CAJ | 학술논문

目的：分析睾丸扭转病例临床资料，探讨 Arda 评分方法在睾丸扭转诊治中的临床意义。方法2010年1月至2014年2月作者收治34例拟诊睾丸扭转病例，共34枚睾丸，左侧29例，右侧5例。年龄2天至14岁。起病时间2小时至4天。根据 Arda 三级评分系统，按活检切口有无出血及出血出现的时间分为三级。Ⅰ级：出血明显而迅速；Ⅱ级：10 min 内有出血；Ⅲ级：10 min 内无出血。对评分低者予保留睾丸，评分高者与家属沟通后决定是否切除坏死睾丸。对于睾丸扭转者常规行对侧睾丸固定手术。术后随访1～5个月。随访方法为超声检查。结果34例均接受急诊手术探查，术中证实33例睾丸扭转，1例睾丸附件扭转。扭转270°～720°。Arda 评分Ⅲ级19例，其中行睾丸切除者14例，术后病理检查证实睾丸均梗死，5例家属要求保留睾丸未予切除。Arda 评分Ⅱ级11例，均予保留睾丸。Arda 评分Ⅰ级3例，均保留睾丸。1例睾丸附件扭转予睾丸附件切除。术后23例获得随访，其中切除睾丸组10例，保留睾丸组13例。保留睾丸组中术后随访睾丸萎缩者10例，睾丸正常者3例。结论睾丸扭转病情急，睾丸坏死率高，临床工作中需及时处置。Arda 评分对于预测睾丸预后有指导意义。评分达到3分者睾丸预后不佳，无保留价值。
목적：분석고환뉴전병례림상자료，탐토 Arda 평분방법재고환뉴전진치중적림상의의。방법2010년1월지2014년2월작자수치34례의진고환뉴전병례，공34매고환，좌측29례，우측5례。년령2천지14세。기병시간2소시지4천。근거 Arda 삼급평분계통，안활검절구유무출혈급출혈출현적시간분위삼급。Ⅰ급：출혈명현이신속；Ⅱ급：10 min 내유출혈；Ⅲ급：10 min 내무출혈。대평분저자여보류고환，평분고자여가속구통후결정시부절제배사고환。대우고환뉴전자상규행대측고환고정수술。술후수방1～5개월。수방방법위초성검사。결과34례균접수급진수술탐사，술중증실33례고환뉴전，1례고환부건뉴전。뉴전270°～720°。Arda 평분Ⅲ급19례，기중행고환절제자14례，술후병리검사증실고환균경사，5례가속요구보류고환미여절제。Arda 평분Ⅱ급11례，균여보류고환。Arda 평분Ⅰ급3례，균보류고환。1례고환부건뉴전여고환부건절제。술후23례획득수방，기중절제고환조10례，보류고환조13례。보류고환조중술후수방고환위축자10례，고환정상자3례。결론고환뉴전병정급，고환배사솔고，림상공작중수급시처치。Arda 평분대우예측고환예후유지도의의。평분체도3분자고환예후불가，무보류개치。
Objetive To review the cases of testicular torsion,evaluation of Ardaˊs classification criteria in the clinical treatment of testicular torsion in children,sum up the experience,and guide clinical work. Methods Retrospective analysis 34 testicular torsion cases registed in our hospital between January 2010 and February 2014.A total of 34 testicles,in which left side 29 cases,5 cases on the right side were included. Age ranged 2 d to 14 y.The onset time ranged 2 h to 4 d.Emergency operations were carried out to all the pre-diagnosed testicular torsion cases.Ardaˊs classification criteria was employed,according to biopsy incision with-out bleeding and bleeding time is divided into 3 types:levelⅠ,bleeding obvious and fast;level Ⅱ there is bleeding within 10mins level Ⅲ,no bleeding within 10 minutes.For levelⅠkeep the testis.For level Ⅱ,deci-ding whether to remove necrotic testis after communication with family members.For level Ⅲ,resect the testis unless the parents declared keep the testis in any situation.The contralateral testis fixation was carried out reg-ularly.Postoperative followed-up for 1 ~5 m with ultrasound. Results 34 cases were underwent emergency surgery exploration,intraoperative confirmed 33 cases of testicular torsion,the other 1 cases of torsion of ap-pendix testes.Turn degree range 270 °to 720 °.According to Arda scoring system,19 cases were divided to level Ⅲ,of which 14 cases underwent testicular resection,the other 5 cases have not been resected because of their parents want to keep testicles.Level Ⅱ 11 cases,and no testes resected.Level Ⅰ3 cases,all testes re-tained.1 case of testicular appendix torsion received testicular appendix resection.23 cases were follow-up for 1 ~5 months after operation,including resection group 10 cases,testis retained group of 13 cases.In testes re-tained group,10 testis atrophied,and the other 3 testis normal in size.Conclusions The testicular torsion is an emergency condition,testicular necrosis rate is high,in the clinical work should be treated timely.Ardaˊs classification criteria for predicting prognosis of testicular torsion is effective.