新生儿睾丸扭转临床特点探讨

Neonatal testicular torsion

目的 探讨新生儿睾丸扭转发生的特点及治疗时机选择。方法 回顾性分析近10年新生儿睾丸扭转患儿可能的致病危险因素、临床特点、超声检查结果、治疗策略、病理结果及术后随访情况。结果 新生儿睾丸扭转共17例，左侧7例，右侧10例；其中剖腹产11例（65％），第二产程延长5例（29％），羊水过少2例（12％）；术前体检均发现睾丸增大，多伴有阴囊色泽改变（94％）。超声检查均发现患睾体积增大、回声不均或增强、血流信号减小或消失。术中探查打开肉膜组织后均发现精索睾丸扭转并已坏死而行患睾切除，其中14例行对侧睾丸固定术。所有患睾病理活检均提示睾丸坏死，7例（4l％）可见钙化灶。所有随诊病例超声检查未发现对侧睾丸异常。结论 新生儿睾丸扭转失睾率极高；当发现阴囊色泽改变、睾丸增大等改变，即应考虑睾丸扭转可能；超声检查敏感性高，可作为首选检查方法；患儿出生过程出现异常可能是新生儿睾丸扭转的诱因。

Objective To investigate the clinical characteristics and management of neonatal testicular torsion. Methods Neonatal testicular torsion were reviewed focusing on the possible risk factors, clinical features, ultrasonic characteristics, management, pathological outcome and follow-up results. Results A total of 17 neonatal testicular torsion （left side 7, right side 10） was diagnosed, 11 cases of them were cesarean delivery （65%）. 5 cases were found a prolonged second stage of labor （29%）, and 2 cases with oligohydramnios （12%） before birth. All patients presented an enlarged testes. Most of them presented with scrotal discoloration （94%）. Ultrasound examination showed enlargment of testicular volum, heterogeneity and lacked of blood flow. The twisted testes and spermatic cord showed necrosis intra-operatively. Orchiectomy was carried out. Orehidopexy on contralateral testis was performed in 14 cases. Pathology of ipsilateral testes showed necrosis, and calcification occurred in 7 cases（41%）. All contralateral testes presented normal Ultrasound image during the followup. Conclusions The rate of testicular necreosis was high in neonatal testicular torsion. Testicular torsion should be suspected when neonatal testis presents scrotal discoloration and enlarged testieular mass. Ultrasound inspection is a sensitive method in diagnosing neonatal testis torsion, and should be recommended. Abnormal labor may lead to the neonatal testis torsion.