新生儿睾丸扭转的早期干预效果及其必要性:11例分析  

Effect and necessity of early surgical management of neonatal testicular torsion:an analysis of 11 cases

作　　者：陈浩 戴育坚[1] 孙小刚[2] 张振华 王春田 陈维秀[2] 王若义[2] Hao Chen;Yujian Dai;Xiaogang Sun;Zhenhua Zhang;Chuntian Wang;Weixiu Chen;Ruoyi Wang(Department of Pediatric Surgery,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou 362000,China;Department of Pediatric Surgery,the Second Hospital of Shandong University,Jinan 250033,China)

机构地区：[1]福建医科大学附属泉州第一医院小儿外科,泉州362000 [2]山东大学第二医院小儿外科,济南250033

出　　处：《中华围产医学杂志》2023年第8期676-680,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨新生儿睾丸扭转的临床特点和早期干预的效果及其必要性。方法回顾性分析2017年6月至2022年6月山东大学第二医院收治的11例新生儿睾丸扭转患儿的病例资料。总结临床表现、超声检查结果、手术处理及随访结果。采用描述性统计分析。结果11例新生儿睾丸扭转患儿中位入院日龄为2.6 d(1~5 d)。发现阴囊异常至入院的中位时间为12 h(1~120 h),均存在不同程度阴囊肿胀或硬肿表现,其中7例伴有皮肤青紫或发红的急性炎症体征,触诊可及睾丸样组织硬结。超声均显示患睾血流异常。11例患儿均在急诊全身麻醉下行阴囊切开探查,其中10例行患侧睾丸切除术+对侧睾丸固定术;另1例生后1 h入院者行患侧睾丸固定术,家属拒绝行对侧睾丸探查术。术中发现12睾扭转,鞘膜外扭转7睾,鞘膜内扭转3睾,另外2睾与周围组织粘连,无正常睾丸组织形态,扭转方向和角度已分辨不清;发生在左侧7例,右侧3例,双侧1例。此双侧病例术前诊断为左侧睾丸扭转,术中探查见左睾扭转坏死,予切除,右睾呈180°扭转,血运良好,予复位后固定;1例发现对侧睾丸发育不良且较游离给予固定。睾丸挽救率为2/12,包括生后发现阴囊异常1 h入院者的1睾以及双侧病例中的右睾。切除的10个患睾病理检查提示睾丸坏死,其中2个可见纤维化及钙化灶。11例患儿均未发生围术期并发症,阴囊切口愈合均良好,术后随访6~12个月,定期复查超声,保留睾丸及对侧睾丸均位于阴囊内,血供良好,无扭转、萎缩等异常。结论新生儿睾丸扭转临床少见,表现无特异性,睾丸坏死切除率高,但早期诊断和积极双侧阴囊探查是必要的,是挽救患睾和避免无睾症发生的关键。Objective To investigate the clinical features of neonatal testicular torsion and to evaluate the effect and necessity of early intervention.Methods A retrospective analysis was performed on 11 neonates admitted to the Second Hospital of Shandong University with neonatal testicular torsion from June 2017 to June 2022.Clinical data of these cases including clinical manifestations,ultrasonography findings,surgical management and outcomes were reviewed and analyzed with descriptive statistical methods.Results The median age of the 11 patients on admission was 2.6 d(1-5 d).The median time from finding abnormal scrotum to admission was 12 h(1-120 h).Various degrees of scrotal swelling or scleroma were found in the patients.Among them,seven patients presented with acute inflammatory signs of cyano sis or skin redness,and testis-like tissue induration could be touched.Ultrasound scan showed abnormal blood flow in the affected testicle in all cases.Emergency scrotal exploration under general anesthesia was performed successfully in all cases and ten of them underwent orchiectomy of the affected testicle plus contralateral orchiopexy.The rest one who was admitted within 1 h after birth only underwent orchiopexy of the affected testicle as the parents refused contralateral testicular exploration.During the operation,12 twisted testis were observed,including seven with extravaginal torsion,three with intravaginal torsion and two adhering to the surrounding tissue without normal testicular tissue or distinguishable torsion direction or degree.In this study,ten patients had unilateral testicular torsion,which affected the left side in seven cases and the right side in three cases,and one had bilateral testicular torsion,which was diagnosed as left testicle torsion before surgery.During scrotal exploration,the left testicle of this bilateral case was resected due to necrosis,while the right testicle twisted about 180 degrees with good blood flow and was subjected to orchidopexy after reduction.In one case,the unaffected testic

关 键 词：精索扭转 睾丸固定术 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]