TWIST评分在睾丸扭转诊疗中的应用

Application of TWIST score in the diagnosis and treatment of testicular torsion

目的 探讨睾丸扭转评分系统(TWIST)评分在睾丸扭转诊疗中的应用价值。方法 选取我院收治的59例睾丸扭转患者为研究对象,根据手术方式将患者分为固定组(25例)和切除组(34例),收集2组患者的临床资料,记录2组患者的TWIST评分并进行危险度分层,探讨TWIST评分在睾丸扭转诊疗中的应用价值。结果 与固定组比较,切除组病程更长,睾丸扭转更严重,TWIST评分更高,差异均有统计学意义(P<0.05);切除组病程>24 h比例、扭转>360°比例、误诊附睾炎比例高于固定组,手法复位比例低于固定组,差异均有统计学意义(P<0.05)。2组患者睾丸肿痛发生率比较差异无统计学意义(P>0.05);与固定组相比,切除组患者睾丸变硬、提睾反射消失、恶心呕吐及睾丸高位的发生率明显升高(P<0.05)。依据评分结果对患者进行危险度分层,高危患者睾丸切除率明显高于中、低危患者,差异有统计学意义(P<0.05)。结论 TWIST评分操作简单、实用性强,能够客观、高效地评估睾丸扭转情况。对于TWIST评分高危的患者,建议立即手法复位,行手术探查。

Objective To investigate the application value of testicular workup for ischemia and suspected torsion(TWIST)score in the diagnosis and treatment of testicular torsion.Methods A total of 59 patients with testicular torsion admitted to our hospital were selected,and they were divided into the fixation group(with 25 cases)and the resection group(with 34 cases)based on the surgical procedures.The clinical data of both groups were collected,the TWIST scores of the two groups were recorded and the risk stratification was performed.The application value of TWIST score in the diagnosis and treatment of testicular torsion was explored.Results Compared with the fixation group,the resection group had a longer course of disease,more severe testicular torsion,and a higher TWIST score,with statisti⁃cally significant differences(P<0.05).The proportions of disease course>24 hours,torsion>360°,and misdiagnosis of epididymis in the resection group were higher than those in the fixation group,and the proportion of manual reduction was lower than that in the fixation group,with statistically significant differences(P<0.05).There was no statistically significant difference in the testicular swelling and pain between the two groups(P>0.05).The incidences of hard testis,absent cremasteric reflex,nausea/vomiting,and high-riding testis in the resection group were significantly higher than those in the fixation group(P<0.05).The risk stratification was conducted for patients based on the scoring results,and the orchiectomy rate of high-risk patients was significantly higher than that of the low-and intermediate-risk patients,with statistically significant difference(P<0.05).Conclusion The TWIST score has simple operation and strong practicality,which can objectively and efficiently evaluate testicular torsion.For patients with high-risk TWIST scores,immediate manual reduction and surgical exploration are recommended.