睾丸扭转评分法及标准化流程在提高诊治效率的应用

目的提高基层医院对睾丸扭转的诊治效率。方法收集2011年9月至2017年4月确诊的睾丸扭转患者31例(A组),回顾分析诊治效率;前瞻性纳入2017年5月至2019年1月按标准化流程收治的急诊急性阴囊疼痛患者43例(B组),并采用五要素七分评分法诊断睾丸扭转和采用与中山大学附属第一医院教学平台共建的区域"三基"培训体系的标准化诊治流程,对比两组的诊治效率。结果A组睾丸扭转病例从就诊至临床确诊时间为20~60 min,从入院后至急诊手术时间60~160 min,其中70%患者行睾丸切除,30%行睾丸固定;B组中睾丸扭转确诊时间为5~25 min,入院至手术室45~60 min,B组的诊治效率较高(P<0.001),其中56%患者行睾丸切除,44%为睾丸固定,两组睾丸切除率比较差异无统计学意义(P>0.05)。结论睾丸扭转评分法可快速有效诊断,标准化救治流程可有效缩短患者救治时间,可操作性强,二者联合可以提高基层医院对青少年睾丸扭转的诊治效率。

Application of testicular torsion score and standardized procedure in improving efficiency of diagnosis and treatment

Objective To shorten the treatment time and improve the level of diagnosis and treatment of testicular torsion(TT)in primary level hospitals with higher misdiagnosis and delay rate of TT.Methods Thirty-one patients with TT from September 2011 to April 2017(group A)were collected for retrospective analysis of diagnosis and treatment efficiency.Forty-three patients with acute scrotal pain were included prospectively from May 2017 to January 2019 according to standardized procedures(group B).Scoring system which contains 5 specific variables with 7 scores and the standardized diagnosis and treatment process of TT from the regional"Three Bases"training system,which was jointly constructed with the teaching platform of the first affiliated hospital of Sun Yat-sen university were used in group B.The efficiency of diagnosis and treatment of the two groups was compared.Results In group A,the arrival time of patients to clinical diagnosis of TT was 20-60 min,and the time from admission to operation room was 60-160 min.A total 70%of the patients underwent orchiectomy and 30%of orchiopexy.In group B,the arrival time of patients to clinical diagnosis of TT was 5-25 min,and the time from admission to operation room was 45-60 min.Fifty-six percent of the patients underwent orchiectomy and 44%of orchiopexy.The triage completion and emergency arrival to operating room time were significantly decreased in group B(P<0.001).Although salvage rate was decreased in the prospective group,the differences were not significant(P>0.05).Conclusions TT score can effectively diagnose TT and standardized training can shorten the treatment time of pa-tients,which is feasible to operate and can improve the efficiency of diagnosis and treatment in primary level hospitals.