张力性睾丸鞘膜积液2例报告并文献复习

Tension hydrocele: report of 2 cases and literature review

摘要

目的 分享张力性睾丸鞘膜积液的诊疗经验，提高临床对该疾病的诊疗认识。方法 回顾性分析北京大学第三医院泌尿外科收治的2例张力性睾丸鞘膜积液患者的临床资料和诊治过程。检索相关中英文文献，分析张力性睾丸鞘膜积液的临床特点。结果 患者1因“外伤后左侧阴囊肿大伴疼痛1月余、加重1 d”就诊。查体示左侧阴囊张力高，透光试验阳性。超声示左侧睾丸内血流信号消失。急诊行手术探查、睾丸鞘膜翻转术，术中未见睾丸扭转迹象。患者2因“右侧睾丸鞘膜积液1年、加重1周”就诊。查体示右侧阴囊张力高，透光试验阳性。超声示右侧睾丸内血流信号减少，抽出40 mL睾丸鞘膜积液后血流信号恢复，次日行睾丸鞘膜翻转术。2例患者随访8个月均未见复发。该病国内文献尚未见报道，国外共报道11例。结论 张力性睾丸鞘膜积液是少见的阴囊急症，应尽早手术或抽液减压以恢复睾丸血供，同期或分期行睾丸鞘膜翻转术以防止复发。

Abstract

Objective To explore the diagnosis and treatment experience of tension hydrocele. Methods The clinical data of 2 patients with tension hydrocele treated in our hospital were retrospectively analyzed. Relevant literature was retrieved to analyze the clinical characteristics of this disease. Results Case 1 was diagnosed due to swelling and pain of the left scrotum after trauma for more than one month, which worsened for one day. Physical examination showed high tension in the left scrotum and positive light transmission test. Ultrasound examination revealed that the blood flow signal in the left testis disappeared. Emergency left scrotal exploration and hydrocelectomy were performed. There was no sign of testis torsion during the operation. Case 2 was diagnosed mainly due to hydrocele of the right testis for 1 year, which worsened for 1 week and complicated with testis distension and pain. Physical examination showed high tension in the right scrotum and positive light transmission test. Ultrasound examination revealed that the blood flow signal in the right testis decreased. After 40 ml of fluid was extracted under ultrasound monitoring, the blood flow signal in the right testis recovered. Hydrocelectomy was performed the next day. During the follow-up of 8 months, there was no recurrence of hydrocele. A search of domestic and foreign literature showed that there were no reports in domestic literature, while a total of 11 cases were reported in foreign literature. Conclusion Tension hydrocele of the testis is a rare emergency of the scrotum. Surgery or decompression should be performed as soon as possible to restore testicular blood supply, and hydrocelectomy should be performed simultaneously or in stages to prevent recurrence.

关键词

睾丸鞘膜积液 / 张力性 / 超声 / 睾丸鞘膜翻转术

Key words

testis hydrocele / tension / ultrasound / hydrocelectomy

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