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成人阴囊急症的评估

Author
Robert C Eyre, MD
Section Editor
Michael P O'Leary, MD, MPH
Deputy Editor
Lee Park, MD, MPH
Translators
陈合群, 主任医师，教授

引言

一系列的病况可累及阴囊及其内容物，从仅需要对患者进行安慰的偶然发现到需要立即进行手术干预的急性病理性事件不等。

本专题将总结阴囊急症的临床评估和治疗。成人非急性阴囊病变和儿童阴囊疾病将单独详细讨论。 (参见“成年男性非急性阴囊病变的评估”和“儿童及青少年阴囊疼痛或肿胀的评估”)

正常解剖

睾丸、鞘膜、附睾、精索和睾丸附件是重要的解剖结构，急性阴囊病变可能会累及这些结构(图 1)：

  • 睾丸是男性的性腺，负责产生精子和雄激素(主要是睾酮)。
  • 睾丸鞘膜是一个包绕睾丸前2/3的潜在腔隙。鞘膜中可能蓄积不同类型的液体(即，鞘膜积液、鞘膜积血和鞘膜积脓)。
  • 附睾是紧密卷曲的管状结构，位于睾丸后部，从上极走行至下极。精子从睾丸网的小管进入附睾，附睾最终连接输精管。附睾的功能是帮助存储和运输睾丸产生的精子细胞，并促进精子的成熟。
  • 精索由睾丸血管和输精管组成，精索连接附睾基底部，并进入腹部。
  • 睾丸附件是位于睾丸前上部的小型残余结构(苗勒管系统的胚胎残余物)(图 2)，大小约0.3cm，它的蒂状外形使其容易扭转，尤其是在儿童时期。

评估

阴囊急症评估的最重要目的是识别出任何需要立即手术干预的泌尿系急症。泌尿系急症手术干预延迟可导致睾丸丧失、不育以及其他严重并发症。成人急性阴囊疼痛中最常见的泌尿系急症包括睾丸扭转、严重感染性附睾炎以及Fournier坏疽(会阴坏死性筋膜炎)。 (参见下文‘睾丸扭转’和‘附睾炎’和“坏死性软组织感染”)

                           

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Literature review current through: 2017-06 . | This topic last updated: 2016-04-07.
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