小儿阴囊急症的诊断和处理（附106例临床分析）

目的：探讨小儿阴囊急症的临床诊断和处理方法。方法：回顾性分析我院自1985-1999年收治的106例睾丸扭转、睾丸附件扭转和睾丸附睾炎的小儿阴囊急症病例。对其在病史、体征和彩色多普勒超声等方面进行统计学处理。结果：全部14例睾丸扭转均有睾丸触痛和提睾反射消失。有6例睾丸扭转患者通过彩色多普勒超声证实而手术，睾丸附件扭转88.9%有附睾触痛，85.2%有睾丸上极触痛以及37.0%有硬结，睾丸附睾炎90.8%有阴囊红肿，结论：体格检查在鉴别小儿阴囊急症中有显著作用。提睾反射的消失是睾丸扭转最敏感。最准确的体格检查表现。彩色多普勒超声在小儿阴囊急症的诊断中是一项有价值的辅助检查。如已明确或怀疑睾丸扭转，应尽可能早地施行探查手术。

The Diagnosis and Treatment of the Acute Scrotum in Children: Clinical Analysis of 106 Cases

Objective: To compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with testicular torsion, torsion of appendix testis, and epididymitis. Methods: 106 cases with acute scrotum between 1985 and 1999 were reviewed retrospectively. Results: 14 with testicular torsion, 27 with torsion of appendix testis, and 65 with epididymitis were studied. All 14 patients with testicular torsion had a tender testicle and an absent cremasteric reflex. Most of patients with torsion of appendix testis had tenderness of epididymis and superior pole of the testis. When compared with testicular torsion group, more patients with epididymitis had scrotal erythema/edema. Color Doppler ultrasound had been performed in 55 patients, 6 patients with testicular torsion had a salvageable testicle at the time of surgery. Conclusion: The physical examination is helpful in distinguishing testicular torsion, torsion of appendix testis, and epididymitis. Patients with a tender testicle and absent cremasteric reflex are more likely to have a testicular torsion rather than epididymitis or torsion of appendix testis. Absent cremasteric reflex is the most sensitive physical finding for diagnosing testicular torsion. Color Doppler ultrasound is useful in the evaluation of the acute scrotum when physical findings are equivocal.If testicular torsion is dianosed based on clinical evaluation,emergent operative intervention should be performed.