From the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital.
Yale University School of Medicine.
Pediatr Emerg Care. 2022 Feb 1;38(2):e799-e804. doi: 10.1097/PEC.0000000000002383.
The aim of this study was to describe genital hair thread tourniquet syndrome (HTTS) and its treatment by pediatric and adolescent health care providers through a systematic literature review.
We performed a systematic literature review on pediatric male and female genital HTTS. Studies were included if they involved genital HTTS in males or females 21 years and younger and were published in English. The main outcomes were body parts involved, symptoms, treatment, anesthetic type, providers involved in diagnosis and management, and implications of delayed or missed diagnosis.
There were 38 female cases from 33 publications (1973-2020) and 147 male cases from 47 publications (1951-2019). The average age among females and males was 9.1 and 5.1 years, respectively. Among cases involving female patients, 93% of them were premenarchal; patients were circumcised in 90% of reviewed cases of male HTTS. The most commonly involved body parts were clitoris and labia minora in females, and penis and urethra in males. Males most commonly presented with edema and urinary symptoms, whereas females most commonly presented with edema and pain. General anesthesia was used for tourniquet excision in most cases. Male and female genital HTTS were mostly managed by urologists and emergency medicine physicians, respectively.
This systematic literature review of more than 150 cases of male and female genital HTTS describes evaluation and management of genital HTTS spanning 7 decades. The main treatment of genital HTTS remains prompt diagnosis and removal of the tourniquet, as well as education on prevention strategies. Delayed diagnosis due to lack of recognition of the HTTS can lead to serious sequelae. Development of national guidelines regarding best practices in management of genital HTTS disseminated to all providers taking care of pediatric and adolescent patients will lead to improved patient care.
本研究旨在通过系统文献回顾，描述小儿和青少年保健医生治疗生殖器毛发绞窄带综合征（HTTS）的方法。
我们对小儿男性和女性生殖器 HTTS 进行了系统的文献回顾。纳入研究的标准为：研究对象为年龄在 21 岁及以下的男性或女性生殖器 HTTS；研究报告为英文。主要结局指标包括受累部位、症状、治疗方法、麻醉类型、参与诊断和管理的医务人员以及延迟或漏诊的影响。
共有 33 篇文献（1973-2020 年）报道了 38 例女性病例，47 篇文献（1951-2019 年）报道了 147 例男性病例。女性和男性的平均年龄分别为 9.1 岁和 5.1 岁。在涉及女性患者的病例中，93%的患者为月经初潮前；90%的男性 HTTS 患者接受了包皮环切术。女性最常受累的部位为阴蒂和小阴唇，男性最常受累的部位为阴茎和尿道。男性最常见的表现为水肿和排尿症状，而女性最常见的表现为水肿和疼痛。大多数情况下，手术切除绞窄带时采用全身麻醉。男性和女性生殖器 HTTS 主要由泌尿科医生和急诊医学医生管理。
本系统文献回顾涵盖了 70 年来 150 多例男性和女性生殖器 HTTS，描述了生殖器 HTTS 的评估和治疗方法。生殖器 HTTS 的主要治疗方法仍然是及时诊断和去除绞窄带，并教育患者预防策略。由于未能认识到 HTTS，可能会导致严重的后果。制定国家指南，向所有照顾儿科和青少年患者的医务人员传播有关管理生殖器 HTTS 的最佳实践方法，将有助于提高患者的治疗效果。
