小儿IgA血管炎导致睾丸坏死2例报告及文献复习  

Pediatric IgA vasculitis causes testicular necrosis:report of 2 cases and literature review

作　　者：姚逸凡 刘雨杭 宁峰[2] 陈卫坚[2] 龙兴宇 何军[2] Yao Yifan;Liu Yuhang;Ning Feng;Chen Weijian;Long Xingyu;He Jun(The School of Pediatrics,University of South China(Hunan Children’s Hospital),Changsha 410007,Hunan,China;Department of Urology,Hunan Children’s Hospital,Changsha 410007,Hunan,China)

机构地区：[1]南华大学儿科学院(湖南省儿童医院),湖南长沙410007 [2]湖南省儿童医院泌尿外科,湖南长沙410007

出　　处：《中国男科学杂志》2023年第6期114-117,共4页Chinese Journal of Andrology

基　　金：腹腔镜Fowler-Stephens I期手术治疗小儿高位隐睾的临床疗效研究(2021SK50517)。

摘　　要：目的 总结我院2例小儿免疫球蛋白(IgA)血管炎导致睾丸坏死病例的诊疗过程,为诊断及治疗这类罕见情况提供临床参考。方法 2022年10月—11月我院收治2例IgA血管炎男性患儿,年龄分别为4岁2月和6岁6月,1例因出现腹痛、皮疹入院,经治疗症状减轻,入院第3天出现阴囊红肿,超声提示右侧睾丸无彩色血流信号,经手术探查证实睾丸缺血坏死;另1例有IgA血管炎病史,经治疗出院后因阴囊肿痛再次入院,彩超提示右侧睾丸占位,手术探查证实右侧睾丸坏死,无肿瘤组织。结果 两例患儿缺血坏死的睾丸均切除,病例1的病理提示:IgA血管炎累积精索、附睾、睾丸实质等多部位血管,尤其破坏静脉血管导致睾丸淤血坏死。免疫组化:睾丸、附睾、精索组织IgA(2+)。病例2的病理提示:镜下见较多坏死的生精小管残影,周边散在生精小管结构,伴有少量毛细血管增生,间质内散在淋巴细胞浸润,血管壁完整,未见纤维素样坏死。免疫组化:IgA(+)。结论 IgA血管炎导致的睾丸坏死罕见,且发病隐匿,在临床中容易误诊和漏诊。应尽早监测,及时改善睾丸血运,避免睾丸坏死。Objective To summarize the diagnosis and treatment of two cases of testicular necrosis caused by pediatric IgA vasculitis,and provide clinical reference for such rare cases.Methods Two male children with IgA vasculitis who aged 4 and 6 respectively were hospitalized from October to November 2022.One patient was admitted to the hospital due to abdominal pain and rash.After treatment,the symptoms were reduced,and the scrotal swelling appeared on the 3rd day of admission,ultrasound suggested that the right testiticle had no color blood flow signal,and testicular ischemia and necrosis was confirmed by surgical exploration.Another had a history of IgA vasculitis,and color ultrasound indicated that right testicular space was occupied,and surgical exploration proved right testicular necrosis and no tumor tissue.Results Ischemic necrotic testis of two patients were all removed.The pathology results of case 1 indicated that IgA vasculitis accumulated spermatic cord,epididymis,testicular parenchyma and other blood vessels,especially destroyed venous vessels,resulting in testicular congestion and necrosis.Immunohistochemistry:IgA(2+)in testis,epididymis and spermatic cord tissues.The pathological results of case 2 indicated that more necrotic seminiferous tubular remnant,scattered seminiferous tubular structure,with a few capillary hyperplasia,scattered lymphocyte infiltration in the interstitium, intact vascular wall, and no celluloid necrosis. Immunohistochemistry: weakly positive for IgA.Conclusion Testicular necrosis caused by IgA vasculitis is rare and insidious, which is easy to misdiagnosis and missdiagnosis in clinical practice. We should monitor it as soon as possible and improve the testicular blood transport in timeto avoid testicular necrosis.

关 键 词：免疫球蛋白血管炎 过敏性紫癜 睾丸坏死 睾丸缺血 

分 类 号：R697.22[医药卫生—泌尿科学]