睾丸扭转35例临床分析

Diagnosis and treatment of testicular torsion(report of 35 cases)

目的探讨睾丸扭转的诊治方法。方法回顾性分析35例睾丸扭转病例的临床资料。患者年龄14～29岁,发病至确诊时间7h～45d。入院前误诊为急性睾丸附睾炎抗炎治疗23例,误诊时间3～45d,误诊为急性阑尾炎行阑尾切除术1例。结果所有患者均行彩色多普勒超声检查,33例确诊。4例试行手法复位均失败。手术探查示精索鞘膜内型扭转34例,鞘膜外形扭转1例;扭转度数360°～720°。2例行患睾复位和固定术,其余患者均切除患睾。所有患者同时行健侧睾丸固定术。结论对于非外伤性阴囊急症,尤其对青壮年患者,临床医生要考虑到睾丸扭转的可能,有条件者应立刻行CDFI等辅助检查以帮助诊断和鉴别,高度怀疑睾丸扭转者应早期果断行手术探查以最大限度地提高睾丸的挽救率。

Objective To study the diagnosis and treatment of testicular torsion.Methods The clinical data of 35 cases of testicular torsion were retrospectively analysed.The age ranged from 14 to 29 years,and the elapsed time from onset to definite diagnosis was 7 hours through 45 days.There were 23 patients misdiagnosed as acute orchitis-epididymitis who were given anti-inflammatory treatment,and the length of misdiagnosis was 3 days to 45 days,and one paitent misdiagnosed as acute appendicitis who was operated.Results All the patients had been examined by color Doppler ultrasound,by which 33 ones had been confirmed the diagnosis.Four patients of them were tentatively treated with manual reduction but failed.Thirty-four ones explored by operation were confirmed to be torsion in the tunica vaginalis,while one to be torsion out of the tunica vaginalis.The degree of torsion was 360-720°.Two ones received testicle reduction and orchiopexy,while in the others the involved testes were resected by orchiectomy.All the patients received orchiopexy of the opposite side testes at the time.Conclusion We should preferentially consider testicular torsion for acute nontraumatic scrotum,especially during adolescence.Timely color Doppler ultrasound examination is useful for diagnosis and differential diagnosis if situation permits.Once a patient is suspicious of testicular torsion,he will be treated with surgical exploration to improve the survival rate of torsional testes.