Traditional Culture Encyclopedia - Weather inquiry - Brief introduction of spermatic cord torsion
Brief introduction of spermatic cord torsion
Testicles settle in the scrotum, and the left and right sides are connected with the body through a tissue called spermatic cord, which provides blood circulation for the testicles, so the spermatic cord is the lifeblood of the testicles. The testis is connected to the scrotum by a tissue called testis mesothelium, which fixes the testis to the scrotum. One or both testicle mesangiums of some fetuses are too long during development. After birth, the activity of testis and spermatic cord will be great. In case of sudden force or violent impact, the testis and spermatic cord will twist more than 360 degrees, also known as testicular torsion. Torsion of spermatic cord is an emergency that occurs at the same time as testicular torsion, which is more common in teenagers. Due to testicular torsion, testicular blood supply disorder, if not treated in time, can cause testicular necrosis Torsion of spermatic cord mostly occurs after strenuous exercise and also occurs during sleep. Torsion of spermatic cord is related to anatomical factors of testis, such as mesentery or cryptorchidism at the dorsal attachment point of testis. Torsion of spermatic cord should be diagnosed as soon as possible and re-fixed by surgery. If the ischemia time is too long, it will lead to testicular necrosis.
The mechanism of testicular injury caused by torsion is well understood. Circulation disorder and venous occlusion lead to testicular congestion and swelling. If it is delayed, venous thrombosis will form, and finally arterial embolism will lead to tissue necrosis. The degree of testicular injury is related to two factors, namely, the degree and duration of torsion. Surgical exploration should be carried out as soon as possible 4 hours after the initial symptoms appear. After testicular ischemia 1.2 hours, necrosis can hardly be spared.
The onset of spermatic cord torsion is sudden and fierce, and there will be severe pain in the affected testis and scrotum. At the initial stage of torsion, the pain is still confined to the scrotum, and later it will develop to the lower abdomen with vomiting, nausea or fever, with redness, swelling and tenderness. Because the spermatic cord is also twisted, the blood vessels in the spermatic cord are blocked and the blood supply to the testis is insufficient. If not treated in time, the testis will appear ischemic necrosis, black color, atrophy gradually and lose its function. The clinical manifestations of spermatic cord torsion are mainly pain and swelling. If it happens to children, the diagnosis is usually more difficult. Generally, children will have unexplained anorexia and restlessness, and their condition will develop rapidly. Sometimes the treatment is delayed because there is no clear diagnosis, which causes unnecessary harm to patients.
The transverse swelling and upward movement of testis is a special sign of this disease, with obvious tenderness and twisted and shortened spermatic cord in hemp rope shape. If the pain does not decrease or increase when the scrotum is lifted or the testicles are moved, the Prehn sign is positive. The testis and epididymis are swollen and the boundary is unclear. The light transmission test is negative.
It should not be too difficult to make a correct diagnosis in time if we are alert to spermatic cord torsion, combined with medical history, age of onset and physical examination, supplemented by Doppler ultrasound and radionuclide examination when necessary.
Surgery is a reliable and effective method to treat torsion of spermatic cord, which can not only treat twisted testis, but also prevent healthy testis from getting sick. In general surgery, in addition to the treatment of testicular torsion, the testicles on the healthy side should also be fixed, because the incidence of both sides is often similar, one side will get sick, and the other side will get sick sooner or later.
If the spermatic cord is twisted, the patient can operate within 4 ~ 8 hours and fix the contralateral testis. The prognosis of spermatic cord torsion is good. Before a more effective and practical method to prevent ischemic testicular autoimmunity appears, the best way may be to remove the damaged testis.
2 disease name spermatic cord torsion
Testicular torsion
4 spermatic cord alias torsion; ; Testicular torsion
5 classification urology >; Other diseases of genitourinary system
6 ICD N44
Epidemiological torsion of spermatic cord can occur at any age, and it is most common in the adolescence of 12 ~ 18 years old. According to statistics, the incidence of < 25 years old is 1∶4000, and then gradually decreases. Torsion of spermatic cord can also occur in neonatal period.
