Friedman R M, Flashner S C, Akwari O E, King L R
Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina 27710.
J Urol. 1993 Jul;150(1):246-8. doi: 10.1016/s0022-5347(17)35455-1.
The present study was designed to determine whether extravaginal torsion of the spermatic cord (EVT) can be distinguished from intravaginal torsion (IVT) on the basis of gross and histologic examination of the testis. It is traditionally believed that EVT, postulated to occur only in neonates, can be grossly distinguished from IVT, which occurs in older patients, on the basis of adherence between testis and tunica vaginalis. Such adherence is felt to be present in EVT but not IVT. This concept that the two types of torsion can be distinguished in the operating room has important clinical ramifications. In cases of EVT, contralateral orchidopexy theoretically need not be performed, since adhesions develop between tunica vaginalis and dartos by a few weeks of age. This is in contrast to IVT, in which contralateral orchidopexy is necessary due to the bilateral nature of the bell clapper deformity. Using a rat model, we first demonstrated that IVT could produce adherence of the tunica vaginalis to testis. Then, eight rats were operated on, producing right IVT and left EVT. Animals were then sacrificed at intervals of up to one month. Gross and histologic examination showed involvement of the tunica vaginalis in an ischemic and inflammatory response in a majority of testes, regardless of the type of torsion. Attempts to distinguish EVT from IVT on the basis of grossly evident adhesions between tunica vaginalis and testis are of questionable validity. Early contralateral orchidopexy is therefore recommended in all cases of neonatal torsion.
本研究旨在通过对睾丸进行大体和组织学检查，确定精索外扭转（EVT）是否可与精索内扭转（IVT）相区分。传统观点认为，EVT仅发生于新生儿，据信可根据睾丸与鞘膜之间的粘连情况，在大体上与发生于年龄较大患者的IVT相区分。EVT中存在这种粘连，而IVT中则没有。认为这两种扭转类型在手术室中可被区分的观点具有重要的临床意义。对于EVT病例，理论上无需进行对侧睾丸固定术，因为在几周龄时鞘膜与肉膜之间就会形成粘连。这与IVT相反，在IVT中，由于钟摆样畸形的双侧性，对侧睾丸固定术是必要的。我们首先使用大鼠模型证明IVT可导致鞘膜与睾丸粘连。然后，对8只大鼠进行手术，造成右侧IVT和左侧EVT。随后每隔一个月处死动物。大体和组织学检查显示，无论扭转类型如何，大多数睾丸的鞘膜均参与了缺血和炎症反应。试图根据鞘膜与睾丸之间明显的粘连在大体上区分EVT和IVT，其有效性存疑。因此，建议对所有新生儿扭转病例均早期进行对侧睾丸固定术。
