慢性睾丸痛的诊断与治疗

慢性睾丸痛是泌尿男科的常见疾病,其病因复杂、诊断困难、治疗棘手。依据不同的病因,慢性睾丸痛可分为特发性和继发性,特发性慢性睾丸痛约占慢性睾丸痛的50%,其可能与精索神经的华勒变性及外周致敏有关;继发性慢性睾丸痛能找到引起疼痛的直接病因,治疗主要针对解决原发病进行。目前治疗慢性睾丸痛的主要方法包括保守治疗和手术治疗,其中显微精索去神经术是一微创、有效的治疗慢性睾丸痛的手术方法,而睾丸切除术应当作为不得已的治疗手段。     

精索显微去神经术治疗慢性睾丸痛1例报告并文献复习

目的：探讨慢性睾丸痛（CTP）的临床特点和诊治方法。方法：报告1例CTP患者的临床资料,患者输精管结扎术后多年双侧CTP,左侧附睾切除后仍无缓解。术前疼痛视觉模拟评分（VAS）：左侧睾丸疼痛8分,右侧4分。人院后接受左侧精索显微去神经术（MDSC）＋右侧输精管再通术。结果：术后随访1年VAS评分：左侧睾丸疼痛2分,右侧0分,患者恢复正常生活工作。结论：MDSC通过切断髂腹股沟神经和精索内相关神经,来阻断睾丸疼痛信号的传导,在特发性或难治性CTP的治疗中值得推荐。     

显微镜下精索去神经术治疗难治性睾丸痛的临床观察与分析

目的:显微镜下精索去神经术是一种用于治疗难治性睾丸痛的治疗方式。有研究证实,精索相关神经纤维脱髓鞘是慢性睾丸痛(CO)的可能原因。方法:回顾性分析2014年8月～2018年2月我院28例行显微镜下精索去神经术患者的临床资料。入选标准为慢性睾丸疼痛持续3个月以上,保守治疗失败,神经和泌尿系统检查无阳性发现,且局部麻醉精索后疼痛暂时缓解,最终行显微镜下精索去神经手术。采用主观视觉模拟评分法(VAS)评估术前和术后疼痛,并使用客观标准化和验证的疼痛影响问卷-6(PIQ-6)分数。结果:成功随访28例患者,随访1年25例(89.3%)VAS提示疼痛显著减轻,其中15例(53.6%)疼痛完全缓解;3例(10.7%)无显著疼痛改变。PIQ-6评分显示,随访3个月19例(67.9%)患者有效疼痛缓解;术后6个月22例(78.6%)患者有效疼痛缓解,术后1年、2年均为23例(82.1%)患者有效疼痛缓解。结论:显微镜下精索去神经手术治疗是一种有效地治疗难治性CO的微创方法。     

慢性睾丸痛56例诊治体会

对2001年4月～2005年5月我院门诊以慢性睾丸痛就诊的患者资料进行回顾性分析,并对其发病原因、诊断和治疗方法进行探讨,现报告如下.     

精素静脉曲张性慢性睾丸痛的显微外科治疗

目的 探讨精索静脉曲张性慢性睾丸痛的显微外科治疗的疗效和安全性. 方法 分析2010年9月至2012年6月期间收治的37例精索静脉曲张性慢性睾丸痛患者的临床资料,表现为阴囊坠胀不适、隐痛和钝痛;17例合并不育或少弱精症.采用腹股沟下显微精索静脉结扎术.术后每3个月复查精液进行疼痛评分和复查精液常规.每6个月行B超检查. 结果 术后随访12个月,睾丸疼痛完全消失32例,明显减轻4例,无效1例.未见复发、睾丸萎缩和鞘膜积液发生. 结论 显微外科技术治疗精索静脉曲张性慢性睾丸痛微创、安全和有效.     

精索形态观察在睾丸扭转早期诊治中的意义

目的:提高睾丸扭转早期的诊断和治疗水平。方法:回顾性分析49例睾丸扭转的临床资料及睾丸内血流声像图和精索超声特征。结果:49例睾丸扭转患者,彩色多普勒血流显像出现睾丸血流改变42例,其中血流增加3例,睾丸血流无明显改变7例;二维超声检查发现精索形态异常47例。手术复位固定21例,睾丸存活12例。结论:彩色多普勒超声扫描精索形态与睾丸血流变化对睾丸扭转的早期诊断有重要价值,尽早手术探查有助于挽救存活睾丸。     

Recurrent torsion after previous testicular fixation

Background : Occasionally patients present with acute testicular pain having undergone a previous testicular fixation for torsion. The aim of this article is to review the literature and determine whether recurrent torsion of the testis is possible and whether the technique used at initial fixation is relevant. Methods : A literature search was performed using MEDLINE, Pre‐MEDLINE, EMBASE and CIANHL databases using the terms ‘spermatic cord torsion’ and ‘testicular torsion’ in combination with ‘treatment failure’, ‘re‐operation’ or ‘recurrence’. Results : Twenty cases of recurrent testicular torsion after fixation are described. Fifteen of the 17 that specified the type of suture used at initial fixation had used absorbable suture. Animal models suggest that to produce dense adhesions at testicular fixation, the tunica vaginalis must be everted behind the testis with or without fixation, before the testis is returned to the scrotum. Without this eversion, the adhesions around the testis are fine and only located at the site of fixation suture. The use of non‐absorbable suture led to abscess formation in 30% of testes in animal models. Conclusions : The higher incidence of recurrent torsion after fixation using absorbable rather than non‐absorbable sutures in the literature may be caused by a greater number of fixations being carried out using absorbable suture. Use of non‐absorbable suture is limited by the high rate of abscess formation. The most important factor for adhesion formation would appear to be the eversion of the tunica vaginalis and it is recommended that this is carried out at all testicular fixations.     

