Blesa E, Moreno C, Blesa A, Rodríguez L, Núñez R, Cabrera R
Servicio de Cirugía Pediátrica, Hospital Materno-Infantil Infanta Cristina, Avda. Damián Téllez Lafuente s/n, 06010 Badajoz.
Cir Pediatr. 2003 Apr;16(2):73-6.
The testicular appendages are structures with biologic activity and with the possibility to become ischaemic or to degenerate before determined stimulus. Laterly, we have seen an apparent increase in our cases of torsion of testicular appendages. The said, together with the questions about embriology and pathogenesis of this structures, encourage us to do this work.
1- Retrospective clinical study of patients operated of torsion of testicular appendages, from January 1984 to December 2001. We asses age, year of operation and clinical features. 2- Prospective clinical study of patients operated of torsion of testicular appendages, between March 1999 and March 2000. We asses age, time of evolution, degree of ischaemia, nutritional status, sexual maturity stage and testicular volume. 3- Inmunocytochemical study of testicular and epididymal appendages. We identified the oestrogen receptors.
There is a meaningful increase in the yearly incidence of ischaemia of testicular appendages. The mean age of the patients was 9.3 +/- 2.5 years, similar alone of the study. In the patients of group 2, the mean time of evolution was 49.2 +/- 46.6 hours. The appendages showed oedema and several degrees of ischaemia in the absence of torsion (14/21). The body mass index was 19.5 +/- 3.7, and 90% of patients had stages I and II of Tanner. The mean of testicular volume was 2.1 +/- 1.6 ml. By means of inmunocytochemical study we identified oestrogen receptors in 7 of all testicular appendages studied and absence of oestrogen receptors in all epididymal appendages.
The clinical syndrome of the acute scrotum in the majority of cases is due to oedema and ischemia of the appendages, in absence of torsion, probably related to its enlargement in response to hormonal stimulation, at least in some grade, in prepubertal boys. The difference found, related to oestrogen receptors, suggest a different origin for testicular and epididymal appendages.
睾丸附件是具有生物活性的结构，在特定刺激之前有可能发生缺血或退化。最近，我们发现睾丸附件扭转病例明显增多。上述情况，再加上关于该结构的胚胎学和发病机制的问题，促使我们开展这项工作。
睾丸附件缺血的年发病率有显著增加。患者的平均年龄为9.3±2.5岁，与单独的研究相似。在第2组患者中，平均病程为49.2±46.6小时。在无扭转的情况下，附件显示水肿和不同程度的缺血（14/21）。体重指数为19.5±3.7，90%的患者处于坦纳I期和II期。睾丸体积的平均值为2.1±1.6毫升。通过免疫细胞化学研究，我们在所研究的所有睾丸附件中的7个中鉴定出雌激素受体，而在所有附睾附件中均未发现雌激素受体。
在大多数情况下，急性阴囊临床综合征是由于附件水肿和缺血，在无扭转的情况下，这可能至少在一定程度上与青春期前男孩对激素刺激的反应导致其增大有关。与雌激素受体相关的差异表明睾丸和附睾附件有不同的起源。
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