精索扭转37例误诊分析

Misdiagnosis of Testicular torsion (Report of 37 cases)

目的 :提高精索扭转诊治水平。方法 :对 5 2例精索扭转患者首诊误诊 37例 (71.2 % )的临床诊治资料进行回顾性分析。结果 :37例患者中 ,误诊为急性附睾、睾丸炎 30例 (81.1% ) ,睾丸肿瘤 3例 (8.1% ) ,泌尿系结石 2例 (5 .4 % ) ,附睾结核及慢性结肠炎各 1例 (2 .7% )。 2 8例行B超检查 ,2 1例诊断符合 (75 .0 % ) ,漏诊 3例(10 .7% ) ,误诊为急性附睾、睾丸炎及睾丸占位各 2例 (7.1% )。 2 2例行彩色多普勒血流显像 (CDFI)检查 ,2 0例诊断符合 (90 .9% ) ,误诊为附睾炎及睾丸占位各 1例 (4 .5 % )。 2例入院时患侧睾丸已萎缩未手术。35例探查手术 ,其中 2 6例睾丸切除 ,病理报告均为睾丸缺血性梗死 ;余 9例保留睾丸并予固定 (5例血运完全恢复 ,4例已不可逆性坏死 ,家属坚决要求保留 )。因为首诊误诊 ,86 .5 % (32 / 37)患者睾丸切除或萎缩。结论 :对于阴囊急症患者 ,尤其是青少年 ,首诊医生应高度警惕精索扭转可能性 ,可疑时立即行B超、CDFI检查 ,尽早手术探查 ,是降低误诊率、提高诊治水平。

Purpose:To analyze the reason of misdiagnosis of testicular torsion. Methods:It was analyzed retrospectively that the clinical data of 52 cases of testicular torsion. Results:Thirty seven cases were misdiagnosed respectively as epididymis orchitis( 81.1 %), testicular tumor( 8.1 %) ,lithangiuria( 5.4 %), et al, and 5 cases ( 13.6 %) had the testis saved with function while 32 cases ( 86.5 %) suffered from orthiectomy or atrophy of testis. Conclusions:The most reason of misdiagnosis of testicular tortion was the insufficient knowledge of this diseases, which usually result in serious outcome. Male patients less than 25 years old, especially during adolescence, presenting with a tender testicle, were more likely to have testicular torsion rather than other entities with acute scrotal pain. With color Doppler ultrasonography images ( CDFI) ,testicular torsion has more chances to be diagnosed correctly on time, and the urgent detorsion has to be performed as early as possible.