儿童腹腔型隐睾扭转坏死1例并文献复习

Torsion necrosis of intra⁃abdominal cryptorchidism in children:a case report and literature review

目的 通过1例儿童腹腔型隐睾扭转病例,探讨儿童隐睾扭转的发病机制、临床表现、诊断及治疗方法。方法 回顾性分析我院收治的1例13岁儿童腹腔型隐睾扭转并坏死患儿,表现为左下腹压痛、反跳痛、左侧阴囊空虚,彩超提示左侧隐睾扭转不排除。结果 患儿接受腹腔镜探查,根据探查结果行左侧精索、左侧隐睾切除术、左侧疝囊高位结扎术,术后病理提示:睾丸及附睾广泛充血、出血及梗死,精索脉管扩张、淤血、出血,符合睾丸扭转坏死改变。术后随访2年,复查阴囊彩超提示右侧睾丸正常、左侧腹股沟斜疝未见复发。结论 隐睾扭转临床上少见,腹腔型隐睾扭转较为罕见,临床表现不典型,患者及家属对该疾病认识不足,常常延误诊治,造成睾丸挽救率低。临床上如怀疑隐睾扭转,应尽早行彩色多普勒超声检查及手术探查以明确诊断,尽可能提高睾丸挽救率。应加强患儿和家属的健康教育,早期诊断隐睾并及时行睾丸固定术,以预防后期的隐睾扭转。

Objective To summarize the pathogenesis,clinical manifestations,diagnosis,and treatment of Torsion necrosis of intra⁃abdominal cryptorchidism in children.Methods A retrospective analysis of a 13⁃year⁃old child with abdominal cryptorchid torsion and necrosis was carried out,and his clinical symptoms were manifested as left lower quadrant tenderness,rebound tenderness,and left scrotum emptiness.Color Doppler ultrasound indicated that left cryptorchid torsion could not be excluded.Results The child underwent laparoscopic exploration.According to the exploration results,the left spermatic cord,left cryptorchidectomy,and high ligation of the left hernia sac were performed.The postoperative pathology showed extensive congestion,hemorrhage,and infarction of the testis and epididymis,dilation of the spermatic cord vessels,congestion,and hemorrhage,consistent with testicular torsion and necrosis.After 2 years of follow⁃up,the color Doppler ultrasound of the scrotum revealed that the right testis was normal and the left indirect inguinal hernia had no recurrence.Conclusion Cryptorchid torsion is rare clinically,and abdominal cryptorchid torsion is even rarer.Clinical manifestations of the patient are not typical.Patients and their families do not know enough about the disease,and diagnosis and treatment are often delayed to cause a low testicular salvage rate.Clinically,if cryptorchid torsion is suspected,color Doppler ultrasonography and surgical exploration should be performed as soon as possible to confirm the diagnosis and improve the testicular salvage rate as much as possible.Health education for children and their families should be strengthened,and cryptorchidism should be diagnosed early and orchiopexy performed in time to prevent late cryptorchid torsion.