提睾反射消失及手术探查在睾丸扭转早期诊疗中的临床意义(附22例报告)

Clinical significance of absent cremasteric reflex and operation exploration in early diagnosis of testicular torsion: a report of 22 cases

目的提高睾丸扭转的早期诊断水平及睾丸挽救成功率。方法对22例睾丸扭转确诊病例的临床表现及诊治情况进行回顾分析。结果 22例患者中提睾反射消失者22例（100%）。22例患者中,2例发病2 h就诊者行手法复位成功,经观察,未予手术;20例均行手术探查确诊为睾丸扭转,6例患者发病4~6 h行患侧睾丸复位固定及对侧睾丸固定术,14例患者发病8~18 h因睾丸坏死行患侧睾丸切除加对侧睾丸固定术。随访3月至6年,2例手法复位患者再次发生同侧睾丸扭转。结论提睾反射消失是睾丸扭转患者最敏感的体征之一,在睾丸扭转早期诊断中具有重要的临床意义;对于提睾反射消失患者,尽早行手术探查,可以大大提高睾丸扭转的挽救成功率。

Objectiv salvage rate. Methods e To improve the early diagnostic level of testicular torsion, and increase the testicular From January 2004 to June 2012, the clinical manifestations and the feature of diagnosis and treatment of 22 confirmed cases of testicular torsion in our hospital were retrospectively analyzed. Results There was absent cremasteric reflex （ 100% ） in 22 testicular torsion patients. Among them, 2 cases was successful- ly treated with manipulative reduction, and other 20 patients were confirmed testicular torsion by surgical explora- tion. Testicles of 6 patients whose diseased time were 4 ~ 6 h were salvaged by reduction of bilateral torsion and or- chiopexy, necrotic testicles of 14 patients whose diseased time were 8 -18 h were resected through orchiectomy and their contralateral testicular underwent reduction of bilateral torsion and orchiopexy. All patients were followed up in the range of 3 months to 6 years, homolateral testicular torsion occurred again in 2 cases with manual reduction. Conclusion The absent cremasteric reflex was the most sensitive physical finding for the diagnosis of testicular torsion, which has important clinical significance in early diagnosis of testicular torsion. Early operation exploration can greatly improve testicular salvage rate of testicular torsion.