突然腹痛，小心睾丸扭转而“扯蛋”

牛大夫

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[{"text":"<h3>近日，连续两例突然腹痛的患儿，因基层或非专业医师缺乏对\"睾丸扭转\"了解和认识，导致患儿不得不做一侧睾丸切除手术。造成终身遗憾！<\/h3>"},{"text":"<h3>日常生活中，不少患者对睾丸扭转麻痹大意，疼痛时一忍再忍，以致延误了早期治疗，个别人因此丧失生育能力，酿成终生不幸。因此，青春期及其前后的患者如突然出现阴囊肿胀、疼痛，尤其是青少年，应考虑到睾丸扭转的可能，要及时去医院泌尿外科检查诊治。此外，如果不幸发生睾丸扭转，治疗后要请医生做精液常规检查，以了解病侧睾丸及对侧睾丸的功能，这一点对未婚男青年显得更为重要。<\/h3>"},{"img_height":470,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/9709472\/51d9f7cd24964310bcc37a6f201023c2__jpg.heic","img_width":474,"watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvOTcwOTQ3Mi81MWQ5ZjdjZDI0OTY0MzEwYmNjMzdhNmYyMDEwMjNjMl9fanBnLmhlaWM=\/nickname\/54mb5aSn5aSr\/userid\/OTcwOTQ3Mg==\/sign\/2ff8423c99ce7e1f8fe0955818840029"},{"text":"<h3>什么是睾丸扭转？临床表现常见症状是什么？<\/h3><h3>睾丸通过睾丸系膜与阴囊相连，由睾丸系膜将睾丸固定于阴囊。有的胎儿在发育时会产生一侧或两侧睾丸系膜过长，出生后，睾丸与精索的活动度就很大，如果突然遇上用力或猛烈震荡等情况，睾丸与精索就会发生一定程度的扭转，也叫精索扭转。<\/h3><h3>临床表现：<\/h3><h3>1.腹部突然出现剧痛。<\/h3><h3>2.睾丸出现剧痛。<\/h3><h3>3.发生扭转的睾丸在阴囊内的位置显得较正常睾丸高一些。<\/h3><h3>4.患儿可能会出现恶心、呕吐。<\/h3><h3>5.症状出现数小时后，阴囊会红肿、触痛。<\/h3>"},{"img_height":1100,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/9709472\/b7bd9eef18fc4f81a0abbbc280b601a7__jpg.heic","img_width":1200,"watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvOTcwOTQ3Mi9iN2JkOWVlZjE4ZmM0ZjgxYTBhYmJiYzI4MGI2MDFhN19fanBnLmhlaWM=\/nickname\/54mb5aSn5aSr\/userid\/OTcwOTQ3Mg==\/sign\/2ff8423c99ce7e1f8fe0955818840029"},{"text":"<h3>诊断：<\/h3><h3>1.常见于青少年，而18岁以下青少年除了急性腮腺炎、睾丸炎以外发生附睾睾丸炎的机会较少。青少年阴囊急症应首先考虑睾丸扭转。<\/h3><h3>2.很多患者为睡眠中或剧烈活动后发病，睾丸扭转40%左右发生于安静或睡眠中。可能于睡眠时迷走神经兴奋，提睾肌收缩频率增加，睡眠中不断改变姿势或挤压睾丸造成扭转；<\/h3><h3>3.一般疼痛在前，渐进性睾丸或附睾肿大在后；<\/h3><h3>4.<72h患者多数无发热；<\/h3><h3>5.既往有类似疼痛发作史，持续时间短，一旦扭转复位后疼痛立即消失；<\/h3><h3>6.发病早期常因提睾肌痉挛而精索缩短，睾丸向上移位或呈横位或附睾位置异常；<\/h3><h3>7.托起阴囊，疼痛不减轻反而加重<\/h3><h3>8.提睾肌反射消失：是诊断睾丸扭转最敏感的指标，提睾反射存在可排除睾丸扭转<\/h3><h3>9.彩色多普勒检查CDFI检查有特异性<\/h3>"},{"img_height":1600,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/9709472\/66eb725b3f5a4840a47ff9f2d9f1e148__jpg.heic","img_width":1200,"watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvOTcwOTQ3Mi82NmViNzI1YjNmNWE0ODQwYTQ3ZmY5ZjJkOWYxZTE0OF9fanBnLmhlaWM=\/nickname\/54mb5aSn5aSr\/userid\/OTcwOTQ3Mg==\/sign\/2ff8423c99ce7e1f8fe0955818840029"},{"text":"<h3>治疗<\/h3><h3>复位越早越好，对睾丸扭转的治疗要争分夺秒，一旦确诊或高度怀疑本病时应迅速果断地实施探查术，以保留和挽救睾丸，保护生精功能。<\/h3>"},{"img_height":900,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/9709472\/948a4930ffb544f2acab8d0cd37ef0ea__jpg.heic","img_width":1200,"watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvOTcwOTQ3Mi85NDhhNDkzMGZmYjU0NGYyYWNhYjhkMGNkMzdlZjBlYV9fanBnLmhlaWM=\/nickname\/54mb5aSn5aSr\/userid\/OTcwOTQ3Mg==\/sign\/2ff8423c99ce7e1f8fe0955818840029"},{"text":"<h3>手法复位<\/h3><h3>有人认为，在积极术前准备的同时，可试行手法复位，更能快捷的解救缺血的睾丸，挽救睾丸功能，为手术复位赢得时间。但超过6h的扭转由于睾丸附睾出现不同程度的肿大、淤血，精索扭转处增粗、水肿，甚至发生粘连，故不宜手法复位。行手法复位时要准确判断扭转的方向和程度。否则会加重和延误病情。一般左侧睾丸多为逆时针方向扭转，右侧多为顺时针方向扭转。一旦复位方向正确，复位成功，能迅速恢复睾丸血运，患者局部疼痛可很快减轻或消失。不论复位成功与否，都应立即施行手术复位或固定术。