Sorbonne Université, AP-HP, Hôpital Universitaire La Pitié-Salpêtrière, 75013 Paris, France.
Sorbonne Université, AP-HP, Hôpital Universitaire La Pitié-Salpêtrière, 75013 Paris, France.
Morphologie. 2021 Feb;105(348):1-9. doi: 10.1016/j.morpho.2020.06.006. Epub 2020 Sep 9.
We aim by this article to present a literature review on the anatomical risk factors for spermatic cord torsion and their involvement the different techniques of orchidopexy.
The literature review was conducted following PRISMA check-list, using PubMed database and the Mesh terms: testis, torsion, anomaly, orchidopexy. Techniques of surgical management provided by the EMC (French medico-surgical encyclopedia) were also used.
Database research identified 500 articles, and 16 mores articles were added from the review of the references lists of relevant articles. At the end, 42 articles were useful for our review including 6 reviews, 5 cross-sectional studies, 14 cohorts, 10 case reports, 1 meta-analysis, 1 letter, and 5 experimental studies. High insertion of the tunica vaginalis, a long mesorchium, deficient attachment of the epididymis to the testis, and anomalies of the gubernaculum testis are the anatomical predispositions for spermatic cord torsion. After reduction of torsion, many surgical techniques for the fixation of the testis have been suggested including: conventional technique by triangulation with or without fasciotomy, window orchidopexy, scrotal pouch, and vaginal eversion with or without dartos fixation.
The most common anatomical factor associated with spermatic cord torsion is the high insertion of the tunica vaginalis. Vaginal eversion with fixation to the dartos might be superior to other known techniques and seems promising to become standard.
本文旨在对精索扭转的解剖学危险因素及其与不同精索固定术式的关系进行文献回顾。
本研究按照 PRISMA 清单进行文献回顾，使用 PubMed 数据库和 Mesh 术语：睾丸、扭转、异常、精索固定术。还使用了 EMC（法国医学外科学百科全书）提供的手术管理技术。
数据库研究共确定了 500 篇文章，通过对相关文章参考文献列表的审查，又增加了 16 篇文章。最后，有 42 篇文章对我们的综述有用，其中包括 6 篇综述、5 篇横断面研究、14 篇队列研究、10 篇病例报告、1 项荟萃分析、1 篇信函和 5 篇实验研究。鞘膜的高位附着、中肾管过长、附睾与睾丸附着不充分以及睾丸悬韧带异常是精索扭转的解剖学倾向。扭转复位后，已经提出了许多固定睾丸的手术技术，包括：常规三角固定术，伴或不伴筋膜切开术、窗式精索固定术、阴囊袋、阴道反转术伴或不伴阔筋膜固定术。
与精索扭转最常见的解剖学相关因素是鞘膜的高位附着。带阔筋膜固定的阴道反转术可能优于其他已知技术，有望成为标准术式。
