睾丸钟摆畸形与睾丸扭转22例报告

目的 提高对睾丸钟摆畸形（bell-clapper deformity，BCD）的认识，探讨鞘膜内睾丸扭转的解剖和发病特点。方法 回顾性分析22例间歇性睾丸疼痛病例，年龄7～23岁，平均17岁。左侧18例、右侧4例。其中睾丸扭转坏死16例、睾丸大小正常4例、左侧睾丸萎缩2例。结果 22例解剖上均有钟摆畸形即睾丸缺乏正常鞘膜的包裹，睾丸引带缺如，缺乏与壁层鞘膜的粘连，鞘膜腔大，鞘膜在精索上的止点较高，精索活动度较大。16例睾丸坏死或萎缩者行病侧睾丸切除，对侧睾丸固定；6例间歇性睾丸疼痛患者作双侧睾丸探查及固定。22例随访6个月～10年，平均4年9个月，均无睾丸疼痛症状。结论 应高度重视间歇性睾丸疼痛患者，提高间歇期或扭转早期的诊断率，在睾丸未发生扭转坏死之前及时行双侧睾丸探查及固定术，减少睾丸坏死率。

Bell-clapper deformity and torsion of the testis ( report of 22 cases )

Objective To further identify bell-clapper deformity(BCD) of the testis and to evaluate the anatomical structure and onset characteristics of torsion of the testis in the tunica vaginalis.Methods The data of 22 cases(mean age,17 years;age range,7-23 years) of intermittent testicular pain were retrospectively analyzed.Of them 18 cases had the lesion on the left testis and 4,on the right.Exploratory operation showed torsion and necrosis of the testes in 16 cases,normal testes in 4 cases and left testis atrophy in 2 cases.Results All the 22 cases had BCD of the testes,which involved absence of normal tunica vaginalis for enveloping the testis,absence of gubernaculum testis,no adhesion to parietal tunica vaginalis,enlarged cavity of tunica vaginalis,higher ending point of tunica vaginalis at spermatic cord and greater mobility of spermatic cord.Surgical management consisted of diseased lateral orchiectomy and contralateral orchidopexy in 16 cases who had necrosis and atrophy of the testes,exploration of bilateral testes and orchidopexy in 6 cases who had intermittent testicular pain.The mean follow-up was 4 years and 9 months(range,6 months to 10 years) and no testicular pain occurred in 22 cases.Conclusions BCD tends to develop testicular torsion.Careful attention should be given to patients with intermittent testicular pain so as to improve the early diagnostic rate.Exploration of the two testes and bilateral orchidopexy will ensure the viability of the testis with good results.