Ioannides A S, Turnock R
Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, U.K.
J R Coll Surg Edinb. 2001 Apr;46(2):98-9.
Many children with Henoch-Schonlein anaphylactoid purpura syndrome (HSAPS) who develop an acute scrotum have scrotal explorations to exclude torsion of the spermatic cord. However, the cause of the acute scrotum in the context of HSAPS is known to be vasculitis and not torsion. The aim of this study, therefore, was to identify factors that underlie this practice. In a 10-year retrospective study of male patients admitted to a Children's Hospital with a diagnosis of HSAPS, 22 out of the 93 children identified (22/93 = 24%) had scrotal involvement. Three children (3/22 = 14%) were investigated radiologically, eight children (8/22 = 36%) had surgical exploration and none had testicular torsion. We believe that greater awareness of the syndrome and its clinical presentation amongst paediatric surgical staff could allow the adoption of a conservative approach in children with an unequivocal diagnosis of HSAPS provided such an approach is supported by high resolution colour Doppler sonography and a fully informed parental consent. Surgical exploration is indicated if the diagnosis of the syndrome is not beyond doubt and torsion cannot be excluded on clinical grounds.
许多患有过敏性紫癜综合征（HSAPS）并出现急性阴囊的儿童会接受阴囊探查以排除精索扭转。然而，已知HSAPS背景下急性阴囊的病因是血管炎而非扭转。因此，本研究的目的是确定这种做法背后的因素。在一项对一家儿童医院收治的诊断为HSAPS的男性患者进行的为期10年的回顾性研究中，93名确诊儿童中有22名（22/93 = 24%）阴囊受累。3名儿童（3/22 = 14%）接受了放射学检查，8名儿童（8/22 = 36%）接受了手术探查，无一例发生睾丸扭转。我们认为，如果儿科手术人员对该综合征及其临床表现有更高的认识，那么在明确诊断为HSAPS的儿童中可以采用保守方法，前提是这种方法得到高分辨率彩色多普勒超声的支持且获得家长的充分知情同意。如果综合征的诊断存在疑问且无法基于临床理由排除扭转，则需进行手术探查。
