- 期刊
睪丸附件扭轉
Torsion of the Appendix Testis
摘要
急性睪丸疼痛的鑑別診斷包括精索扭轉、睪丸附件扭轉、精液囊腫扭轉、副睪丸炎、睪丸炎、外傷、疝氣或腫瘤等。其中睪丸附件扭轉是可以早期治療，快速復原的疾病。過年5年中我們經歷了5個睪丸附件扭轉的病例，其平均年齡為11歲(9歲至13歲)，左側3例，右側2例，患者皆因突發性陰囊疼痛而就診，平均疼痛時間為4天(2至7天)。5例小孩，尿液檢查正常。血液白血球數目正常，無明顯感染現象。彩色都卜勒超音波及核子醫學掃描檢查結果模稜可。因與精索扭轉無法確定鑑別診斷。5例均手術探查。術中切除扭轉之睪丸附件，術後患者疼痛改善顯著，均於手術後隔日出院。病理報告為充血及廣泛出血性壞死。由經驗而知，睪丸附件扭轉者，疼痛部位為局部性，疼痛形式較持續性，大都無法全身性症狀。手術治療效果效果良好。本研究認為雖有許多實驗室方法可以榔檢查急性陰病痛，但並無單一有效的方法可以完全正確分辨出這些疾病。延遲治療可能造成不可回覆的睪丸傷害，因此急性陰囊疼痛在排除感染的可能性後，不確定的情況下，儘早手術探查是合理的措施。
關鍵字
無資料並列摘要
The differential dignosis of an catue scrotum includes spermatic cord torsion, torsion of a testicular appendage, torsion of spermatocele, epididymitis, orchitis, trauma, hernia, testicular segmetal infraction and tumor. Among these, torsion of appendix tesis could got dramatic improvement if accurately diagnosed and treated. 5 patients of torsion of appendix testis have been identified in our hospital in the recent 5 years. Ages ranged from 9 to 13 years old(mean age 11). The lesions were on the right side in 2 cases and left sidw in 3 cases. Duration of scrotal pain ranged from 2 to 7 days (mean of 4 days). The urine analyses were normal in all cases. The white blood counts were all within normal limits with mean of 5.72 X 10/ul. No abnormality in passing urine or other infectous sign could be detected. Doppler ultrasonography or nuclear medicine testicular scan were performed selectively due to clinical availability. The result was equivoccal and did not support a definite diagnosis. All 5 cases received surgical treatment. The necrotic testicular appendix was excised and reactive hydrocele treated. All the patients were discharged from the hospital the day after operation and recovered quickly. The pathological report revealed congestion and extensive hemorrhagic necrosis of the testicular appendix. Advances in technology have been helpful in improving the accuracy of dignosis but technology is not infallible and an over reliance on it can also result in misdiagnosis. Various reports supporting the use of acute scrotum pain . ultrasonography has definitely helped in detecting scrotal pathology but its limitations need to be appreciated. Because of the difficulty of making an accurate diagnosis in acute scrotum, misdiagnosis and delayed operation offer result in disappointment of testis salvage rates. We have supported a policy of early scrotal exploration in any case suspicious of torsion of appendix testis.
延伸閱讀
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