Tian Yanjun, Xing Xinran, Cai Hui, Ma Xiaoyan, Liu Qi
Beijing University First Hospital Ningxia Women and Children's Hospital, Yinchuan, 750004, Ningxia, China.
General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.
Pediatr Surg Int. 2025 Jul 14;41(1):210. doi: 10.1007/s00383-025-06124-5.
This study aimed to construct preoperative nomograms for predicting testicular necrosis in pediatric patients with testicular torsion (TT).
This retrospective study analyzed clinical data from 176 patients diagnosed with TT at the Department of Pediatric Surgery, Ningxia Medical General Hospital, between January 2010 and January 2023. To identify independent risk factors for testicular necrosis, both univariate as well as multivariate logistic regression analyses were used. A predictive nomogram model was then developed based on the coefficients derived from multivariate regression analysis. A receiver operating characteristic (ROC) curve analysis and calibration plot were employed to evaluate the performance of the model.
Surgical management included orchiopexy in 55 patients (31.4%) and orchiectomy in 121 patients (68.6%). Multivariate analysis identified five independent predictors of testicular necrosis: symptom duration, torsion severity (≥ 360°), absence of testicular blood flow on Doppler ultrasound, heterogeneous testicular echogenicity, and an elevated preoperative platelet-to-lymphocyte ratio (PLR). Internal validation demonstrated strong discriminative performance of the nomogram, with the area under the ROC curve values of 0.948 for the training cohort and 0.910 for the validation cohort. The calibration plots demonstrated a strong concordance between predicted probabilities and observed outcomes.
These findings highlight duration of onset, degree of TT, ultrasound characteristics (vascularity loss and heterogeneous echotexture), and systemic inflammatory markers (PLR) as key preoperative indicators of testicular viability. The proposed nomogram serves as an evidence-based tool to guide intraoperative decisions on testicular preservation or resection.
本研究旨在构建术前列线图，以预测小儿睾丸扭转（TT）患者的睾丸坏死情况。
本回顾性研究分析了2010年1月至2023年1月期间在宁夏医科大学总医院小儿外科确诊为TT的176例患者的临床资料。为了确定睾丸坏死的独立危险因素，采用了单因素和多因素逻辑回归分析。然后根据多因素回归分析得出的系数建立了预测列线图模型。采用受试者操作特征（ROC）曲线分析和校准图来评估模型的性能。
手术治疗包括55例（31.4%）患者行睾丸固定术和121例（68.6%）患者行睾丸切除术。多因素分析确定了睾丸坏死的五个独立预测因素：症状持续时间、扭转严重程度（≥360°）、多普勒超声显示睾丸无血流、睾丸回声不均匀以及术前血小板与淋巴细胞比值（PLR）升高。内部验证表明列线图具有很强的判别性能，训练队列的ROC曲线下面积值为0.948，验证队列的为0.910。校准图显示预测概率与观察结果之间具有很强的一致性。
这些发现突出了发病持续时间、TT程度、超声特征（血管丧失和回声不均匀）以及全身炎症标志物（PLR）作为睾丸存活的关键术前指标。所提出的列线图可作为一种循证工具，用于指导术中关于睾丸保留或切除的决策。
