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。

Evidence-based diagnosis and treatment of testicular torsion

Objective：To systematically review the diagnosis and treatment in patients with testicular torsion.Method：The Chinese databases involving CNKI,VIP and foreign language databases including PubMed and The Cochrane Library were electronically searched from 1990 to 2012.Randomized controlled trials（RCTs）on testicular torsion were included.Blind method was used for statistical analysis.Result：A total of 27 RCTs and 3,541 patients were included in the study.The results showed that Doppler sonography was superior to conventional sonography in diagnosis of acute scrotum,and became the preferred method for imaging diagnosis of acute scrotum.We supported the practice of surgical exploration for acute scrotal pain suspicious of testicular torsion in patients of any age.There was not enough evidence to support bilateral testicular fixed line with unilateral testicular torsion.The influence of the reproductive function on one side of testicular torsion would increase as the patients age,and controversy still existed in the contralateral testis.Conclusion：Patients with scrotal symptoms should be timely screened by Doppler colour.For the confirmed patients with testicular torsion and scrotal emergency,scrotal exploration should immediately be done.Bilateral orchiopexy should be based on particular case.Follow-up plan for reproductive function should be closely taken.