睾丸扭转外科治疗及误诊分析.docVIP

睾丸扭转外科治疗及误诊分析 　　【摘要】 目的 提高睾丸扭转的诊断和治疗水平。方法 回顾性分析56例睾丸扭转患者的临床资料，52例手术探查,行睾丸切除或睾丸复位固定，健侧睾丸固定。4例未手术。结果 22例患者经B超及CDFI确诊为睾丸扭转， 34例误诊。20例患侧睾丸切除。32例睾丸保留，其中8例萎缩。结论 对于青少年患者阴囊急症，首诊医生应高度警惕睾丸扭转，可疑时立即行B超及CDFI检查，避免延误诊治。及时手术探查是提高睾丸成活率的关健。 　　【关键词】睾丸扭转；手术探查；误诊 　　 　　The surgical treatment and misdiagnosis of testicular torsion 　　REN Xuan-yi， HUANG Sui-fu，DOU Jian-wei.Department of Urology,the First People’s Hospital of Kaifeng Kaifeng Henan Province 475000，China 　　 　　【Abstract】 Objective To improve the diagnosis and treatment of testicular torsion.Methods A retrospective analysis of clinical data of 56 cases of testicular torsion was made and the experience on its diagnosis and treatment was summed up.52 cases had been undergone orchiectomy or scrotal orchidopexy.Results The diagnosis of testicular torsion in 22 cases was assessed on CDFI.The other 34 cases were misdiagnosis.20 cases had been Undergone orchiectomy and contra-lateral orchidopexy.32 caseshadbeenundergone surgicaldetorsionand orchidopexy,8 cases were atrophy.Conclusion Male patients less than 25 years of age，especially during adolescence，presenting with a tender testicle，were more likely to have testicular torsion rather than epididymitis.With CDFI testieular torsion has more chances to be diagnosed correctly on time.The prompt surgical exploration has to be Performed in all cases to avoid serious outcomes. 　　【Key words】Testicular torsion surgical；Exploration;Misdiagnosis 　　 　　睾丸扭转又称精索扭转。自1810年Delasiave首次报告以后,该疾病才渐被人们认识。睾丸扭转如不及时治疗可导致睾丸缺血坏死而被切除，可能导致患者以后的生育功能障碍。基层医生对睾丸扭转没有足够的警惕性，导致目前首诊误诊率仍居高不下，往往造成患者终身残疾。因此如何提高早期正确诊治率，减少睾丸丢失及萎缩率，值得深入探讨。笔者就1987年12月至2006年12月收治的56例睾丸扭转患者进行回顾,以总结睾丸扭转的外科治疗经验，并分析误诊原因，以期提高本???诊治水平。现报告如下。 　　 　　1 资料与方法 　　 　　1．1 临床资料 本组56例,年龄8～35岁,中位年龄14岁,其中24 h者阴囊皮肤有不同程度红肿，透光试验阴性；表现为睾丸质韧痛性结节4例。Prohn’s征(+)22例，提睾反射消失。发病至本院就诊时间为: 10．0×109/L，核左移。在本院行B超检查28例，22例提示睾丸扭转,B超示患侧睾丸内部低回声，或回声不均匀增强， 20例可显示睾丸鞘膜腔内有渗液；误诊为急性附睾、睾丸炎4例，误诊为睾丸占位2例。行彩色多普勒血流动态显像(CDFI)检查26例，22例确诊。其中14例睾丸血流灌注减少,阻力指数增加,形态改变不明显,回声尚均匀；4例睾丸内血流消失,肿