1 group 160 cases of spermatic cord torsion, spermatic cord torsion mostly occurred in adolescence, and 2/3 cases occurred between10 and 20 years old. The second peak occurs in the neonatal period (within 4 weeks after birth), mostly in the first few weeks after birth, showing scrotum swelling, edema and redness, which is related to local congestion caused by torsion. It is not clear whether improper delivery process or midwifery will lead to spermatic cord torsion. When this happens and spermatic cord torsion is diagnosed, it is often more than 24 hours, and most of the testicles have been necrotic.
Etiology Torsion of spermatic cord may be related to anatomical deformity or hypoplasia, such as too wide tunica vaginalis, too long spermatic cord or incomplete testicular descent. Sometimes the external force is not obvious, and it can even occur during sleep, which may be due to the excitement of vagus nerve and the strong contraction of cremaster muscle with testicular erection. Trauma, strenuous exercise and even cold weather can also cause testicular spasm or mutation, and can also cause excessive testicular activity and induce spermatic cord torsion.
The mechanism of testicular injury caused by the reversal of pathogenesis is well understood. Circulation disorder and venous occlusion lead to testicular congestion and swelling. If it is delayed, venous thrombosis will form, and finally arterial embolism will lead to tissue necrosis. The degree of testicular injury is related to two factors, namely, the degree and duration of torsion. The animal experiments of Sonde and Lapides in 196 1 year proved that the complete rotation of spermatic cord for 4 weeks and 2 hours could cause irreversible changes in testicular tissue, while the rotation of 1 week (360),12 hours or longer had no adverse effects on testis. Clinical case evidence confirmed that late testicular atrophy could be seen after the torsion lasted for 4 hours. After torsion 12h, if left untreated, most testicles will shrink. But this situation also has great uncertainty. Some patients have intermittent and self-healing torsion, which does not cause testicular damage. Some patients may have complete vascular infarction soon, and testicular injury and necrosis will soon occur. In short, surgical exploration should be carried out as soon as possible 4 hours after the initial symptoms appear. After testicular ischemia 1.2 hours, necrosis can hardly be spared.
10 Clinical manifestations of spermatic cord torsion 10. 1 Symptoms The onset of spermatic cord torsion is sudden and fierce, and there will be severe pain in the affected testis and scrotum. At the initial stage of torsion, the pain is still confined to the scrotum, and later it will develop to the lower abdomen with vomiting, nausea or fever, with redness, swelling and tenderness. Because the spermatic cord is also twisted, the blood vessels in the spermatic cord are blocked and the blood supply to the testis is insufficient. If not treated in time, the testis will appear ischemic necrosis, black color, atrophy gradually and lose its function.
The clinical manifestations of spermatic cord torsion are mainly pain and swelling. If it happens to children, the diagnosis is usually more difficult. Generally, children will have unexplained anorexia and restlessness, and their condition will develop rapidly. Sometimes the treatment is delayed because there is no clear diagnosis, which causes unnecessary harm to patients.
10.2 examination showed that testicular swelling moved up, and the transverse position was a specific sign of spermatic cord torsion, with obvious tenderness, and the spermatic cord twisted and shortened in a hemp rope shape. If the pain does not decrease or increase when the scrotum is lifted or the testicles are moved, the Prehn sign is positive. The testis and epididymis are swollen and the boundary is unclear. The light transmission test is negative.
1 1 Laboratory examination Patients with spermatic cord torsion may have slight leukocytosis during routine blood examination.
12 supplementary examination 1. Doppler ultrasound examination: testicular blood flow decreased.
2. Radionuclide 99m technetium (99mTc) testicular scan: It showed that the blood perfusion of twisted testis was reduced, showing a radioactive cold zone. The diagnostic accuracy rate is 94%, which is recognized as the most reliable auxiliary diagnostic method.
3. Ultrasonic examination and CT scan: It is helpful to distinguish whether the testis is swollen, acute hydrocele, scrotal edema and incarcerated hernia, but it is not reliable in distinguishing spermatic cord torsion from epididymitis.