膝骨性关节炎慢性疼痛的机制及其综合治疗进展

膝骨关节炎(KOA)是慢性疼痛最常见的原因之一,其治疗仅限于对乙酰氨基酚、非甾体抗炎药和物理治疗等,全膝关节置换术是解决关节疼痛的最终选择。因此,对于KOA疼痛的产生机制需进一步了解,以希望找到更好的治疗方法。     

慢性骨盆疼痛综合征的诊治

目的　探讨慢性骨盆疼痛综合征 (CPPS)的诊断和治疗。方法　按照NIH分类标准 ,采用PPMT法 ,结合EPS涂片检测和培养结果 ,共筛选出 6 9例患者 ,其中炎症性CPPS(Ⅲa) 15例 ,非炎症性CPPS(Ⅲb) 5 4例。Ⅲa类患者口服广谱抗生素 8周 ,Ⅲb类患者先后或同时应用抗抑郁药、肌肉松弛剂、a受体阻滞剂和镇痛剂 ,同时配合前列腺按摩、中药调理和热水坐浴等综合治疗 12周。结果　前列腺液培养 4 8次 ,支原体感染 5例 ,衣原体感染 3例。治疗 6周前后CPSI症状评分 ,显效 17例 ,有效 4 6例 ,6例无效。31例患者停止治疗 2周 ,16例复发 ;停止治疗 4周 ,2 7例复发 ;停止治疗 6周 ,31例全部复发。结论　综合治疗和治疗个体化对慢性骨盆疼痛综合征有较好疗效 ;坚持用药治疗以降低复发     

腹股沟疝修补术后慢性疼痛的诊治体会

目的 报告腹股沟疝修补术后慢性疼痛的诊治经验.方法 回顾性分析35例腹股沟疝修补术后慢性疼痛患者的临床资料,总结其诊断和治疗经验.结果 28例患者经物理治疗联合药物治疗疼痛缓解;4例经神经阻滞治疗后好转;3例手术治疗,1例神经瘤形成,切除瘤体后将断端植入肌肉后治愈,1例补片移位,1例补片内环口固定过紧,皆经手术清除补片和周围瘢痕组织而治愈.结论 疝修补术后慢性疼痛要早期积极治疗,应先行理疗、药物治疗或神经阻滞等保守治疗,疗效差者或疼痛程度严重者才考虑手术治疗.     

Rectus sheath block: successful use in the chronic pain management of pediatric abdominal wall pain

Seven pediatric patients (aged 11-16 years) with chronic abdominal wall pain are presented who gained significant relief from a rectus sheath block (RSB). We describe the case histories and review the relevant literature for this technique. The etiology of the abdominal wall pain was considered to be abdominal cutaneous nerve entrapment, iatrogenic peripheral nerve injury, myofascial pain syndrome or was unknown. All patients showed significant initial improvement in pain and quality of life. Three patients required only the RSB to enable them to be pain-free and return to normal schooling and physical activities. Two children received complete relief for more than 1 year. In the majority of cases, the procedure was carried out under general anesthesia as a daycase procedure. Local anesthetic and steroids were used. This is the first report of the successful use of this technique in the chronic pain management setting in children.     

慢性疼痛基因治疗相关研究的进展

急性疼痛是组织损伤的生理性预警信号，而慢性疼痛则是一种病理状态。慢性疼痛常与痛觉感知、传递和调制有关的神经系统的改变一中枢或外周敏化有关。中枢敏化时神经元的反应性增加，疼痛甚至可以由非痛觉感觉神经纤维的激活产生；而神经末梢伤害感受器长期暴露在组织损伤或炎性产物（如细胞因子、缓激肽、花生四烯酸等）中将产生外周敏化，导致感受器活化阈值降低。由于慢性疼痛本身涉及到很复杂的中枢调控机制及神经元的结构重塑，目前的治疗手段和药物的疗效均尚不能令人满意，因此，基因治疗可能的有广阔应用潜在前景。     

Questionnaire survey of Japanese urologists concerning the diagnosis and treatment of chronic prostatitis and chronic pelvic pain syndrome

OBJECTIVES: We performed a questionnaire survey to investigate various issues in the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome by Japanese urologists and to clarify the circumstances surrounding prostatitis in Japan. METHODS: Japanese urologists (n = 1869) were surveyed by mail using a 17-item questionnaire to determine current diagnostic and treatment practices for prostatitis/chronic pelvic pain syndrome. RESULTS: Only 1.5% (11/739) of urologists diagnosed chronic prostatitis/chronic pelvic pain syndrome using the 4-glass test, while most did so using the 2-glass test (voided bladder [VB]2 and VB3, or VB2 and expressed prostatic secretion [EPS]). Approximately half (55.2%; 412/746) did not perform urine cultures to differentiate chronic bacterial prostatitis from chronic abacterial prostatitis/chronic pelvic pain syndrome. Approximately half (46%; 343/746) did not count the number of leukocytes in VB2 or VB3/EPS to differentiate chronic abacterial prostatitis from chronic pelvic pain syndrome. Although many urologists (63.8%; 459/720) thought that chronic abacterial prostatitis/chronic pelvic pain syndrome was not an infectious disease, many chose antimicrobial agents as the primary treatment. More than half (52.2%; 384/735) of all urologists felt pessimistic about dealing with chronic prostatitis/chronic pelvic pain syndrome compared to treating benign prostatic hypertrophy or prostate cancer, because of the high number of complaints by patients and their own lack of confidence in diagnosing and treating the condition. CONCLUSION: There is much confusion and frustration among Japanese urologists about chronic prostatitis/chronic pelvic pain syndrome. Further studies are needed to elucidate its etiology and pathogenesis, and to establish guidelines for its diagnosis and treatment.