儿童睾丸扭转临床诊治结果分析及思考

Analysis of clinical diagnosis and treatment of testicular torsion in children and further consideration

目的总结分析小儿睾丸扭转的临床特点、诊治结果并思考。方法回顾性分析2015年1月—2021年10月本院收治的71例睾丸扭转患儿的临床资料,并对经不同术式的睾丸扭转患儿的年龄分布、扭转时间、扭转度数及首诊误诊方面进行比较。结果42例发生于冬季,14例发生春季,6例发生于夏季,9例发生于秋季。左侧扭转53例,右侧扭转18例;62例患儿临床表现较典型,9例不典型;所有病例均行彩色多普勒超声(CDFI)检查和手术探查,两者结果均相符。其中手术切除者52例,年龄中位数12岁(5天-14岁),首诊误诊27例(51.9%),发病至手术时间中位数48 h(3 h-18天),扭转角度中位数720°(180°-1260°);术后随访无明显异常。而19例复位固定者中,年龄中位数9岁(6岁-14岁),首诊误诊3例(15.7%),发病至手术时间中位数24 h(6 h-72 h),扭转角度中位数270°(90°-900°);术后随访萎缩5例。切除组与固定组在年龄分布、扭转时间、扭转角度及首诊误诊方面均存在统计学差异(P<0.05)。结论睾丸扭转危害颇大,应增强家长及医生对此病的认识度和重视度,及时就诊,常规予CDFI检查,并尽早手术探查,从而提高扭转睾丸的挽救率。

Objective To summarize and analyze the clinical characteristics,diagnosis and treatment results of testicular torsion in children,and deeply considered.Methods The clinical data of 71 children with testicular torsion who were diagnosed and hospitalized in our hospital from January 2015 to October 2021 were retrospectively analyzed.The age distribution,time,degree and misdiagnosis of testicular torsion were compared in children with testicular torsion.Results Among the children with testicular torsion,42 cases occurred in winter,14 cases in spring,6 cases in summer and 9 cases in autumn.There were 53 cases twisting on the left side and 18 cases on the right side.The clinical manifestations of 62 cases were typical and 9 cases were atypical.Color Doppler flow imaging(CDFI)and surgical exploration were performed in all cases,and the results were consistent.Among them,52 cases underwent surgical resection,with a median age of 12 years old(5 days to 14 years),and 27 cases(51.9%)were misdiagnosed at first diagnosis.The median time from onset to operation was 48 h(3 h to 18 days),and the median torsion Angle was 720°(180°to 1260°).Postoperative follow-up showed no obvious abnormalities.Among the 19 patients with reduction and fixation,the median age was 9 years old(6-14 years old),and 3 cases(15.7%)were misdiagnosed at first diagnosis.The median time from onset to operation was 24 hours(6 h-72 h),and the median torsion angle was 270°(90°-900°).Postoperative follow-up showed atrophy in 5 cases.There were significant differences in age distribution,torsion time,torsion angle and misdiagnosis at first diagnosis between the resection group and the fixation group(P<0.05).Conclusions Because testicular torsion is very harmful,parents and doctors should be strengthened to recognize and pay attention to this disease;timely medical treatment,routine CDFI examination,and early surgery exploration should be carried out,so as to improve the rescue rate of testicular torsion.