56例小儿睾丸扭转的诊断与治疗

目的提高对小儿睾丸扭转的临床诊断和治疗水平。方法回顾性分析56例睾丸扭转患儿的临床资料,左侧扭转32例,右侧扭转24例。初诊时间<6h20例,6～24h28例,>24h8例。初诊确诊为睾丸扭转34例,延误诊断22例(本院8例,外院14例)。结果12例发病后<6h就诊者手法复位成功,其余44例手术探查,16例手术探查发现睾丸已坏死而行睾丸切除,其中>24h者7例。结论提高首诊诊断正确率将有助于扭转睾丸的救治。彩色多普勒超声是首选的辅助检查方法。主张尽早手术及预防性对侧睾丸固定。     

儿童阴囊急症的诊治分析

阴囊急症是小儿泌尿外科常见急症,临床诊断与鉴别有一定困难,延误诊断及治疗可能发生睾丸坏死及其他并发症。现将我院自1998年1月至2 0 0 2年1月收治的6 0例阴囊急症患儿的诊断及治疗情况,总结分析如下。1　临床资料1.1　一般资料6 0例阴囊急症患儿,其中外伤4例、睾丸扭转18例(其中4例为隐睾)、睾丸(附睾)附件扭转2 2例、睾丸炎14例、自发性阴囊肿胀2例。1.2　年龄与类型4例外伤均为学龄儿童,平均年龄8岁;睾丸扭转18例,<1岁5例,2～6岁9例,8～10岁4例;隐睾伴睾丸扭转者年龄分别为4月、8月、2岁和8岁。多在发病2 4h内就诊,最长为发病后7d就诊…     

睾丸扭转23例

目的探讨儿童睾丸扭转的诊治方法。方法回顾分析23例睾丸扭转患儿临床资料。患儿年龄3 d~12岁,病程3 h~5 d。入院后立即急诊行睾丸探查术。其中7例睾丸血运不恢复予切除,余行睾丸固定术。结果7例6 h内手术或扭转小于360度复位后血运恢复好,16例超过6 h且扭转超过360度均有不同程度的血运障碍,其中720度以上者7例均呈坏死改变。患儿均治愈出院。结论及早手术是提高儿童睾丸扭转疗效的关键。     

小儿阴囊急症的鉴别诊断和手术治疗

目的探讨小儿阴囊急症的鉴别诊断及治疗方法。方法总结分析我院近7年收治的小儿阴囊急症病例资料。结果133例阴囊急症中睾丸附件扭转105例(79.0%),睾丸附睾炎16例(12.0%),睾丸扭转4例(3.0%),其他8例(6.0%)。附件扭转以6～12岁居多,其阴囊肿痛程度较睾丸附睾炎为轻(P<0.005)。在睾丸附件扭转中蓝斑征9例(8.6%),痛性结节23例(21.9%),超声附件检出率为90.5%。手术中发现不完全性坏死附件、哑铃状附件节间扭转、慢性附件扭转等特殊病例。睾丸附睾炎好发于6岁内,可双侧发病或反复发作。睾丸扭转其提睾反射均消失,超声显示睾丸无血流。结论小儿阴囊急症以睾丸附件扭转最常见,睾丸扭转发病最急。病史、体征及超声检查有助于鉴别诊断,主张积极探查手术。     

儿童睾丸扭转34例

睾丸扭转易误诊 ,常导致睾丸坏死或不可逆睾丸萎缩 ,早期诊断和及时手术是治疗的关键。我院 1991年 1月～2 0 0 2年 12月共收治 34例睾丸扭转 ,对其进行回顾性分析 ,现报告如下。临床资料一、一般资料　本组 34例 ,年龄 2d～ 18岁 ,平均 9岁。其中新生儿 8例 ,2d 1例 ,6d 2例 ,16d 2例 ,2 3d 1例 ,2 7d2例 ;1～ 14岁 4例 ;～ 18岁 2 2例。左侧 2 2例 ,右侧 12例。病程 4h～ 2 8d ,其中 2 8例 >2 4h。初诊 2 0例 ;误诊睾丸炎 8例 ,阑尾炎、肠痉挛、腹股沟嵌顿疝各 2例。患儿均有睾丸疼痛 ,发热、恶心、呕吐 14例 ,同侧腹部、腰部不适或疼痛 1…     

