睾丸扭转的诊治分析（附20例报告）

Diagnosis and treatment of testicular torsion （ report of 20 cases ）

目的 提高睾丸扭转的诊断和治疗水平.方法 回顾性分析本院2004年10月～2010年7月诊治的20例睾丸扭转患者的临床资料.平均年龄22.1（15～30）岁,发病至确诊的时间4h～3个月,平均7.4天.9例发病于睡眠中,18例以突发睾丸剧烈疼痛起病,15例提睾反射消失,10例阴囊抬高试验（Prehn征）阳性,7例睾丸横位.20例患者均行彩色多普勒超声检查,确诊睾丸扭转者19例（95%,19/20）,彩色多普勒血流显像（CDFI）示8例血流消失,6例血流明显减少.结果 左侧扭转13例（65%,13/20）,其中9例逆时针扭转,4例顺时针扭转;右侧扭转7例,其中5例顺时针扭转,2例逆时针扭转.4例扭转180°,6例扭转360°,1例扭转540°,9例扭转720°.20例均行手术治疗,6例发病至手术时间＜24h者均行睾丸复位固定术;14例＞24h者2例行睾丸复位固定术,12例行睾丸切除术,其中7例同时行对侧睾丸固定术.平均手术时间57.2（25～100）min,包括10～30min的术中湿热敷观察时间.结论 睾丸扭转容易误诊,睡眠或运动中突发睾丸剧烈疼痛、提睾反射消失、Prehn征阳性是重要的临床表现,彩色多普勒超声是首选的辅助检查,及早手术探查行睾丸复位固定术或睾丸切除术是主要的治疗手段,扭转的程度和睾丸缺血的时间是决定睾丸最终结局的重要因素.

Objectives To improve the levels of diagnosis and treatment of testicular torsion. Methods The clinical data of 20 cases with testicultr torsion from October 2004 to July 2010 were retrospectively summarized and analyzed. The mean age of patients was 22.1 years （ range 15 to 30）. The duration between the onset and definite diagnosis varied from 4 hours to 3 months,averaging 7.4 days. The testicular torsion of 9 cases occurred in the sleep and 18 patients presented with severe testicular pain of sudden onset. The ipsilateral cremasteric reflex was absent in 15 cases and testicular pain was exacerbated by scrotsl elevation in 10 cases. There were 7 patients with horizontal lie of the tests. All the 20 cases underwent the examination of color doppler ultrasonography of scrotum, with the positive rates of 95% （19/20）. Color doppler flow imaging（CDFI） showed that the intratesticular blood flow disappeared in 8 cases and dramatically reduced in 6 cases. Results Among the 13 cases of left torsion,9 were in an anticlockwise direction and 4 were in a clockwise direction. Among the 7 cases of right torsion,5 were in a clockwise direction and 2 were in an anticlockwise direction. The degree of torsion was 180° in 4 cases,360° in 6 cases,540°in 1 case and 720° in 9 cases. The total of 20 cases were performed with surgical treatment. 6 cases who received operation within 24 hours of onset were cured by surgical detorsion and fixation of ipsilateral tests. The rest of 14 cases who received operation more than 24 hours from attack time all underwent orchidectomy,7 of which underwent contralater al orehidopexy at the same time. Mean operation time was 57.2 min （range 25 to 100 ）, including the intraoperative moist heat time（ range 10 to 30 min）. Conclusions Testicular torsion is likely to be misdiagnosed as orchiepididymitis and others. The significant clinical manifestations of testicular torsion include sudden onset severe testicular pain in the sleep or movement, absence of cremasteric reflex, positive Prehn＇s sign and so forth. Color doppler ultrasonography is the preferred auxiliary examination. The main treatment modality is emergent scrotal exploration with detorsion under direct vision followed by orchidopexy when vascularity is confirmed or orchidectomy if testicular infarction is present. Testicular viability has been shown both experimentally and clinically to correlate directly with degree of torsion and duration of ischemia.