儿童睾丸扭转复位术后睾丸萎缩的危险因素分析  

Risk factors analysis of testicular atrophy after torsion reduction in children

作　　者：许鹏 周云[1] 贾蓉 高靖达 贾鹏宇 褚登伟 时林梦 XU Peng;ZHOU Yun;JIA Rong;GAO Jingda;JIA Pengyu;CHU Dengwei;SHI Linmeng(Department of Urology,Hebei Province Children's Hospital,Shijiazhuang,050000,China;Department of Neurorehabilitation,Hebei Province Children's Hospital)

机构地区：[1]河北省儿童医院泌尿外科,石家庄050000 [2]河北省儿童医院神经康复科

出　　处：《临床泌尿外科杂志》2024年第3期222-226,共5页Journal of Clinical Urology

基　　金：2023年度河北省医学科学研究课题计划(No:20231147)。

摘　　要：目的:研究儿童睾丸扭转复位固定术后睾丸萎缩的危险因素,探讨预测睾丸萎缩的指标。方法:回顾性分析2018年1月—2022年12月河北省儿童医院收治的72例行睾丸扭转复位固定术患儿的临床资料,患儿年龄1~13岁,平均(7.31±0.32)岁;均为单侧,其中左侧43例,右侧29例。记录患儿的临床表现、术中睾丸颜色变化情况、实验室和超声检查结果,术后均随访6个月,依据术后超声结果将患儿分为睾丸萎缩组和非睾丸萎缩组,将2组患儿的资料进行单因素分析,并将其中差异有统计学意义的因素纳入多因素logistic回归模型,分析睾丸扭转复位后睾丸萎缩的危险因素。结果:72例患儿均行睾丸扭转复位固定术,其中术后睾丸萎缩39例,未发生睾丸萎缩33例,单因素分析结果显示术前疼痛持续时间、术前超声不均质表现、睾丸扭转复位10 min后颜色评分与睾丸扭转复位术后发生睾丸萎缩密切相关(P<0.05)。年龄、阴囊红肿、术前血常规白细胞数值等因素与睾丸扭转复位术后发生睾丸萎缩无相关性(P>0.05)。多因素logistic回归分析结果显示,患儿术前疼痛持续时间>12 h、睾丸扭转复位后10 min颜色评分1~2分、术前超声睾丸实质不均质回声是儿童睾丸扭转复位固定术后发生睾丸萎缩的独立危险因素(P<0.05)。结论:睾丸扭转复位10 min后颜色评分1~2分,睾丸已产生不可逆损伤,睾丸切除概率大,即使术中保留睾丸,术后发生睾丸萎缩概率高。术前疼痛持续时间>12 h、术前超声不均质表现是睾丸扭转复位术后发生睾丸萎缩的危险因素。当怀疑睾丸扭转时,应积极手术探查,减少睾丸缺血时间从而最大可能的保留睾丸。Objective: To study the risk factors of testicular atrophy after torsion reduction and fixation in children, and to explore the index of predicting testicular atrophy. Methods: The clinical data of 72 children who underwent testicular torsion reduction and fixation in our hospital from January 2018 to December 2022 were retrospectively analyzed. The age ranged from 1 to 13 years, with an average age of(7.31±0.32) years. The patients were followed up for 6 months. According to the results of postoperative ultrasound, the patients were divided into testicular atrophy group and non-testicular atrophy group. The data of the two groups were analyzed by univariate analysis, and the factors with statistically significant differences were included in the multivariate logistic regression model. The risk factors of testicular atrophy after reduction of testicular torsion were analyzed. Results: All the 72 children underwent testicular torsion reduction and fixation, among whom 39 cases had testicular atrophy after surgery, and 33 cases did not have testicular atrophy. Univariate analysis showed that there were no significant differences in age, scrotal redness and swelling, or preoperative white blood cell count between the two groups(P>0.05). There were significant differences in the duration of preoperative pain, the appearance of preoperative ultrasound heterogeneity, and the color score after 10 minutes of testicular torsion between the two groups(P<0.05). Multivariate logistic regression analysis showed that the duration of preoperative pain >12 hours, color score of 1-2 at 10 minutes after reduction of testicular torsion, and the heterogeneous echo of testicular parenchyma on preoperative ultrasound were independent risk factors for testicular atrophy after reduction and fixation of testicular torsion in children(P<0.05). Conclusion: The color score of 1-2 at 10 minutes after reduction of testicular torsion indicates that the testis has been irreversibly damaged, and the probability of orchiectomy is high. Even if t

关 键 词：睾丸扭转 睾丸萎缩 危险因素 儿童 

分 类 号：R697[医药卫生—泌尿科学]