儿童睾丸附件扭转的保守治疗指征

目的探讨儿童睾丸附件扭转保守治疗的指征。方法回顾性总结分析1993～1997年底的25例急性阴囊疼痛患儿的诊疗情况，结合文献提出鉴别诊断及选择疗法的依据，将其应用于1998年以后收治的26例患儿中，进一步探讨诊断和治疗指征。结果回顾性总结表明睾丸扭转症状重，就诊早，就诊时间多在发病24h之内。附件扭转疼痛轻，就诊晚，多有48h以上的病史，两者比较，差异有显著性意义(P＜0.05)。1998年后治疗的26例中，5例就诊时疼痛时间短于48h，1例在睾丸上极摸到疼痛性结节，诊断睾丸附件扭转，行保守治疗；4例行急症手术，证实1例睾丸扭转、3例附件扭转。21例就诊时疼痛已48h以上，19例症状轻，彩色多普勒检查，睾丸血流正常，行保守治疗，治疗过程中均可摸到大小不等的触痛性结节，诊断睾丸附件扭转。2例睾丸扭转坏死而行睾丸切除。结论睾丸附件扭转是一种自限性疾病。扪到其特有体征，即阴囊内触疼性结节者；阴囊痛持续48h以上，彩色多普勒检查，睾丸血流正常者，可行保守治疗。睾丸扭转是外科急症，应急症手术。彩色多普勒超声检查对鉴别诊断有重要意义。

Indications of conservative management for twisted testicular appendages in children

Objective To explore the indication of conservative management for twisted testicular appendages. Methods From 1993 to 1997, 25 children with acute scrotal pain had been analyzed retrospectively. On the basis of this study, a prospective study was conducted in 26 cases after 1998. Differences were analyzed by x2 test. Results The retrospective study indicated that boys with testicular torsion tended to visit doctor earlier (< 24 h) because of the bad pain, while those with twisted appendages tended to come later (>48 h) for pain was mild (P<0.05). In 26 cases of prospective study, 5 cases visited doctor within 24 h after the onset of pain. One of them was treated non-surgically as a twisted appendage because a tender nodule was palpated at the upper pole of the testis. In the other 4, the diagnosis at emergency exploration disclosed 1 testicular torsion and 3 twisted appendages. In 21 cases who visited doctor later than 48h after the onset of pain, 19 of them had mild symptoms and normal blood flow of spermatic cord and testis under color Doppler examination. They were treated conservatively. Diagnosis of twisted appendages in these 19cases was made on the basis of a tender nodule at the upper pole of the testis. Orchidectomy was done in 2cases of testicular torsion. Conclusions Twisted appendage is a self-limiting disease and conservative management ought to be adopted when a tender nodule was palpated, or the duration of pain is over 48 hours,particularly blood flow in testis was normal under color Doppler examination. Testicular torsion before necrosis needs emergency operation. Color Doppler is useful for the differential diagnosis.