片側精巣捻転症の臨床的検討と精巣固定術例における両側精巣の解剖学的比較検討

Abstract

片側精巣捻転症の臨床的検討と精巣固定術例における両側精巣を解剖学的に比較検討した.対象は, 手術を行った片側精巣捻転症例48例であった.好発年齢は10歳代が29例と大部分を占め, 40歳以上には認めず, 捻転側は左33例, 右15例であった.主訴は陰嚢痛, 下腹部痛が多く, 陰嚢所見は発症後8時間以内では仰臥位で精巣が体軸と直角方向の変位が多かった.そして時間の経過に伴って陰嚢内容の腫脹, 陰嚢の浮腫, 発赤が加わり, 回転は左右どちら側も時計方向・反時計方向とも360度回転が多かった.治療は48例中20例に固定術, 28例に摘出術を施行した.48例中5例に徒手整復を試み3例で成功し, 7例では整復せず回転が元に戻り固定できた.精索や精巣と鞘膜の関係はすべてBell-clapper typeであった.精巣固定できた20例では, 捻転側と反対側の精巣構造が同じ形が13例, 異なる形が7例であった

Fourty-eight patients were operated on for unilateral intravaginal testicular torsion at Yokohama Red Cross Hospital during the period between July 1976 and December 2001. Orchiopexy was carried out on 20 out of 48 patients. Only 8 patients could receive orchiopexy within 8 hours after the onset of symptoms. Although, 24 of the 48 patients had visited a medical doctor within 8 hours after the onset. Therefore, the less the testes might be sacrificed if these patients could be immediately sent to a clinic with an urologic speciality. The contralateral uninvolved testis has been said to require orchiopexy because it has an anatomical structure similar to the testis with torsion. However, the contralateral testes in 5 out of 20 patients with ipsilateral orchiopexy turned out to have a normal anatomical structure according to our classification of intravaginal testicular torsion. This suggests that no orchiopexy is necessary if the contralateral uninvolved testis has a normal anatomical structure from the standpoint of torsion type.