Belman A Barry, Rushton H Gil
Division of Pediatric Urology, Children's National Medical Center, and Department of Urology and Pediatrics, George Washington University Medical School, Washington, DC, USA.
J Urol. 2003 Oct;170(4 Pt 2):1674-5; discussion 1675-6. doi: 10.1097/01.ju.0000083888.22807.b8.
We determine whether the finding of a nonpalpable left testis and hypertrophied(2 cc or greater) right testis is predictive of an atrophic (perinatal torsion) left testis.
Prospectively, all boys with a nonpalpable left testis and hypertrophied right testis seen between May 2000 and May 2002 were included in the study. Testicular measurement was performed preoperatively with an orchidometer. In 19 of 22 boys size was also confirmed intraoperatively. Surgical exploration was done initially through a scrotal incision. Diagnostic laparoscopy was performed in boys in whom intrascrotal tissue that was consistent with a "nubbin" was not found. All tissue removed was submitted for histological evaluation.
In 19 of 22 boys tissue was found in the left hemiscrotum that was clinically consistent with a scrotal nubbin, and histological confirmation was absolute in 18. In 1 patient a hollow oval mass attached to a cord extending to the external inguinal ring was found without the other classic histological features of torsion. In 3 cases scrotal exploration was negative and diagnostic laparoscopy was performed. Of this group the pathognomonic findings of a closed internal ring with hypoplastic vas and vessels were noted in 2 cases, and normal vas and vessels were seen to exit an open internal inguinal ring in 1. Inguinal exploration demonstrated an enlarged intracanalicular testis measuring 3 cc in volume, comparable in size to the descended right testicle.
The combination of a nonpalpable left testis and an enlarged right testis is highly predictive of perinatal testicular torsion. When both criteria were met 20 of 22 (91%) consecutive patients had histological or laparoscopically confirmed perinatal torsion and 1 had only clinical features. This finding supports the concept of scrotal exploration as the initial procedure in the child who has an empty left hemiscrotum and hypertrophied descended right testis. Laparoscopy should be reserved for boys in whom a distinct remnant is not found on scrotal exploration.
我们要确定无法触及左侧睾丸且右侧睾丸肥大（2立方厘米或更大）这一发现是否可预测左侧睾丸萎缩（围产期扭转）。
前瞻性地，将2000年5月至2002年5月期间所有出现无法触及左侧睾丸且右侧睾丸肥大的男孩纳入本研究。术前使用睾丸计进行睾丸测量。22名男孩中有19名的睾丸大小也在术中得到确认。最初通过阴囊切口进行手术探查。对于阴囊内未发现与“小结节”相符组织的男孩，进行诊断性腹腔镜检查。所有切除的组织均送检进行组织学评估。
22名男孩中有19名在左侧阴囊内发现了临床上与阴囊小结节相符的组织，其中18名经组织学确诊。1例患者发现一个中空的椭圆形肿块附着于延伸至腹股沟外环的精索，未发现其他扭转的典型组织学特征。3例阴囊探查结果为阴性，遂进行诊断性腹腔镜检查。在该组中，2例发现内环关闭、输精管和血管发育不全的典型表现，1例可见正常的输精管和血管从开放的腹股沟内环穿出。腹股沟探查发现管内睾丸增大，体积为3立方厘米，大小与已降入阴囊的右侧睾丸相当。
无法触及左侧睾丸且右侧睾丸增大这一组合高度提示围产期睾丸扭转。当这两个标准都满足时，22例连续患者中有20例（91%）经组织学或腹腔镜检查确诊为围产期扭转，1例仅有临床特征。这一发现支持将阴囊探查作为左侧阴囊空虚且右侧睾丸已降入阴囊并肥大患儿的初始检查方法。腹腔镜检查应仅用于阴囊探查未发现明显残余组织的男孩。
