非阴囊首发症状的睾丸扭转临床分析  

Clinical analysis of testicular torsion without typical scrotal symptoms in children

作　　者：齐灿[1] 周云[1] 褚登伟 张铁军[1] 史丽萍[1] 胡岩[1] 邢民者 刘朋 高靖达 郭付臣[1] Qi Can;Zhou Yun;Chu Dengwei;Zhang Tiejun;Shi Liping;Hu Yan;Xing Minzhe;Liu Peng;Gao Jingda;Guo Fuchen(Department of Urology,Children's Hospital of Hebei Province,Shijiazhuang 050031,China;Department of Operative Anesthesiology,Children's Hospital of Hebei Province,Shijiazhuang 050031,China;Division of Medical Affairs,Children's Hospital of Hebei Province,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院泌尿外科,石家庄050031 [2]河北省儿童医院手麻科,石家庄050031 [3]河北省儿童医院医务处,石家庄050031

出　　处：《中华小儿外科杂志》2020年第12期1118-1122,共5页Chinese Journal of Pediatric Surgery

基　　金：2019年度河北省医学科学研究课题计划(20190793)。

摘　　要：目的探讨非阴囊首发症状的睾丸扭转患儿的临床特征,为其诊治提供新思路。方法回顾性分析2009年1月至2018年12月在河北省儿童医院就诊的非阴囊首发症状的睾丸扭转患儿24例。收集患儿的一般临床资料,根据患儿的症状和体征进行TWIST(testicular workup for ischemia and suspected torsion)评分,统计TWIST评分在患儿中的应用情况。根据年龄将患儿分为婴幼儿组(13例)和儿童青春期组(11例),分析两组患儿临床表现的差异,从而分析非阴囊首发症状的睾丸扭转的临床特征。结果24例患儿中,首发症状为腰痛4例,腹股沟区疼痛8例,下腹疼痛4例,脐周疼痛2例,哭闹拒食2例,恶心呕吐3例,以及发热1例。TWIST评分分布为低评分(0~2分)5例、中评分(3~4分)17例及高评分(5~7分)2例。婴幼儿组与儿童青春期组首发症状中仅腹股沟疼痛患儿比例的差异具有统计学意义(P=0.043)。两组间TWIST总评分差异无统计学意义。24例患儿中,3例睾丸扭转缺血坏死,手术切除睾丸;21例睾丸复位后血运恢复,行睾丸固定术。结论症状不典型的阴囊红肿的睾丸扭转患儿临床首诊症状复杂,应提高对该类疾病的认识和警惕性;TWIST评分的中、高评分对睾丸扭转有一定提示作用,通过全面仔细体格检查并结合超声检查综合诊断,以免漏诊或者误诊,争取最大可能性保留睾丸组织。Objective To explore the clinical characteristics of testicular torsion in children without typical scrotal symptoms and provide new rationales for its diagnosis and treatment.Methods A retrospective study was performed for 24 cases of testicular torsion without typical scrotal symptoms from January 2009 to December 2018.Clinical data were analyzed and TWIST score was calculated by symptoms and signs for evaluating the application of scoring system in special testicular torsion samples.Furthermore,they were further divided by age into infantile and adolescent groups and then inter-group differences of clinical data were analyzed.Results Three cases of ischemic necrosis underwent testicular resection while the remainder of partial necrosis had testicular fixation.Their initial symptoms included lumbago(n=4),inguinal pain(n=8),abdominal pain(n=4),periumbilical pain(n=2),crying&refusing food(n=2),nausea&vomiting(n=4)and fever(n=1).The distribution of TWIST total scores was low(0-2 points,n=5),medium(3-4 points,n=17)and high(5-7 points.n=2).Statistically significant inter-group difference existed in inguinal pain manifestations(P=0.043).No statistically significant inter-group difference existed in TWIST score.Conclusions The clinical symptoms of testicular torsion without typical scrotal swelling are complex in children.High TWIST score has certain implications of testicular torsion.We should improve the understanding of this disease,stay vigilant for its timely diagnosis and perform comprehensive and careful physical examinations plus ultrasonic examination and TWIST score so as to preserve testicle as much as possible.

关 键 词：睾丸扭转 儿童 睾丸扭转评分 误诊 

分 类 号：R726.9[医药卫生—儿科]