274例睾丸扭转的临床特征及误诊分析  

Clinical features of testicular torsion and its misdiagnosis: analysis of 274 cases

作　　者：李旭睿 高云亮[1] 尹焯[1] 杨金瑞[1] LI Xurui;GAO Yunliang;YIN Zhuo;YANG Jinrui(Department of Urology, Second Hospital of Central South University, Changsha 410011, China)

机构地区：[1]中南大学湘雅二医院泌尿外科,湖南长沙410011

出　　处：《南方医科大学学报》2019年第4期490-494,共5页Journal of Southern Medical University

摘　　要：目的讨论睾丸扭转的临床特点,探究导致误诊及睾丸损毁的相关因素、辅助检查的参考价值、发病率与气温的关系,起病后白细胞的变化水平,为及时明确诊断及处理睾丸扭转提供临床思路。方法回顾性分析2009年5月1日～2018年11月1日湖南地区9家医院诊断为睾丸扭转的274例患者的临床资料,比较首诊医院为三甲医院及非三甲医院的误诊率及睾丸损毁率差异,分析发病时温度、起病后血WBC值,总结关于睾丸扭转发病和诊疗的影响因素。结果共274例病例纳入本研究,按照首诊医院等级分为两组,两组间病人一般资料无明显差异。其中首诊医院为三甲医院者59例,误诊率30.5%,睾丸损毁率57.6%;而在非三甲医院首诊的215例患者中误诊率达到61.9%,睾丸损毁率85.6%。两组患者的误诊率、睾丸损毁率比较,差异有统计学意义(P<0.05)。睾丸扭转好发于气温较低的冬季和春季。起病后2～4 d时血WBC值高于正常水平。结论首次就诊于三甲医院患者的误诊率低于非三甲医院患者,保留睾丸的概率也高于非三甲医院。应加大力度在人群中普及关于睾丸扭转的医学知识,并加强基层医师诊断能力和手术水平。Objective To summarize the clinical characteristics of testicular torsion and explore the relationship between its incidence and temperature, the value of supplementary examinations, and the factors causing misdiagnosis and testicular lesions. Methods We retrospectively analyzed the clinical data of the patients with testicular torsion diagnosed in 9 hospitals in Hunan Province from May 1, 2009 to November 1, 2018. The temperature at onset and WBC value after onset were analyzed. The misdiagnosis rate and testicular lesion rate in the first-visit hospitals were compared between the large general hospitals and local hospitals. The factors that affected the diagnosis and treatment of testicular torsion were analyzed. Results A total of 274 cases were included in this study, and misdiagnoses occurred in 151 cases(61.9%). The initial diagnosis was made in large general hospitals in 59 cases;misdiagnosis occurred in 30.5% of the cases and the rate of testicular lesions was57.6%. Of the 215 cases first diagnosed in local hospitals, only 82 cases were diagnosed correctly, and the misdiagnosis rate was as high as 61.9%;the rate of testicular lesion was 85.6% in these cases. There were significant differences in the misdiagnosis rate and testicular lesion rate between the two groups(P<0.05). Conclusion The first-visit misdiagnosis rate of testicular torsion is much lower and the probability of testicle preservation is significantly higher in large general hospitals than in the local hospitals, suggesting the importance of health education for testicular torsion, enhancing the awareness of this condition and training of the surgeons in primary hospitals.

关 键 词：睾丸扭转 误诊率 睾丸损毁率 气温 白细胞计数 

分 类 号：R697.22[医药卫生—泌尿科学]