儿童睾丸扭转早期临床诊治的多因素分析  

Multivariate analysis in early diagnosis and treatment of testicular torsion in Children

作　　者：邢民者 齐灿[2] XING Minzhe;QI Can(Operating Room,Hebei Provincial Children’s Hospital,Hebei,Shijiazhuang 050031,China;不详)

机构地区：[1]河北省儿童医院手术室,石家庄市050031 [2]河北省儿童医院泌尿外科,石家庄市050031

出　　处：《河北医药》2022年第13期1989-1992,共4页Hebei Medical Journal

基　　金：河北省医学科学研究课题计划(编号:20190793);河北省重点研发计划项目-民生科技专项(编号:19277796D)。

摘　　要：目的 综合临床表现、实验室检查、影像学资料和TWIST评分系统对睾丸扭转诊断进行临床分析,为睾丸扭转诊断提供新思路。方法 回顾分析2008年1月至2018年12月收治的怀疑睾丸扭转完成手术探查的141例患儿的临床资料,收集患儿的临床症状体征、超声检查、实验室检查等治疗,然后进行TWIST评分,对睾丸扭转诊治影响因素进行单因素及多因素分析,探究早期诊断睾丸扭转的风险因素。结果 141例患儿均完成手术,其中睾丸扭转116例(82.3%),非睾丸扭转25例(17.7%)(睾丸附件扭转20例,睾丸或者阴囊感染、水肿性疾病5例)。睾丸扭转组患儿中96例(85.8%)患儿睾丸扭转坏死手术切除,20例(14.2%)患儿睾丸复位后血运有所恢复行睾丸固定术后进行远期随访。TWIST评分中低分31例,中分34例,高分76例,其中睾丸扭转组低分8例,中分32例,高分76例,非睾丸扭转组低分23例,中分2例,无高分患儿。单因素分析结果显示提睾反射消失,超声下睾丸血流消失、睾丸形态不均匀和TWIST评分在睾丸扭转组和非睾丸扭转组差异有统计学意义(P<0.001)。多因素结果显示查体提睾反射消失,超声睾丸血流消失和睾丸形态不均匀、TWIST中高评分是影响睾丸扭转诊断的危险因素(P=0.013、0.002、0.025、0.010)。结论 TWIST评分在睾丸扭转的早期诊断中具有重要价值,临床诊断时应综合查体、TWIST评分、超声及实验室检查综合诊断,当怀疑睾丸扭转时应积极手术探查,减少睾丸扭转的诊断时间从而最大可能性保留睾丸。Objective To investigate the clinical symptom,laboratory examination,color doppler examination,and to perform TWIST score to diagnose the testicular torsion in Children,so as to provide an new idea for the diagnosis of testicular torsion.Methods The clinical data about 141 children patients with suspected testicular torsion who received the exploratory surgery in our hospital from January 2008 to December 2018 were retrospectively analyzed,including clinical symptoms and signs,ultrasound examination,laboratory examination and surgical exploration result.Moreover TWIST scoring was performed.Moreover the influencing factors on the diagnosis and treatment of of testicular torsion were anylyzed by univariate and multivariate analysis,and the risk factors of early diagnosis of testicular torsion were explored.Results A total 141 children patients underwent surgery,including 116 cases(82.3%)of testicular torsion,25 cases(17.7%)of non-testicular torsion.In testicular torsion group,96 cases(85.8%)with necrosis were treated by surgical ablation,and 20 cases(14.2%)who underwent orchiorrhaphy were given a long-term follow up.According to TWIST score,there were 31 cases with low scores,34 cases with middle scores and 76 cases with high scores,in testicular torsion group,there were 8 cases with low scores,32 cases with middle scores and 76 cases with high scores,in non-testicular torsion group,there were 23 cases with low scores,2 cases with middle scores and no high score cases.The univariate analysis showed that there were significant differences in TWIST scores between testicular torsion group and the non-testicular torsion group(P<0.01).The multifactor analysis showed that the disappearance of cremasteric reflex,the disappearance of ultrasonic testicular blood flow,the non-uniformity of testicular morphology and the middle-high TWIST scores were the risk factors affecting the diagnosis of testicular torsion(P<0.05).Conclusion TWIST score is of important value in the earlt diagnosis of testicular torsion,it should be diagn

关 键 词：睾丸扭转 TWIST评分 多因素分析 睾丸坏死 

分 类 号：R697.22[医药卫生—泌尿科学]