If 13 is used to diagnose spermatic cord torsion, it should not be too difficult to make a correct diagnosis in time by combining medical history, onset age and physical examination, supplemented by Doppler ultrasound and radionuclide examination when necessary.
14 differential diagnosis 14. 1 acute orchitis and epididymitis may have symptoms such as testicular pain, accompanied by fever and leukocytosis. It is more common in adults, with slow onset and mild pain symptoms.
14.2 patients with incarcerated hernia have a history of indirect inguinal hernia. Oblique inguinal hernia can cause severe scrotal pain with obvious tenderness. There is also tenderness in the abdomen, accompanied by nausea and vomiting. Stop defecation and exhaust. Auscultation can hear bowel sounds hyperactivity and excessive breathing. Testis and epididymis are normal.
14.3 Ureteral calculi showed sudden abdominal cramps, which could radiate to thighs, abdomen and scrotum with nausea and vomiting, but the scrotum and its contents were normal.
14.4 torsion of testicular appendage The clinical symptoms of torsion of testicular appendage are similar to torsion of spermatic cord, and nausea, vomiting and abdominal discomfort may also occur. The onset is generally mild, and gradually increases within a day or two, but there are also severe acute attacks. Physical examination can touch the mass on the upper pole of testis. Bed rest, application of non-hormonal anti-inflammatory drugs and lifting scrotum can relieve symptoms.
14.5 patients with scrotal hematoma mainly have obvious history of trauma.
14.6 hydrocele This is a chronic disease, which generally does not hurt very much.
It should also be differentiated from varicocele, idiopathic scrotal edema, fat necrosis and virus infection.
15 is a reliable and effective treatment for torsion of spermatic cord, which can not only treat twisted testis, but also prevent healthy testis from getting sick. The operation should be treated according to the specific situation. During the operation, the testicles were dark purple. After the twisting was released, the recovery of blood circulation was observed. Within half an hour, if the blood circulation gradually recovers, the dark purple testicles gradually turn red, indicating that the lesion time is short and the testicular function has recovered and can be preserved. If the color of the testis does not recover during the operation, it means that it has been necrotic and should be removed. Because in recent years, medical research has found that necrotic testicles can cross the blood-testis barrier in the body and form anti-* * * antibodies, which easily affect the function of the other testicles. In general surgery, in addition to the treatment of testicular torsion, the testicles on the healthy side should also be fixed, because the incidence of both sides is often similar, one side will get sick, and the other side will get sick sooner or later.
15. 1 once the diagnosis of manual reduction and torsion of spermatic cord is confirmed, manual reduction and correction can be performed immediately. Manual reduction may relieve torsion and restore blood supply to testis for future selective surgery. During the reset, 1% lidocaine 5 ~ 10 ml was injected around the external spermatic cord for block anesthesia, and the reset was carried out 5 minutes later. The spermatic cord at the accessible torsion has a knot-like change, which can disappear immediately after successful reduction in the opposite direction. The pain also eased quickly. Selective testicular fixation can be postponed to 48 hours.
15.2 if manual reduction fails, testicular necrosis is suspected, or the diagnosis of spermatic cord torsion cannot be ruled out, scrotal exploration should be carried out immediately. Because testicular necrosis is related to the torsion time of spermatic cord, it is very important to prevent improper delay of special examination. The research data prove that patients can get the best effect by operating within 4 hours after symptoms appear. If the torsion lasts for more than 8 hours, the incidence of testicular atrophy will increase obviously in the later period, but it is meaningless to save the testis after 24 hours of torsion.
Because of the obvious difference between the degree of torsion and individual response, all patients with spermatic cord torsion should be treated by surgery as soon as possible, regardless of the severity of their symptoms. Surgical exploration should adopt scrotal incision to facilitate direct observation of testis; Swelling testicles should not be pulled through inguinal incision and outer ring, which will aggravate the injury. Open the tunica vaginalis cavity, observe the torsion degree of spermatic cord, and make a definite diagnosis. Rotate the testicles to see if they can return to normal color. If testicular vitality is in doubt, it should be covered with warm saline gauze. 10 minutes later, observe the testis, and if it still cannot recover, remove it. If you regain vitality, you should do testicular fixation and fix it at the bottom of scrotum with non-absorbable thread to make sure it will not be twisted again. It is reported that the torsion of spermatic cord is easy to recur after being fixed with absorbable suture.
