儿童和青少年睾丸扭转109例诊断与治疗分析

Diagnosis and treatment of 109 cases of testicular torsion in children and adolescents

目的:探讨儿童和青少年睾丸扭转的诊断和治疗方式并分析术后转归。方法:回顾性分析2014～2017年收治的儿童和青少年睾丸扭转患者109例,患者年龄(9. 7±3. 3)岁(4 d至15岁)。均为单侧睾丸扭转,其中左侧62例(56. 9%),右侧47例(43. 1%);鞘膜内扭转98例(89. 9%),鞘膜外扭转11例(10. 1%)。患者临床表现为阴囊疼痛96例(88. 1%),阴囊红肿70例(64. 2%),腹痛25例(22. 9%),恶心呕吐33例(30. 3%)。所有患者均接受阴囊彩超检查。根据患者起病时间分为3组:<12 h组(11例),12～24 h组(19例),> 24 h组(79例)。分析患者临床表现,B超检测结果,术中以及术后随访结果。结果:96例(88. 1%)患者阴囊彩超检查提示睾丸血流减少或者无血流,13例(11. 9%)提示睾丸血流减少不明显,阴囊壁增厚、鞘膜囊积液等。手术切除睾丸83例(76. 1%),保留睾丸26例(23. 9%)。26例保留睾丸患者的随访中,2例失访,24例术后6个月复查阴囊彩超,其中8例(33. 3%)睾丸坏死,16例(66. 6%)睾丸存活。<12 h组、12～24 h组、> 24 h组睾丸切除率分别为9. 1%、47. 4%、92. 4%,术后睾丸萎缩率分别为10. 0%、25. 0%、83. 3%,均有统计学差异(P <0. 01)。结论:睾丸扭转好发于儿童以及青少年,临床表现为阴囊疼痛,阴囊红肿,腹痛以及恶心呕吐等。阴囊彩超能有效的检查出睾丸血流情况,但是手术是最有效的治疗方式,对于扭转时间12 h以内的睾丸保留价值最大,> 24 h的睾丸已产生不可逆损伤,睾丸切除概率大,即使保留睾丸,术后出现睾丸萎缩的可能性也大。

Objective:To investigate the diagnosis and treatment of testicular torsion in children and adolescents and to analyze the postoperative outcomes.Methods:We retrospectively analyzed 109 cases of unilateral testicular torsion treated in our hospital between 2015 and 2017,including 62 cases of left(56.9%)and 47 cases of right torsion(43.1%),and 98 cases of intravaginal(89.9%)and 11 cases of extravaginal torsion(10.1%),clinically 96 cases with scrotal pain(88.1%),70 with scrotal redness and swelling(64.2%),25 with abdominal pain(22.9%),and 33 with nausea and vomiting(30.3%).The patients ranged in age from4 days to 15 years,averaging 9.7±3.3 years,and fell into 3 groups according to the time of onset:<12 h,12-24 h and>24 h.We analyzed the results of scrotal ultrasonography,clinical manifestations,and intraoperative and follow-up data of the patients.Results:Scrotal ultrasonography showed no or decreased testicular blood flow in 96 cases(88.1%)and unconspicuously reduced testicular blood flow with scrotal wall thickening and vaginal sac effusion in 13 cases(11.9%).Eighty-three(76.1%)of the patients were treated by orchiectomy and the other 26 by testis-sparing surgery.Of the latter 26 cases,2 were lost to follow-up,16(66.6%)achieved testis survival,and 8(33.3%)developed testicular atrophy at 6 months after surgery.The rates of orchiectomy were 9.1%,47.4%and 92.4%,and the incidences of postoperative testicular atrophy were 10.0%,25.0%and 83.3%in the<12 h,12-24h and>24 h groups,respectively,both with statistically significant differences among the three groups(P<0.01).Conclusion:Testicular torsion is common in children and adolescents,with clinical symptoms of scrotal pain,scrotal redness,abdominal pain,and nausea and vomiting.Scrotal ultrasonography can effectively display the status of testicular blood flow,and surgery is the most accurate treatment.Testis-sparing surgery is most valuable for the cases with the onset time of<12 hours,while orchiectomy is preferable for those with the onset time of>24 hours.