水肿 ,提睾反射消失。 32例精索缩短 ,4例可触及精索呈“麻绳状”扭曲 ,睾丸抬高或横位。 5例WBC (10 .0～15 .0 )× 10 9/L ,余正常。彩色多普勒检查 :2例睾丸无血供 ,32例睾丸血流明显减弱 ,14例睾丸血流减弱不明显。 4 8…     

睾丸附件扭转8例报告

回顾分析我院1992年～2002年间睾丸附件扭转8例的诊治经验,报告如下。1临床资料本组8例,年龄:6岁1例,7岁3例,10岁1例,12岁3例;侧别:右侧5例,左侧3例,无双侧同时发病者。发病至入院时间:<24h2例(25%),>24h6例。本组2例有明确外伤史,以阴囊肿痛起病,可以忍受,下蹲时疼痛加剧,无发热及其它症状。患侧阴囊皮肤微红、肿胀,呈透明样水肿,在睾丸上或附睾头与睾丸之间有明显触痛点。B型超声检查:与对侧比较,患侧睾丸有不同程度肿胀。术中发现鞘膜层内有少量渗液,较浑浊,暗红色,鞘膜壁层有充血、增厚。6例为顺时针扭转约180°～720°,2例为逆时针扭…     

睾丸扭转的诊断及治疗

目的 提高睾丸扭转的诊治水平。方法 回顾性分析总结16例睾丸扭转的临床资料。结果 16例均经彩色多谱勒血流成像(Color Doppler ultrasonics flow image，CDFI)确诊为睾丸扭转，2例经手法复位，5例经手术复位固定，9例行睾丸切除加对侧睾丸固定。11例获0．5～4．5年随访，手法复位者1例再次发生扭转，经手术复位治愈。结论 CDFI是诊断急性睾丸扭转的可靠方法，早期诊断、及时手术探查是提高睾丸存活率的关键，术中应同时固定对侧睾丸。     

儿童睾丸扭转34例

睾丸扭转易误诊 ,常导致睾丸坏死或不可逆睾丸萎缩 ,早期诊断和及时手术是治疗的关键。我院 1991年 1月～2 0 0 2年 12月共收治 34例睾丸扭转 ,对其进行回顾性分析 ,现报告如下。临床资料一、一般资料　本组 34例 ,年龄 2d～ 18岁 ,平均 9岁。其中新生儿 8例 ,2d 1例 ,6d 2例 ,16d 2例 ,2 3d 1例 ,2 7d2例 ;1～ 14岁 4例 ;～ 18岁 2 2例。左侧 2 2例 ,右侧 12例。病程 4h～ 2 8d ,其中 2 8例 >2 4h。初诊 2 0例 ;误诊睾丸炎 8例 ,阑尾炎、肠痉挛、腹股沟嵌顿疝各 2例。患儿均有睾丸疼痛 ,发热、恶心、呕吐 14例 ,同侧腹部、腰部不适或疼痛 1…     

新生儿睾丸扭转1例

患儿 ,男 ,4ｄ。右侧阴囊肿胀 4ｄ ,在当地医院医治无效后转入我科。查体 :右侧阴囊肿胀 ,局部皮肤增厚 ,颜色变青。右阴囊内可扪及 4ｃｍ× 2ｃｍ× 2ｃｍ肿块 ,质中。Ｂ超示右侧睾丸增大 ,回声增强 ,睾丸鞘膜增厚。彩色多普勒示右侧睾丸血流信号未见增多。急诊腹股沟及阴囊探查 ,术中见右侧睾丸黑紫色坏死 ,精索逆时针旋转 3 60度。切除坏死睾丸。术后病检 :送检组织结构不清 ,内有散在坏死的精曲小管。讨　　论新生儿睾丸扭转是一种罕见的疾病 ,常为精索扭转。患儿表现为阴囊无痛性包块 ,但亦可表现为阴囊红肿、皮肤水肿。查体时除发现阴…     

