Yu Kai-Jie, Wang Ta-Min, Chen Hsiao-Wen, Wang Hsu-Han
Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung Med J. 2012 Jan-Feb;35(1):38-45. doi: 10.4103/2319-4170.106168.
Acute painful scrotum is one of the most challenging urological emergencies. Irreversible parenchymal damage will develop if a testicle is twisted. The aim of the study was to determine the importance of different clinical clues to help differentiate the causes of this devastating condition.
The medical charts of teenagers with acute scrotal pain between January 2003 and December 2008 were reviewed retrospectively.
Seventy-six patients were included in this study, including 47 initially suspected of having testicular torsion and 29 suspected of having epididymo-orchitis. Testicular torsion was confirmed in 39 of the suspected 47 cases after surgical exploration. Twnety-one of these 39 testicular torsion patients underwent orchiectomy, and 18 were rescued and underwent orchiopexy. The mean pain duration was significantly longer in the orchiectomy group than the orchiopexy group (38.05 hours vs 14.14 hours, p = 0.009). In the testicular torsion group, fewer patients had elevated C-reactive protein levels no patients had pyuria, and the pain duration was shorter compared with the epididymo-orchitis group (5/11 vs 13/22 [p = 0.045], 0/28 vs 8/28 [p = 0.004] and 27.0 vs 74.5 hours [p = 0.0003], respectively). The sensitivity of color Dopper ultrasound in diagnosing testicular torsion and epididymo-orchitis was 84.09% vs 92.59%. Logistic regression for multivariate analysis showed that left side manifestation and pain duration were significantly different between testicular torsion and epididymo-orchitis with odds ratios of 4.76, p = 0.020 and 0.98, p = 0.029, respectively.
Pain duration and left side manifestation are independent risk factors of testicular torsion. Prompt surgical exploration should be done if testicular torsion is highly suspected.
急性阴囊疼痛是最具挑战性的泌尿外科急症之一。如果睾丸发生扭转，将会出现不可逆的实质损害。本研究旨在确定不同临床线索在鉴别这种严重疾病病因方面的重要性。
回顾性分析2003年1月至2008年12月期间青少年急性阴囊疼痛患者的病历。
本研究共纳入76例患者，其中47例最初怀疑患有睾丸扭转，29例怀疑患有附睾炎。经手术探查，47例疑似病例中有39例确诊为睾丸扭转。这39例睾丸扭转患者中，21例行睾丸切除术，18例获救并行睾丸固定术。睾丸切除组的平均疼痛持续时间显著长于睾丸固定术组（38.05小时对14.14小时，p = 0.009）。在睾丸扭转组中，C反应蛋白水平升高的患者较少，无脓尿患者，与附睾炎组相比疼痛持续时间较短（分别为5/11对13/22 [p = 0.045]，0/28对8/28 [p = 0.004]，以及27.0小时对74.5小时 [p = 0.0003]）。彩色多普勒超声诊断睾丸扭转和附睾炎的敏感性分别为84.09%和92.59%。多因素分析的逻辑回归显示，睾丸扭转和附睾炎在左侧表现和疼痛持续时间方面存在显著差异，优势比分别为4.76，p = 0.020和0.98，p = 0.029。
疼痛持续时间和左侧表现是睾丸扭转的独立危险因素。如果高度怀疑睾丸扭转，应立即进行手术探查。
