新生兒陰囊睪丸疾病之診斷

Diagnosis of Scrotal and Testicular Lesions in Newborn

江正德(Chen-Te Chiang) ； 蔡炳照(Peeng-Jau Tsai)

《Acta Paediatrica Sinica》 14卷1期 (1973/03) Pp. 13-17

摘要

新生兒之陰囊與睪丸疾病主要包括㈠精索扭轉或睪丸扭轉。㈡陰囊膿腫㈢睪丸腫瘍㈣少見有趣之病例㈤水囊腫，腹股溝赫尼亞、未降睪丸，假性半陰陽人等五項。對新生兒陰囊疾病之診斷首先我們要有一詳盡之病史，包括母親懷孕之經過與生產之過程情形。對局部之檢查包括視診與觸診，看有無畸型、腫大、顏色之變化，有無硬塊，壓痛感或波動點。Trans-illumination Test與指診(Digital Examination)有時有助診斷。有時要做局部之穿刺如第二病例在波動點刺得膿液可診斷爲陰囊膿腫，又如得血液如第五病例可證明腹膜腔積血(Hemoperitoneum)腹部X在診斷上很重要，尤其是全身性疾病引起陰囊之病變，腹部X光更是不可缺少。如第四例胃穿孔可見膈膜下自由空氣或Football Sign，有腸阻塞則見其他特徵。而在陰囊中所見之自由空氣則須與赫尼亞之腸內空氣區別，如第五病例腹腔內出血可見腹部廣泛之糢糊如腹部積水(Ascites)之顯像，第六例新生兒急性闌尾炎更有賴腹部X光之幫助診斷如前討論所述。新生兒陰囊疾病有時不只是局部之病變而是全身疾病之一徵候，又新生兒異於較大嬰兒：常常不易顯出全身症狀，而一旦病狀出現如發燒、嘔吐、腹瀉、呼吸困難等則已是嚴重垂危之信號，所以我們主張一般的常規檢查男性新生兒時應包括檢查其外陰部陰囊、睪丸腹股溝等處資能得早期治療。

並列摘要

In the past three years, we have encountered five different categories of testicular lesions of the neonates namely 1) torsion of the testicle or spermatic cord, 2) scrotal abscess, 3) testicular tumor, 4) testicular lesion related to intraabdominal condition, 5) hernia and undescended testis. Except the last entity which are commonly seen, we illustrated with the case and then discussed the diagnostic approach and treatment. Finally we made a comment on the case.
In taking care of the newborn baby, a routine examination of the testicular area for every male infant should be made. In case a male neonate presented himself with a swelling scrotum or testicle, a detail history (including maternal history delivery course, postnatal history) as well as thorough physical examination should be carried out to differentiate the possible pathology invoved. Local examination includes; inspect the color change of scrotum, palpate the size and location of the mass, detect the fluctuation and tenderness, examine the patency of the inguinal canal, and a rectal examination to rule out the possible intraabdominal pathology. In addition, transilluminate the tumor, tape the mass if it is fluctuate. X-ray of the abdomen will offer important information as demonstrated by the case examples given.
We wish to emphasize that the discovered lesion of testicle could be a sole sign of systemic disease, particulary a sign of intraabdominal condition. For examples free air seen inside the scrotum because of gastrointestinal perforation, a purpurish discoloration of scrotum due to intraabdominal hemorrhage, a swelling tender mass because of ruptured appendicitis descended into the scrotum are good examples to be emphasized the relation.