小儿睾丸扭转的诊治体会

目的 探讨小儿睾丸扭转的诊断和治疗。方法 回顾性分析获随访的8例小儿睾丸扭转病例。结果 发病24h内就诊并及时手术治疗者睾丸发育正常。超过24h后诊治者4例中有3例睾丸轻微萎缩。结论 小儿睾丸扭转须早诊断，及时治疗，才能提高睾丸的生存质量。     

小儿阴囊急症的治疗体会(附50例报告)

小儿阴囊急症包括:急性睾丸扭转、睾丸附件扭转,阴囊内容物的炎症。在临床治疗过程中易造成误诊,延误治疗,严重者造成睾丸坏死,现将我院诊治的50例患儿分析如下。1临床资料我院从1996～2003年间共收治阴囊急症患儿50例,年龄6月～12岁,平均7.8岁;左侧35例,右侧15例,未见双侧者,其中3例为隐睾并发睾丸扭转。共有睾丸扭转17例,其中有8例为漏诊病例,包括1例来院时已有睾丸坏死;附件扭转与炎症33例。就诊时间:6h内有12例,6～10h有14例,11～24h为12例,25～48h为7例,49～72h3例。本组根据临床表现和彩色多普勒血流显像CD-FI诊断如表1。其中9例明…     

儿童睾丸附件扭转的保守治疗指征

目的探讨儿童睾丸附件扭转保守治疗的指征。方法回顾性总结分析1993～1997年底的25例急性阴囊疼痛患儿的诊疗情况,结合文献提出鉴别诊断及选择疗法的依据,将其应用于1998年以后收治的26例患儿中,进一步探讨诊断和治疗指征。结果回顾性总结表明睾丸扭转症状重,就诊早,就诊时间多在发病24h之内。附件扭转疼痛轻,就诊晚,多有48h以上的病史,两者比较,差异有显著性意义(P＜0.05)。1998年后治疗的26例中,5例就诊时疼痛时间短于48h,1例在睾丸上极摸到疼痛性结节,诊断睾丸附件扭转,行保守治疗;4例行急症手术,证实1例睾丸扭转、3例附件扭转。21例就诊时疼痛已48h以上,19例症状轻,彩色多普勒检查,睾丸血流正常,行保守治疗,治疗过程中均可摸到大小不等的触痛性结节,诊断睾丸附件扭转。2例睾丸扭转坏死而行睾丸切除。结论睾丸附件扭转是一种自限性疾病。扪到其特有体征,即阴囊内触疼性结节者;阴囊痛持续48h以上,彩色多普勒检查,睾丸血流正常者,可行保守治疗。睾丸扭转是外科急症,应急症手术。彩色多普勒超声检查对鉴别诊断有重要意义。     

睾丸附件扭转8例报告

回顾分析我院1992年～2002年间睾丸附件扭转8例的诊治经验,报告如下。1临床资料本组8例,年龄:6岁1例,7岁3例,10岁1例,12岁3例;侧别:右侧5例,左侧3例,无双侧同时发病者。发病至入院时间:<24h2例(25%),>24h6例。本组2例有明确外伤史,以阴囊肿痛起病,可以忍受,下蹲时疼痛加剧,无发热及其它症状。患侧阴囊皮肤微红、肿胀,呈透明样水肿,在睾丸上或附睾头与睾丸之间有明显触痛点。B型超声检查:与对侧比较,患侧睾丸有不同程度肿胀。术中发现鞘膜层内有少量渗液,较浑浊,暗红色,鞘膜壁层有充血、增厚。6例为顺时针扭转约180°～720°,2例为逆时针扭…     

睾丸扭转的诊断及治疗

目的 提高睾丸扭转的诊治水平。方法 回顾性分析总结16例睾丸扭转的临床资料。结果 16例均经彩色多谱勒血流成像(Color Doppler ultrasonics flow image，CDFI)确诊为睾丸扭转，2例经手法复位，5例经手术复位固定，9例行睾丸切除加对侧睾丸固定。11例获0．5～4．5年随访，手法复位者1例再次发生扭转，经手术复位治愈。结论 CDFI是诊断急性睾丸扭转的可靠方法，早期诊断、及时手术探查是提高睾丸存活率的关键，术中应同时固定对侧睾丸。     

Resveratrol reduces ischemia reperfusion injury after experimental testicular torsion.

