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目的:提高精索扭转的早期诊断和治疗水平,减少睾丸丧失。方法:回顾性分析2003年8月~2011年12月收治的67例青春期精索扭转的临床资料:患者年龄13~16岁,平均14.6岁。发病6小时内就诊23例,6~24小时39例,24小时以上5例。本组彩超检查53例;手术治疗63例,非手术治疗4例。并分析其确诊、误诊及睾丸挽救率。结果:首诊确诊率72%(48/67),误诊率28%(19/67)。误诊病种包括附睾-睾丸炎52%(10/19),鞘膜积液16%(3/19),腹股沟疝16%(3/19),输尿管结石11%(2/19),睾丸血肿5%(1/19)。67例中,外科干预63例,均为鞘膜内360°~1 080°扭转,其中发病6小时内手术探查19例,睾丸挽救率84%(16/19);6小时以上手术探查44例,睾丸挽救率23%(10/44),两组间差异有统计学意义(P<0.05,两组睾丸中位扭转角度540°)。挽救及健侧睾丸行阴囊肉膜下固定术。切除睾丸病理检查结果为出血坏死性改变。非手术治疗4例中,2例手法复位成功,1例就诊睾丸已萎缩,1例自发缓解。挽救睾丸26例,其中16例随访6~18个月,睾丸萎缩11例。结论:精索扭转误诊率较高,青春期突发阴囊剧痛首先要考虑精索扭转的可能。彩超为一线检查方法。扭转程度及缺血时间是影响睾丸结局的重要因素,及时手术探查可降低睾丸切除率。因此,早期确诊和治疗是避免睾丸丧失的关键。
Objective: To improve the early diagnosis and treatment of sphincter torsion and reduce testicular loss. Methods: The clinical data of 67 adolescent spermatic cord twists treated from August 2003 to December 2011 were retrospectively analyzed. The patients were 13 to 16 years old with an average of 14.6 years old. Within 6 hours of onset, 23 cases were treated, 39 cases were 6-24 hours, and 5 cases were over 24 hours. The group of color Doppler ultrasound examination of 53 cases; surgical treatment of 63 cases, 4 cases of non-surgical treatment. And analyze the diagnosis, misdiagnosis and testicular salvage rate. Results: The first diagnosis was 72% (48/67), misdiagnosis rate was 28% (19/67). Misdiagnosed diseases included epididymitis-orchitis 52% (10/19), hydrocele 16% (3/19), inguinal hernia 16% (3/19), ureteral calculi 11% (2/19), testicular hematoma 5% (1/19). Of the 67 cases, surgical intervention was performed in 63 cases, all of which were intrathecal 360 ° ~ 1 080 ° twist, of which 19 cases were detected within 6 hours of onset and 84% (16/19) of testicular salvage; 44 cases , Testicular salvage rate was 23% (10/44), the difference between the two groups was statistically significant (P <0.05, the two groups of testis torsion angle 540 °). Saving and contralateral testicular scrotum subgingival fixation. Excision of testicular pathology results of hemorrhagic necrosis. Of the 4 non-surgical treatments, 2 were successful in the procedure, 1 had a testicular atrophy and 1 had spontaneous remission. Twenty-six testes were saved, of which 16 were followed up for 6-18 months and 11 were testicular atrophy. Conclusion: The misdiagnosis rate of spermatic cord torsion is higher. The onset of severe scrotal pain in adolescence should first consider the possibility of spermatic cord twisting. Color ultrasound for first-line inspection methods. Torsion and ischemia time is an important factor affecting the testicular outcome, timely surgical exploration can reduce the rate of testicular resection. Therefore, early diagnosis and treatment is the key to avoid testicular loss.