以急性腹痛为首发症状的青少年及幼儿睾丸扭转临床分析  

Clinical analysis of testicular torsion with the primary symptom of abdominal pain in adolescents and boys

作　　者：王富军[1] 韩哲[1] 

机构地区：[1]山东省菏泽市立医院泌尿外科,274000

出　　处：《中华泌尿外科杂志》2015年第6期454-457,共4页Chinese Journal of Urology

摘　　要：目的：探讨以急性腹痛为首发症状的睾丸扭转患者的特点。方法回顾性分析1998年10月至2014年5月8例以急性腹痛为主要首发症状，且早期无明显阴囊疼痛的睾丸扭转患者的临床表现。年龄3～16岁，平均12岁。均以急性下腹痛为主要首发症状，其中伴有呕吐4例，腹股沟区疼痛2例，发热1例。外生殖器检查患侧阴囊皮肤红肿，睾丸呈横位并触痛，牵拉睾丸时腹痛加剧。行彩色多普勒超声检查发现睾丸血运减少或消失。结果8例患者中5例首诊未查外生殖器，复诊怀疑睾丸扭转，手术探查见睾丸坏死，行睾丸切除；3例首诊行外生殖器检查发现阴囊及睾丸异常，急诊彩色多普勒超声检查示睾丸血运异常，手术探查见睾丸扭转，复位后观察睾丸血运恢复，保留了睾丸。睾丸保留组自症状发作至手术的平均时间为4 h，睾丸切除组为28 h。随访10～36个月，平均18个月。睾丸保留组患者1例睾丸萎缩，2例睾丸血运良好。5例睾丸切除组未出现严重并发症。结论在青少年及幼儿男性急性下腹疼痛的鉴别诊断中，应考虑睾丸扭转，应将外生殖器检查列入常规检查。Objective To evaluate the characteristics of the testicular torsion patients with the first symptom of acute abdominal pain.Methods From October 1998 to May 2014, 8 adolescent or boys with testicular torsion presenting acute abdominal pain instead of scrotal pain as their primary symptom were retrospectively reviewed.The average age was 12 （3-16） years.An acute abdominal pain presented firstly in all cases, which accompanied by nausea and vomiting in 4 cases, groin pain in 2 cases, fever in 1 case. In genital examination, the scrotum skin was red and swollen, while the testis was in transverse position and tenderness.The testicular and homolateral abdominal pain got worse when we pulled the involved testis. Doppler ultrasound examination revealed that the blood supply of the involved testis decreased or disappeared.Results In the 8 cases, 5 cases were not examined their testicles or scrotum during the first evaluation, which were found the testicular necrosis during the following exploratory surgery, and orchidectomy was performed. In the other 3 cases, external genital were examined during the first evaluation, and the scrotal and testicular abnormalities were detected.Doppler ultrasonography showed abnormality in testicular blood supply.Testicular torsion was proved during the emergent operation, and the 3 testes were salvaged.The mean duration time from symptom onset to operation was 4 h in the salvaged group, while the average time was 28 h in the orchiectomy group.The mean follow-up time was 18 （ 10-36） months.In the 3 cases whose testis was saved, 1 affected testis was atrophied, and the blood supply of the other two was good.No severe complications occurred in the other 5 cases.Conclusions Testicular torsion should be considered in adolescents and boys with acute lower abdominal pain.The routine external genital examination should be performed when a boy or adolescent complains of abdominal pain.

关 键 词：睾丸扭转 青少年及幼儿 急性腹痛 急性阴囊疼痛 

分 类 号：R726.9[医药卫生—儿科]