Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 of Nanlishi road, Xicheng District, Beijing, 100045, China.
Department of Pediatric Surgery, Beijing Aiyuhua Women and Children Hospital, Beijing, 100176, China.
Int Urol Nephrol. 2020 Jun;52(6):1009-1014. doi: 10.1007/s11255-020-02382-5. Epub 2020 Feb 12.
This study aims to explore the theoretical method and clinical application of manipulation reduction for testicular torsion.
A total of 28 patients with testicular torsion were recruited from the Emergency Surgery Department of Beijing Children's Hospital affiliated to Capital Medical University from July 2016 to July 2018. Among these patients, 22 patients (age: 10.80 ± 3.50 years old) were treated with manual reduction using the elastic retraction method and push-and-turn method. Observation indexes included dramatically alleviated or completely disappeared pain without general anesthesia; the spermatic cord being smooth and unknotted; the restoration of the suffered testis to normal anatomical position under ultrasonography monitoring; blood flow signals increased in the affected testis and epididymis, which was regarded as the main sign of a successful reduction.
Among the 22 cases who received manual reduction, 19 patients were successfully treated (left side: n = 11, right side: n = 8) with a total success rate of 86.36%. The other three cases showed either incomplete (n = 2) or failed (n = 1) reposition. Among the 19 patients who were successfully treated by manual reduction, 2 of them did not undergo prophylactic orchiopexy, and no abnormalities were found during the follow-up.
The reduction of testicular torsion using the elastic retraction method and push-and-turn method may improve the success rate of the manual reduction of testicular torsion, especially for incomplete testicular torsion. Furthermore, manual reduction may help increase the rate of testicular salvage in a timely manner before emergency surgery. Hence, this skill should be extended to primary hospitals to reduce the possibility of testectomy caused by testicular torsion.
本研究旨在探讨睾丸扭转手法复位的理论方法和临床应用。
选取 2016 年 7 月至 2018 年 7 月首都医科大学附属北京儿童医院急诊外科收治的睾丸扭转患者 28 例，其中采用弹性回缩法和推挤复位法进行手法复位 22 例（年龄：10.80±3.50 岁）。观察指标包括：无需全身麻醉即可明显缓解或完全缓解疼痛；精索平滑无结；超声监测下患侧睾丸恢复正常解剖位置；患侧睾丸和附睾血流信号增加，认为是复位成功的主要征象。
22 例手法复位患者中，19 例成功复位（左侧：n=11，右侧：n=8），总成功率为 86.36%。另外 3 例复位不完全（n=2）或失败（n=1）。在 19 例成功复位的患者中，2 例未行预防性睾丸固定术，随访未见异常。
采用弹性回缩法和推挤复位法复位睾丸扭转可提高手法复位睾丸扭转的成功率，尤其是不完全性睾丸扭转。此外，手法复位有助于在急诊手术前及时提高睾丸保存率。因此，该技术应推广至基层医院，以降低因睾丸扭转而导致的睾丸切除术的可能性。