The aim of the study was to evaluate the effects of resveratrol on testicular ischemia reperfusion injury. Forty Wistar albino rats were divided into 4 groups. Torsions (ischemia) were created by rotating the right testis 720 degrees in a clockwise direction for 4 hours in all groups except the control group. In the torsion group after 4 hours' ischemia bilateral orchiectomy was performed. In the detorsion group, saline was injected by an intraperitoneal route, 30 min before detorsion (reperfusion). In the resveratrol group, 30 mg/kg resveratrol was injected by an intraperitoneal route, 30 min before detorsion. In the detorsion and resveratrol groups, the bilateral testes were removed after 20 hours of detorsion. In all groups, the tissue levels of malondialdehyde (MDA) and glutathione (GSH) and histological changes were determined. In rats treated with resveratrol, MDA levels (138 +/- 25 nmol/mg protein) were significantly decreased compared with torsion (426 +/- 178 nmol/mg protein) and detorsion (370 +/- 76 nmol/mg protein) groups (p < 0.05). GSH levels (6.54 +/- 0.8 micromol/g wet tissue) were significantly increased compared with torsion (4.61 +/- 0.4 micromol/g wet tissue) and detorsion groups (5.24 +/- 0.9 micromol/g wet tissue) (p < 0.05). The mean testicular tissue injury score in the resveratrol group was significantly lower than in torsion and detorsion groups (p < 0.05). The present study demonstrates that intraperitoneal administration of resveratrol in rats may protect testis against injury associated with reperfusion.     

Rosuvastatin Prevents No-Reflow Phenomenon Due to Detorsion of Testicular Torsion

PurposeTreatment of testicular torsion by detorsion may further damage the testis due to ischemia/reperfusion (I/R) injury. After reestablishment of blood flow, the blood flow diminishes after a while, which is called as the no-reflow phenomenon. Rosuvastatin, a HMG-CoA reductase inhibitor, has “pleiotropic” vasculoprotective effects that include anti-inflammatory and antioxidant effects. This study was designed to determine the effect of rosuvastatin pretreatment on the I/R injury induced no-reflow phenomenon encountered after detorsion of testicular torsion.Material and MethodsWistar albino rats were used in the study. Blood flow of testis were measured before the torsion (baseline value), before the detorsion and 1 hour after detorsion using Laser Doppler flowmetry. Rats were divided into three groups. Sham group (n = 5): Basal blood flow, flow before detorsion, and flow after detorsion of the testis was determined. Torsion/detorsion group (n = 8): After 2 hours torsion of the testis, blood flow before and after detorsion was determined. Torsion/detorsion + rosuvastatin group (n = 8): After measurement of the basal blood flow, Rosuvastatin (10 mg/kg) was injected intraperitoneally 30 minutes before the detorsion of 2 hour torsion and blood flow before and after detorsion was determined.ResultsThere was no significant difference between the the baseline blood flow values of the groups. Blood flow decreased significantly after the torsion. One hour after the detorsion, mean blood flow of the torsion/detorsion + Rosuvastatin group was found significantly higher than the torsion/detorsion group.ConclusionsPretreatment with Rosuvastatin before detorsion prevents reperfusion injury induced no-reflow phenomenon after detorsion of testicular torsion.     

西地那非对大鼠单侧睾丸扭转后对侧睾丸的影响及作用研究

目的 探讨大鼠单侧睾丸扭转后对侧睾丸的损伤以及西地那非（万艾可）的保护机理.方法 将72只健康雄性SD大鼠,随机分为假手术组、安慰剂组、西地那非组.3组分别在假手术/左侧睾丸扭转复位术后4 h、24 h、2周时,各组各处死8只大鼠.分别观察右侧睾丸组织病理学变化、测定右侧睾丸组织中MDA、NO/NOS含量.结果 术后4 h,各组间组织病理学变化、MDA、NOS含量无明显差异,睾丸组织未见损伤,但NO在两地那非组较假手术组、安慰剂组明显增加（P〈0.05）.术后24 h,假手术组右侧睾丸组织损伤最小,西地那非组较严重,安慰剂组最为严重;与假手术组比,其余两组MDA、NO/NOS含量明显升高（P〈0.05）;西地那非组NO/NOS含量与安慰剂组相比明显下降（P〈0.05）;术后2周时,睾丸组织损伤有不同程度恢复,但仍以安慰剂组最为严重;与假手术组比,其余两组MDA、NO/NOS含量仍然升高（P〈0.05）;西地那非组NO/NOS含量与安慰剂组相比明显下降（P〈0.05）.结论 大鼠单侧睾丸扭转复位后,对侧睾丸组织术后4 h时.睾丸组织未见损伤.12 h后睾丸组织明显损伤,并且持续至2周后.早期应用适量西地那非（万艾可）可促局部NO增加,扩血管作用加强,拮抗交感神经缩血管作用,进而保护对侧睾丸.     