For all patients with spermatic cord torsion, contralateral testicular fixation should also be performed at the same time. Because almost all these patients have anatomical defects of bilateral testis and scrotum, there is still the danger of contralateral torsion in the future. It is not appropriate to sew only a few stitches on the contralateral testicular septum during the operation on the affected side. Standard operations should be performed. Sew the upper, middle and lower parts of the testis on the flesh membrane with non-absorbable thread, so that the testis still has enough mobility and does not twist.
15.3 Testicular excision What kind of testicles should be removed? In the past, most surgeons thought that if the testicles were still alive, they should be preserved and only the testicles that had been obviously necrotic should be removed. Recent data show that testicles lacking blood supply will produce anti-antibodies, which will damage healthy testicles. Therefore, some scholars suggest that only the testicles that obviously restore circulation after torsion reduction should be preserved. After 1.2 hours of torsion, most of the injured testicles shrank in the later stage, and the * * * count decreased. We believe that under the present circumstances, it should be prudent to keep the testicles that have been twisted for more than 1.2 hours, and we should make up our minds to remove them. If the survival of testis is still uncertain during operation, fluorescein can be injected and the testis can be observed under ultraviolet lamp. When fluorescein is injected into testis, testis can survive and be preserved. Patients with testicular necrosis can be implanted with testicular prosthesis at the same time or in two stages.
15.4 treatment of neonatal spermatic cord torsion In the neonatal period, the testis just descended to the scrotum, and the guide belt was not completely integrated into the scrotum wall. Therefore, the testis and the guide belt can rotate freely in the scrotum of the newborn. In this age group, the whole testis, epididymis and narrow tunica vaginalis can rotate together along the longitudinal axis under the spermatic cord to form the external torsion of tunica vaginalis. Torsion of tunica vaginalis is the most common manifestation after puberty. Clinically, it was found that the scrotum on one side of the newborn was swollen, and the hard mass could be touched, and the light transmission test was positive. There was no obvious tenderness, and the newborn did not feel uncomfortable touching the tumor. Occasionally, there will be anxiety and unwillingness to eat, and the diagnosis can be established. Although immediate surgical exploration is very valuable, most testicles were found gangrenous during exploration, and the survival rate was zero. Generally speaking, unless there is suppurative infection, the torsion of spermatic cord found at birth does not necessarily require surgical exploration, because most of these testicles are necrotic. And if there is spermatic cord torsion after birth, timely surgery may be able to save it. But this is still controversial. Some pediatric urologists have immediately performed surgical exploration on the torsion of spermatic cord diagnosed within 48 hours after birth, and removed the testis if it is necrotic. At the same time, contralateral testicular fixation was performed. In recent years, the study of experimental animals has provided a basis for the preservation of testicles. The results showed that the ischemic testis before puberty did not produce anti-* * antibodies, and it was found that leydig cells of testis were more resistant to the influence of ischemia than Bacillus. Therefore, some people think that unless the testis is completely necrotic, it is not necessary to remove it, which may provide appropriate endocrine function in adolescence.
Treatment of adolescent spermatic cord torsion 15.5 Acute pain and swelling of testis in adolescent patients are mostly caused by torsion. Because the testicular band has fused with the scrotal wall and the closure of the tunica vaginalis is relatively high, torsion is often formed in the tunica vaginalis. The scrotum suddenly hurts, and then the scrotum soon edema. Once diagnosed, scrotal exploration and contralateral testicular fixation should be performed immediately. If the torsion can be reduced manually, testicular fixation should still be performed, because the patient may have torsion recurrence and testicular necrosis before discharge.
