Anderson J B, Williamson R C
University Department of Surgery, Bristol Royal Infirmary, UK.
Br J Surg. 1988 Oct;75(10):988-92. doi: 10.1002/bjs.1800751015.
To identify changes in incidence, presentation, management and outcome, 670 patients with torsion of the spermatic cord presenting in Bristol between 1960 and 1984 have been reviewed. Among the susceptible population of 150,000, the annual incidence of torsion has increased fourfold from 11.2 cases between 1960 and 1964 to 42.8 cases between 1980 and 1984. Throughout this period greater than 90 per cent of patients have been managed by general surgeons. Patients aged between 12-18 years comprised 62 per cent but 20 per cent were 21 years or older. Torsion was commoner in the cold months, 24 per cent of cases occurring during December and January (chi 2 = 30.26, P less than 0.01). When acute torsion was relieved within 12 h of the onset of symptoms only 4 per cent of affected testes were considered non-viable, but beyond this time 75 per cent of patients received orchidectomy. Overall, 238 of 624 (38 per cent) acutely twisted testes were found to be infarcted at operation, and a further 35 patients (6 per cent) had marked testicular atrophy on review 3 months later. The testicular salvage rate has steadily improved from 45 per cent in the years 1960-64 to 67 per cent in 1980-84. Much of the increased incidence of testicular torsion is likely to reflect a greater awareness of the condition by general practitioners. It has been more than matched by an improvement in testicular salvage rate because of earlier referral.
为了确定发病率、临床表现、治疗方法和治疗结果的变化，我们回顾了1960年至1984年间在布里斯托尔出现精索扭转的670例患者。在15万易感人群中，扭转的年发病率增加了四倍，从1960年至1964年的11.2例增至1980年至1984年的42.8例。在此期间，超过90%的患者由普通外科医生治疗。年龄在12 - 18岁之间的患者占62%，但20%的患者年龄在21岁及以上。扭转在寒冷月份更为常见，24%的病例发生在12月和1月（χ² = 30.26，P < 0.01）。当在症状出现后12小时内解除急性扭转时，只有4%的受影响睾丸被认为无法存活，但超过这个时间，75%的患者接受了睾丸切除术。总体而言，624例急性扭转睾丸中有238例（38%）在手术中被发现梗死，另有35例患者（6%）在3个月后的复查中出现明显的睾丸萎缩。睾丸挽救率已从1960 - 1964年的45%稳步提高到1980 - 84年的67%。睾丸扭转发病率的增加很大程度上可能反映了全科医生对该病的认识提高。由于更早转诊，睾丸挽救率的提高与之相匹配。
