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儿童及青少年的阴囊创伤

Author
Catherine E Perron, MD
Section Editor
Susan B Torrey, MD
Deputy Editor
James F Wiley, II, MD, MPH
Translators
欧善际, 主任医师，教授

引言

在男孩中，对阴囊的大部分损伤是由运动或者骑跨伤造成，而且通常不会导致严重损伤[1]。由于青春期前睾丸的大小较小并具有可移动性，穿透性损伤引起的睾丸损伤不常见于这一年龄组。在青少年和年轻男性中，对睾丸活力构成显著威胁的穿透性阴囊损伤更为普遍。阴囊损伤的范围从轻度局部水肿和浅表撕裂伤到具有失去可能的睾丸破裂均有。

本文将讨论儿童阴囊创伤的评估和处理。儿童及青少年的泌尿生殖系统钝挫伤、骑跨伤和阴囊疼痛的内科病因及其评估将单独讨论。 (参见“儿童骑跨伤的评估和处理”和“泌尿生殖系统钝挫伤：初步评估和治疗”和“儿童及青少年阴囊疼痛或肿胀的评估”和“儿童及青少年阴囊疼痛的原因”)

流行病学

在儿童及青少年中严重阴囊创伤罕见。闭合性阴囊损伤最常见发生于6-12岁的男孩，并具有典型机制，包括跌倒或运动时被踢以及因自行车或机动车辆碰撞(motor vehicle collisions, MVC)造成的损伤[2]。在年幼儿童和幼儿中(年龄小于6岁)，阴囊损伤主要源于跌倒或马桶座圈。在青少年男性中也会发生与运动和跌倒相关的损伤，但由机动车辆事故和受袭造成的伴有阴囊损伤的多发性创伤也是一个重要病因。闭合性阴囊损伤通常为单侧损伤，并涉及阴囊内容物撞到耻骨而造成的压迫[3]。

儿童中并不常见穿透性阴囊损伤，但其发生可源于自行车车把(撞击)、跌倒并戳伤以及动物咬伤[4,5]。在青少年和年轻成人中，枪弹伤占据大部分穿透性损伤[6]。刺伤也被介绍过，包括自阉性残伤和人或动物咬伤。

解剖学

阴囊的解剖 — 应当将阴囊的解剖当作一个分层的结构。阴囊是一个含有睾丸和部分精索的囊。它为睾丸提供两个分离的腔。这两个腔在中缝处相连，即从阴茎背侧向肛门延伸的阴囊突出部分。阴囊的分层包括皮肤和肉膜，后者是一层为两个阴囊腔提供隔膜并形成阴囊最外筋膜层的肌层(图 1)。

                 

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Literature review current through: 2017-06 . | This topic last updated: 2016-09-23.
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