儿童腹股沟管隐睾睾丸扭转的治疗和预后分析  

Treatment and prognosis of children with torsion of inguinal cryptorchidism

作　　者：王文杰[1] 张潍平[1] 谢向辉[1] 许帅 何梦 孙宁[1] Wang Wenjie;Zhang Weiping;Xie Xianghui;Xu Shuai;He Meng;Sun Ning(Department of Pediatric Urology,Beijing Children*s Hospital Affiliated to Capital Medical University&National Children’s Medical Center,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院泌尿外科,北京100045

出　　处：《中华泌尿外科杂志》2020年第9期687-691,共5页Chinese Journal of Urology

摘　　要：目的探讨儿童腹股沟管隐睾睾丸扭转的治疗方法及预后。方法回顾性分析2015年10月至2019年2月首都医科大学附属北京儿童医院收治的15例腹股沟管隐睾睾丸扭转患儿的临床资料。年龄4个月至17岁,平均5.1岁。临床表现为腹股沟肿痛13例,腹痛1例,腹痛伴呕吐1例。症状持续时间(至手术时)平均为45.9(5〜170)h。查体:患侧阴囊空虚,腹股沟肿胀伴触痛。病变位于左侧12例,右侧3例。腹股沟彩色多普勒超声检查:腹股沟管区睾丸增大,回声不均,血流信号减少或消失,怀疑睾丸扭转。临床诊断为腹股沟管隐睾睾丸扭转。全麻下行腹股沟管睾丸探查术。术中见睾丸呈扭转状态、暗黑色,扭转度数平均为600°(180°〜1080°)。暴露睾丸,复位扭转后观察睾丸活力。5例复位后睾丸颜色立即恢复,切开睾丸白膜有鲜血流出,行睾丸固定术,将睾丸固定于阴囊内。2例术中发现睾丸无活力但家长要求保留睾丸,行睾丸固定术。8例因睾丸坏死行睾丸切除术。睾丸固定术组和睾丸切除术组平均症状持续时间(至手术时)分别为24.3(5~73)h和64.8(7〜170)h;平均扭转度数分别为514°和675°。结果本组15例,手术时间平均56.7(40〜85)min。术中出血量平均1.5(1~2)ml。术中、术后无并发症。术后随访平均27(8-47)个月。睾丸固定术组7例中,3例术后平均7.3个月出现睾丸萎缩,余4例睾丸正常。睾丸切除术组8例对侧睾丸正常,未发生扭转。结论儿童腹股沟管隐睾睾丸扭转是一种相对少见的疾病,彩色多普勒超声检查及腹股沟管探查术可帮助诊断及治疗,根据睾丸情况可采用睾丸固定术或睾丸切除术。本病早期确诊困难,易导致睾丸丢失或术后萎缩。Objective To discuss the treatment and prognosis of children with torsion of inguinal cryptorchidism.Methods Clinical data of 15 cases of inguinal cryptorchidism with testicular torsion admitted to Bejing Children's Hospital from October 2015 to February 2019 were retrospectively analyzed.The average age of onset was5.I years(4 months-17 years).The elinical manifestations included inguinal swelling and pain in 13 cases,abdominal pain in 1 case and abdominal pain with vomiting in 1 case.The average duration of symptoms(up to the time of surgery)was 45.9(5-170)h.Physical examination showed scrotal voided on afected side,groin swelling with tendemness.Lesions were found in 12 cases on the left and 3 cases on the right.Groin color Doppler ultrasound examination showed testis enlargement,uneven echo,decrease or disappearance of blood flow signal,suspected testicular torsion.Clinical diagnosis was inguinal cryptorchidism testicular torsion.Inguinal canal testicular exploration under general anesthesia.During the operation,the testicle was dark and twisted with an average torsion of 600°(180°-1080°).Testicular activity was observed after exposure and reduction and torsion.After reduction,testicular color was immediately restored in 5 cases.After cutting open the white membrane of the testicular,there was blood outflow.In 2 cases,the testis was found to be inactive during the operation,but the parents requested tc retain the testis and performed orchiopexy.8 cases underwent orchiectomy due to necrosis of testis.The mean symptorm duration(up to the time of operation)of the orchiectomy group and the orchiectomy group was24.3(5-73)h and 64.8(7-170)h,respectively.The average torsion degree was 514°and 675°,respectively.Results The average operative time of 15 patients was 56.7 min(40-85 min).Intraoperative blood loss averaged 1.5(1-2)ml.There were no complications during and after operation.Postoperative fllow-up averaged 27(8-47)months.Among the 7 patients in the orchiopexy group,3 patients had atrophy of testis 7.3 mo

关 键 词：隐睾 睾丸扭转 腹股沟管 儿童 

分 类 号：R726.9[医药卫生—儿科]