<\/h3>"},{"img_height":1328,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/9709472\/7f47823c44024a73b7f599321c620fd6__jpg.heic","img_width":1200,"watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvOTcwOTQ3Mi83ZjQ3ODIzYzQ0MDI0YTczYjdmNTk5MzIxYzYyMGZkNl9fanBnLmhlaWM=\/nickname\/54mb5aSn5aSr\/userid\/OTcwOTQ3Mg==\/sign\/2ff8423c99ce7e1f8fe0955818840029"},{"text":"<h3>手术治疗：<\/h3><h3>1.睾丸固定：术中探查复位，如睾丸白膜无缺血性改变，切除部分鞘膜，将睾丸前、后、下各固定1针，精索与外周组织固定2针。<\/h3><h3>2.部分切除：对白膜呈紫斑点状的，可试行切开白膜向睾丸门方向逐步剔除坏死组织，如遇到有新鲜出血即可留下残留组织<\/h3><h3>3.行睾丸切除时在白膜内切除坏死组织，保留白膜等残留结构，减轻患者的心理负担。 <\/h3>"},{"img_height":622,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/9709472\/fbb71a84f7704549bd0f5b5efad2478a__jpg.heic","img_width":1200,"watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvOTcwOTQ3Mi9mYmI3MWE4NGY3NzA0NTQ5YmQwZjViNWVmYWQyNDc4YV9fanBnLmhlaWM=\/nickname\/54mb5aSn5aSr\/userid\/OTcwOTQ3Mg==\/sign\/2ff8423c99ce7e1f8fe0955818840029"},{"text":"<h3>遵循原则：<\/h3><h3>1.睾丸生机判断不清时一律切除；<\/h3><h3>2.扭转时间>24h者一律切除；<\/h3><h3>3.扭转>360°、时间>12h或扭转>720°、时间>6h者一律切除。<\/h3>"},{"img_height":458,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/9709472\/6792f450faac4e7eb4af24b21b65ee44__jpg.heic","img_width":538,"watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvOTcwOTQ3Mi82NzkyZjQ1MGZhYWM0ZTdlYjRhZjI0YjIxYjY1ZWU0NF9fanBnLmhlaWM=\/nickname\/54mb5aSn5aSr\/userid\/OTcwOTQ3Mg==\/sign\/2ff8423c99ce7e1f8fe0955818840029"},{"text":"<h3>睾丸存活的判断：<\/h3><h3>睾丸扭转后如何判断睾丸是否存活 ：与扭转时间有关： <\/h3><h3>扭转发生６小时内手术，睾丸存活率１００％； <\/h3><h3>扭转发生后６－１２小时手术，睾丸存活率７０％； <\/h3><h3>扭转发生后１２－２４小时手术，睾丸存活率２０％； <\/h3><h3>睾丸扭转发生２４小时以上手术，睾丸多无存活可能．<\/h3><h3>睾丸扭转所致的睾丸缺血坏死，不仅与扭转程度有关，还与扭转持续的时间有关。持续扭转90°、180°、360°和720°时发生睾丸坏死的时间分别为7d、3-4d、12-24h和2h。<\/h3><h3>一般睾丸扭转在10h以内复位者，睾丸可存活，无严重不良后果，24h内复位者约半数可恢复睾丸功能，超过24h者多不可避免发生睾丸坏死、萎缩。当睾丸扭转.>360°，且>24h者最终均导致睾丸坏死。 <\/h3>"},{"text":"<h3>研究表明，睾丸缺血6h即对生精功能产生严重损害，而更严重的是，它还可以引起对侧睾丸细胞凋亡，并诱导产生抗精子抗体，而使精子数量减少，精液质量下降，影响生育能力，且影响程度与睾丸坏死情况，扭转时间呈正相关。因此对生育力有要求者要放宽睾丸切除的适应证。 <\/h3>"},{"img_height":480,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/9709472\/6f66e661bec74d7d8e88b6dc81ddd601__jpg.heic","img_width":566,"watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvOTcwOTQ3Mi82ZjY2ZTY2MWJlYzc0ZDdkOGU4OGI2ZGM4MWRkZDYwMV9fanBnLmhlaWM=\/nickname\/54mb5aSn5aSr\/userid\/OTcwOTQ3Mg==\/sign\/2ff8423c99ce7e1f8fe0955818840029"},{"img_height":894,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/9709472\/5d5aa8a331234a4f902ef426501b74a0__jpg.heic","img_width":1024,"watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvOTcwOTQ3Mi81ZDVhYThhMzMxMjM0YTRmOTAyZWY0MjY1MDFiNzRhMF9fanBnLmhlaWM=\/nickname\/54mb5aSn5aSr\/userid\/OTcwOTQ3Mg==\/sign\/2ff8423c99ce7e1f8fe0955818840029"},{"img_height":872,"img_url":"https:\/\/ss-mpvolc.meipian.me\/users\/9709472\/948f83066fb749049857a893071dee24__jpg.heic","img_width":656,"watermark":"?meipian-watermark\/bucket\/ivwen\/key\/dXNlcnMvOTcwOTQ3Mi85NDhmODMwNjZmYjc0OTA0OTg1N2E4OTMwNzFkZWUyNF9fanBnLmhlaWM=\/nickname\/54mb5aSn5aSr\/userid\/OTcwOTQ3Mg==\/sign\/2ff8423c99ce7e1f8fe0955818840029"}]