Administration of N-Acetylcysteine Reduces Germ Cell-Specific Apoptosis and Oxidative Injury Following Testicular Torsion in Rats

PurposeTesticular torsion/detorsion (T/D) RESULTS in enhanced formation of free radical species, which contribute to the pathophysiology of tissue damage. Numerous studies in recent years have shown protective effects of N-acetylcysteine (NAC) on cardiac and renal tissue damage following ischemia/reperfusion. We assessed the effectiveness of systemic administration of NAC – at therapeutic doses – in a rat model one-hour 720° testicular T/D. We chose the dose of NAC that reduced general ischemia/reperfusion syndrome in patients who had undergone abdominal aortic aneurysmectomy.Materials and MethodsSprague-Dawley rats were divided into 5 groups, 14 animals in each. Group 1 underwent sham operation as the control group. In group 2, rats underwent T/D and received vehicle injections. Animals in groups 3, 4 and 5 received intraperitoneal injections of 150 mg/kg NAC, 30 minutes before torsion, after torsion and after detorsion, respectively. Markers of oxidative stress as well as germ cell apoptosis indices were determined 4 and 24 hours after detorsion, respectively.ResultsApoptosis indices were significantly higher in group 2 compared to control group. Four hours after detorsion, testicular level of lipid peroxidation was significantly increased and antioxidant enzymes activities were significantly decreased in group 2 in comparison with controls. Administration of NAC either 30 minutes before or after torsion (group 3 and 4), significantly improved the germ cell apoptosis indices and oxidant/antioxidant balance. Administration of NAC after detorsion had no significant effects on oxidant/antioxidant balance or germ cell apoptosis.ConclusionsAdministration of NAC prior to torsion or detorsion, but not after detorsion, is protective against ischemia/reperfusion tissue damage in the rat model of testicular torsion. Since NAC has an established safety after almost 40 years of clinical use as mucolytic agent and antidote of acetaminophen toxicity, one can suggest this agent as an adjunct therapy for “testicular torsion rescue”. Supplying intracellular glutathione as well as anti-oxidant and anti-inflammatory properties of NAC could be the possible mechanisms of this protective effect.     

Testicular torsion: Orchiectomy or orchiopexy?

ObjectiveTo evaluate the impact on testicular function of the surgical approach used to treat testicular torsion.Patients and methodsSeventeen males operated on for testicular torsion at a median age of 14 years were investigated. Serum follicle-stimulating hormone (FSH), testosterone and inhibin B as well as testicular volume were measured early (median 36 days) and/or late (median 1.1 years) after operation.ResultsOrchiectomy was performed in six, and testicular detorsion and orchiopexy in 11 patients. The duration of the preoperative symptoms in the detorsion group was 15 h (range 6–168) and in the orchiectomy group 42 h (range 24–96) (P = 0.03). Preoperative colour Doppler ultrasonography showed some circulation in 40% of the patients. At 1 month the median serum inhibin B level was significantly higher after preserving surgery (P = 0.01). At 1 year postoperatively, the median serum FSH level tended to be lower after testicular preservation (P = 0.09). Abnormal inhibin B or FSH values were observed in 35% of the patients.ConclusionsTesticular function is often compromised in patients with testicular torsion. Testis-preserving surgery yields better testicular function than orchiectomy in the short term if the testis is not obviously necrotic. Testicular torsion does not necessarily cause the circulation to cease completely, and preserving surgery can also sometimes be attempted after delayed diagnosis.     

The protective effect of dexpanthenol on testicular atrophy at 60th day following experimental testicular torsion