新生儿睾丸附件扭转67例分析

目的 探讨新生儿睾丸附件扭转的诊断依据以及治疗方法。方法回顾分析67例新生儿发生睾丸附件扭转的病理及临床特点，以及手术中所观察到的一些情况，强调的诊断及手术中需要引起警惕的问题，以免引起误诊、漏诊造成严重后果。结果67例新生儿睾丸附件扭转中经手术治疗均治愈出院，10年随访未出现睾丸萎缩及其它不良反应。结论新生儿睾丸附件扭转，应该引起广泛的重视和关注，早期发现，早期手术治疗是非常必要和及时的。     

Division of the genitofemoral nerve and late orchiectomy: effects on the contralateral testis in ipsilateral testicular torsion

Unilateral torsion of the spermatic cord has been demonstrated to damage the contralateral testis; however, the pathogenesis has not yet been examined in detail. The purpose of this study was to evaluate the influence of unilateral torsion on the contralateral testis in rats by performing ipsilateral division of the genitofemoral nerve (GFN) and/or late orchiectomy. Male 25-day-old, prepubertal Wistar albino rats were divided into five groups: (1) sham operation; (2) unilateral testicular torsion; (3) simultaneous unilateral testicular torsion and ipsilateral GFN division; (4) unilateral testicular torsion and orchiectomy on the 4th day after torsion; and (5) simultaneous unilateral testicular torsion and GFN ipsilateral division, and orchiectomy on the 4th day after torsion. Torsions performed were 720°, all on the right testes. On day 55 after torsion, which represents the early postpubertal period of the rat, the contralateral testes were removed. Tubular biopsy score (TBS) was calculated, and seminiferous tubular diameters (STD) were measured. Student's t-test was used for statistical analysis. There was no contralateral testicular damage in the control group, but in all of the study groups destructive changes were found in the left gonad after torsion of the right testicle. The mean TBS of the study groups was higher than that of the control group. STD values were lower in the study groups, but the differences were not statistically significant between groups. In prepubertal rats, unilateral torsion causes histologically measurable changes in the contralateral testis. Ipsilateral division of the GFN and late orchiectomy did not cause any significant alterations in terms of contralateral damage. Further investigations are needed to determine the role of the GFN in testicular torsion.     

Effect of phospodiesterase 5 inhibitors on apoptosis and nitric oxide synthases in testis torsion: an experimental study

To investigate the effects of phosphodiesterase (PDE) 5 inhibitors, sildenafil citrate and vardenafil HCl, on testicular germ cell apoptosis and also on the expressions of eNOS and iNOS within the bilateral testis after a unilateral torsion in a rat model. Forty-eight Wistar Albino rats, weighing between 210 and 262 g, were housed in individual cages. The rats were randomly assigned into four main groups and each group received drugs. Saline, sildenafil citrate and vardenafil HCl were given to each for 1 month and the last received no drug. After 1 month, testicular torsion was created for 1 h of ischemia and the left testis was untwisted and replaced to the scrotum for 2 h of reperfusion. At the end of 3 h, contralateral and ipsilateral testes were removed for histopathologic and biochemical examinations. Under light microscopy; the histopathological patterns of the contralateral testes in all groups were not affected. Mean apoptotic cell, eNOS and iNOS levels were increased in saline study group. The rats treated with vardenafil and sildenafil (groups 2s and 3s) showed significantly increased apoptotic cell, eNOS and iNOS values in ipsilateral testis (P < 0.05). Sildenafil citrate and vardenafil HCl caused an exaggerated testicular apoptosis after IR injury in rats. Additionally these drugs increased the NOSs levels in the testicular tissue.     

An infant with testicular torsion in the inguinal canal

We report a case of testicular torsion in the left inguinal canal of a 7 month old with a history of cryptorchism and no evidence of neuromuscular disease. We discuss the pathophysiological mechanisms, sonographic findings, and treatment of this rare entity.     

Diagnosis and treatment of splenic torsion in a child

A case of splenic torsion in a 4-month-old child is reported. He was extensively investigated but the diagnosis was not made until laparotomy was performed. Retrospectively, the diagnosis of splenic torsion could have been made by ultrasonography and radio-isotope liver/spleen scan. It is possible that the spleen may be able to recover function and consideration should be given to detorsion rather than splenectomy. Offprint requests to: P. M. Davidson