睾丸扭转的诊治及对健侧睾丸功能变化的分析

目的分析睾丸扭转的诊断及治疗方法及对健侧睾丸功能变化的影响。方法对我科2006年1月至2010年6月收治的49例(平均年龄18.65岁)睾丸扭转患者的临床资料进行回顾性分析总结,术前行血清性激素检查,术中行健侧睾丸活检术。结果患者均给予手术探查:行睾丸复位固定术12例,睾丸切除术37例,均行对侧睾丸固定术。发病<12 h的3例患者行手术治疗复位成功,术后1例睾丸萎缩;发病12～24 h的7例患者行手术治疗复位成功,5例复位后睾丸存活,2例睾丸萎缩;发病24 h以上的2例患者行手术治疗复位成功,术后均睾丸萎缩。对侧睾丸活检术12例,10例患者生精细胞、精子细胞及成熟精子有不同程度减少表现。术前行内分泌检查12例,9例FSH升高,8例LH升高,4例T下降。结论睾丸的挽救率与扭转持续的时间和扭转的程度密切相关,延迟就诊是睾丸丢失的重要原因。应首选彩色多普勒超声检查。扭转时间大于24 h并扭转360°以上者,直接行患侧睾丸切除术可减轻对健侧睾丸的损害。

Diagnosis and treatment of testicular torsion and analysis on contralateral testicular function

Objective To analyze the diagnosis and treatment of testicular torsion and its effect on the contralateral testicular function.Methods Clinical data of 49 cases of testicular torsion who were treated in our department of urology in First Affiliated Hospital of Zhengzhou university from January 2006 to June 2010 were summarized and analyzed.Preoperative examination of serum sex hormones and intraoperative biopsy of the contralateral testis were carried out in all the patients.Results All patients were treated with surgical exploration.Among them,12 cases were fixed by surgical reduction and contralateral orchiopexy,and the other 37 cases were treated with orchiectomy and contralateral orchiopexy.Among the 12 patients with surgical reduction,for the 3 cases with operation within 12 h after onset,the surgery was succeed but 1 case had testicular atrophy postoperatively;for the 5 cases with operation within 12 to 24 h after onset,7 cases had testicular survival after operation and the left 2 cases had testicular atrophy;for the 2 cases with operation over 24 h after onset,they both had testicular atrophy though operation was success.In the 12 cases with contralateral testicular biopsy,10 cases showed varied decrease in germ cells,sperm cells and mature sperm.FSH was elevated in 9 cases,LH was increased in 8 cases and T was declined in 4 cases in the 12 cases with preoperative endocrine examination.Conclusion Salvage rate of testicular torsion is closely related to the duration and the degree of torsion.Delayed treatment is an important reason for testicle missing.Color Doppler ultrasonography is recommended first.For the patients with torsion time over 24 h and rotating degree above 360,orchidectomy is suggested directly to reduce the damage to the healthy contralateral testicle to protect fertility.