Despite the prompt diagnosis and treatment of testicular torsion (TT), there are problems with fertility and atrophy after testicular salvage. Dexpanthenol (Dxp) is the biologically active alcohol of pantothenic acid (PA). Dxp is converted to PA in tissues. PA increases the content of reduced glutathione (GSH), Coenzyme A and ATP synthesis in cells. GSH and glutathione-dependent peroxidases (GPX) are the major defense systems against oxidative stress. GPX-4 is the major antioxidant in testicular tissue. However, the activity of GPX-4 appeared and increased only after puberty. We investigated the effect of Dxp on testicular atrophy after TT at the 60th day. Rats were separated randomly into four groups. Group C: control group, group Td: torsion + detorsion, group Sal: torsion + saline + detorsion, group Dxp: torsion + Dxp + detorsion. The left testis was rotated 720° for 2 h. In group Sal, normal saline and in group Dxp, Dexpanthenol were injected intraperitonally, 30 min before detorsion. After 60 days, the testicular weights and volumes were measured. Histopathology of the left testis was evaluated with mean seminiferous tubular diameter (MSTD) and mean testicular biopsy score (MTBS). The left (torsed) testicular weight and volume of groups Td and Sal were significantly lower compared to group Dxp. The MSTD and MTBS of group Td and Sal were significantly lower than group Dxp. Contralateral testicular weight and volume of groups Td, Sal and Dxp had no significant difference compared to the control group. Dxp significantly prevented testicular atrophy after 60 days of TT. Dxp has FDA approval, is safe, cost effective and readily available. Its relevance for clinical trials may especially be for the problem of testicular atrophy catastrophe, seen very frequently following testicular salvage.     

The testes after unilateral incarcerated inguinal hernia in prepubertal rats

The ipsilateral and contralateral testes after unilateral incarcerated inguinal hernia were evaluated, and compared to the contralateral testis after unilateral testicular torsion in 30 prepubertal rats. Control, torsion and detorsion at 24 hours, and incarcerated inguinal hernia and reduction in the 24 hour groups, each consisting of ten rats were established. The testes were harvested after 15 days. Mean seminiferous tubular diameters (MSTD) and mean testicular biopsy scores (MTBS) were determined and compared. A decrease in MSTD and depression in MTBS, which was more prominent in the ipsilateral testes, were found in both ipsilateral and contralateral testes following unilateral incarcerated inguinal hernia. The testicular damage encountered after unilateral incarcerated inguinal hernia was similar to the contralateral testicular damage following unilateral testicular torsion with the utilized parameters.     

The effect of ATP-MgCl(2) on prevention of reperfusion injury after unilateral testicular torsion.

This study was designed to investigate the effect of ATP-MgCl(2) administered before and after detorsion on the prevention of reperfusion injury after unilateral testicular torsion. The rats were divided into six groups, each containing six rats. Torsion was created by rotating the left testes 720 degrees in a clockwise direction. Group 1 functioned as a control group. Torsion only was carried out in Group 2. Detorsion was carried out in Group 3. ATP-MgCl(2) (100 micromol/kg) was injected intravenously immediately before detorsion in Group 4. ATP-MgCl(2) (100 micromol/kg) was injected intravenously immediately after detorsion in Group 5. Saline was injected intravenously immediately after detorsion in Group 6. The effect of ATP-MgCl(2) on reperfusion injury was investigated by determining the levels of thiobarbituric acid-reactive substances (TBAR) and resulting lipid peroxidation in the bilateral testicular tissue. Testicular torsion and detorsion caused a significant increase in the TBAR levels in the bilateral testicular tissue. TBAR levels decreased to approximately normal levels in Groups 4 and 5. It is concluded that if reperfusion injury has occurred in both testes after unilateral testicular torsion, ATP-MgCl(2) administered before or after detorsion may prevent reperfusion injury in testicular torsion.     

Color flow imaging in children with clinically suspected testicular torsion

32 boys with symptoms of an acute scrotum had testicular sonography with color flow imaging (CFI). Patients ranged in age from 4–15 years (avg=11 yrs). Symptoms were present from 12 h to 5 days (avg=42 hrs). CFI correctly predicted presence or absence of testicular perfusion in 11 boys who had surgical exploration of the scrotum. 8 of these 11 patients had hemorrhagic infarction of the testicle, 1 had torsion of the appendix epididymis, 1 had epididymitis, and 1 had bilateral incomplete torsions with normal testicular perfusion. The remaining 21 patients did not have an operation. At least a 1 year followup of all patients has shown no clinical evidence of testicular atrophy to suggest a misse diagnosis of torsion. Absence or markedly decreased testicular flow was easily identified and indicates testicular ischema/infarction. Conversely, hyperemia of the testis and/or epididymis is usually associated with trauma or infection. However, incomplete torsion or spontaneous detorsion may demonstrate normal testicular flow on CFI. Only close correlation of clinical symptomatology and gray scale findings with CFI can identify these patients, who remain at high risk for subsequent complete torsion and infarction.