Treatment of testicular adnexal torsion 15.6 Testicular adnexal torsion is the most common, mostly the remains of Miao Lei's canal. The clinical manifestations are the same as the true spermatic cord torsion, but the degree is slightly mild. Most of them occur in early adolescence. At the beginning of the disease, it is also scrotal pain. If the scrotal swelling has not yet appeared, the characteristic blue dot sign may appear on the scrotal skin. Twisted appendages can be touched, such as 1 soft small tumor 3 ~ 5 mm near the upper pole of testis, but the testis itself is not tender. Once scrotal edema occurs, palpation of appendages is impossible. Occasionally, spermatic cord block anesthesia can make the examination more accurate. Torsion of testicular appendage itself is harmless, and if the diagnosis is established, no surgical treatment is needed. But if the twisted necrotic tissue is removed, the pain of the patient can be eliminated, and the operation is still valuable.
15.7 Treatment of recurrent testicular pain Patients with recurrent testicular pain should undergo bilateral testicular fixation. Without treatment, many patients may have spermatic cord torsion and lose their testicles. 13 of patients with spermatic cord torsion had regular testicular pain in the past.
16 prognosis if the patient with spermatic cord torsion can be operated within 4 ~ 8 hours, and the contralateral testis is fixed. The prognosis of spermatic cord torsion is good. With the improvement of vigilance and first aid awareness, the testicular rescue rate has been greatly improved in the past 10 years. It is reported that the success rate of treatment is above 8 1%, but this success rate is due to the subjective judgment of some surgeons during the operation. To evaluate the real treatment rate, long-term postoperative follow-up is needed.
The results of the current follow-up study are not optimistic. According to statistics, two years after torsion reduction, 2/3 patients developed testicular atrophy, and the degree of atrophy was related to the duration of torsion. The spermatogenic function of 80% ~ 94% patients with unilateral spermatic cord torsion was evaluated. * * * Analysis results show that the amount, * * count, vitality and survival rate are abnormal. This shows that the contralateral testis also has abnormal function. However, the biopsy and * * * analysis of the contralateral testis of patients with torsion injury were mostly within the normal range. This indicates that the preservation of ischemic testis may damage the spermatogenic function of healthy testis. Some authors believe that when the spermatic cord is twisted, some protein may be released into the circulatory system, leading to the production of anti-testicular antibodies, which may damage healthy testis. This theory of testicular autoimmunity is still a hypothesis, which needs more detailed immune response tests to verify. Some scholars believe that testicular dysfunction may have existed before torsion, and histological changes may show the original abnormality of testis.
Therefore, before there is a more effective and practical way to prevent ischemic testicular autoimmunity, the best way may be to remove the damaged testis.
17 related drug lidocaine
18 check anti-* * antibody and * * *
Jinsuo Gu Jing Pill, a Chinese patent medicine for treating torsion of spermatic cord, contains 60g of beard, 30g of calcined keel and 30g of calcined oyster, and has the effects of tonifying kidney and fixing sperm. Attending nocturnal emission. This recipe is often used to treat kidney deficiency and unstable essence. ...
Dosage: 50 capsules each time, with salt soup. Indications: Tonifying kidney and astringing essence. Indications: kidney deficiency, white and turbid nocturnal emission in men and leukorrhagia in women. Theory of immortality on land and water ...
Pilose antler essence róngjρng English: pantocrine pilose antler essence Description: Drug name: pilose antler essence Chinese pinyin: Luron ...
The latent period of compound Xuanju oral liquid for male mice to capture female mice can increase the capture times and capture rate; Shorten the * * * incubation period, improve the * * * times and * * * rate. It can also increase the weight of rat testis. ...
Wuzi Yanzong Pill
- Previous article:What is the impact of heavy snowfall in Northeast China?
- Next article:What are the consequences of the rare snowstorm and gale in Dalian?
- Related articles
- I'm going to Wuhan for a week on business tomorrow, and I'm going to Ji 'an, Jiangxi. I want to know what the local weather is like. Please tell me what kind of clothes I should prepare.
- How to observe temperature and precipitation in Antarctica
- Why does it rain every day in Ezhou?
- Is it cold in September in Hunan lunar calendar?
- Weather in Pingwu, Mianyang County
- Poems describing the night view of Taierzhuang ancient city
- California is the first choice for studying in the United States. Why do you think of California?
- The weather in Daocheng in June
- Is the weather in Hubei bad?
- Excellent composition with photos