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儿童及青少年阴囊疼痛的原因

Authors
Joel S Brenner, MD, MPH
Aderonke Ojo, MD
Section Editors
Amy B Middleman, MD, MPH, MS Ed
Gary R Fleisher, MD
Laurence S Baskin, MD, FAAP
Deputy Editor
James F Wiley, II, MD, MPH
Translators
胡鹏, 副主任医师，副教授

引言

影响阴囊及其内容物的情况有很多种，有的只是偶然发现，有的则是需要迅速诊断及治疗的病理事件，如睾丸扭转、睾丸癌。儿童及青少年急性阴囊疼痛最常见的原因包括：睾丸扭转、睾丸附件扭转和附睾炎。一项回顾性研究在两年期间，纳入了238例0-19岁因急性阴囊疼痛就诊于儿童医院的连续男孩患者，其中16%有睾丸扭转，46%有睾丸附件扭转，35%有附睾炎[1]。

本文将总结阴囊疼痛的原因。阴囊疼痛或肿胀的评估，以及阴囊肿胀的原因将单独讨论。 (参见“儿童及青少年阴囊疼痛或肿胀的评估”和“儿童及青少年无痛性阴囊肿胀的原因”)

睾丸扭转

睾丸扭转是最显著和可能最严重的影响阴囊内容物的急性病变，因为其可导致睾丸失功。正常睾丸解剖如图所示(图 1)。

睾丸通过睾丸引带与睾丸鞘膜固定不充分，可导致鞘膜内扭转。伴有睾丸扭转的最常见异常被称为“睾丸钟摆畸形”：睾丸与睾丸鞘膜缺少正常连接(睾丸活动度增加)，并在阴囊内处于横向位置(图 2)[2]。“睾丸钟摆畸形”可能是双侧的并且易发睾丸扭转。

如果睾丸下极固定于睾丸鞘膜的基底不够宽或无固定，则睾丸可能在精索上发生扭转(图 3)。睾丸鞘膜内精索扭转可导致静脉受压并继发睾丸和精索水肿，并最终由动脉闭塞引起睾丸缺血[2,3]。

                        

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-20.
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