Park Seong Jin, Lee Hae Kyung, Yi Boem Ha, Cha Jang Gyu, Joh Joon Hee, Hong Hyun Sook, Kim Hyun Cheol
Department of Radiology, Soonchunhyang University Bucheon Hospital, 1174 Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do 420-021, Korea.
J Ultrasound Med. 2007 Mar;26(3):293-9. doi: 10.7863/jum.2007.26.3.293.
The purpose of this study was to evaluate the feasibility and safety of manual reduction of torsion of an intrascrotal appendage under ultrasonographic monitoring.
Fifteen boys with torsion of an intrascrotal appendage, confirmed by scrotal ultrasonography and clinical status, were included in the study. The boys were 6 to 13 years old (mean age, 9 years). They all had painful, unilateral swelling of the scrotum and a palpable, tender nodule on physical examination. Scrotal ultrasonography indicated a single, variably echoic mass corresponding to the intrascrotal appendage. The mass was avascular according to Doppler ultrasonography. Thirteen boys underwent manual reduction under ultrasonographic monitoring. We tried to pull and release the swollen appendage in 8 patients and gently squeezed the appendage in 5. The procedure was considered successful when ultrasonography showed reperfusion in the appendage and the patients stated complete relief of scrotal pain. In 14 boys, follow-up scrotal ultrasonography was performed after the manual reduction.
Successful reduction was obtained in 12 (80.0%) of 15 boys. Only 1 boy was regarded as having reduction failure; this patient had intractable pain after the trial reduction, and ultrasonography showed transient vascular flow that promptly disappeared in the appendage. On follow-up ultrasonography, the maximal diameter +/- SD of the intrascrotal appendages significantly decreased from 6.1 +/- 1.2 to 4.0 +/- 1.3 (P=.005) in 11 patients with successful reduction.
Manual reduction under ultrasonographic monitoring seems to be a feasible and effective method for the treatment of torsion of an intrascrotal appendage to immediately relieve pain.
本研究旨在评估在超声监测下手法复位阴囊内附件扭转的可行性和安全性。
纳入15名经阴囊超声检查和临床症状确诊为阴囊内附件扭转的男孩。男孩年龄为6至13岁（平均年龄9岁）。他们均有阴囊疼痛、单侧肿胀，体格检查可触及压痛性结节。阴囊超声显示一个与阴囊内附件相对应的、回声各异的肿块。根据多普勒超声检查，该肿块无血管。13名男孩在超声监测下接受了手法复位。8例患者我们尝试牵拉并松开肿胀的附件，5例患者则轻轻挤压附件。当超声显示附件有再灌注且患者表示阴囊疼痛完全缓解时，该操作被认为成功。14名男孩在手法复位后进行了随访阴囊超声检查。
15名男孩中有12名（80.0%）成功复位。仅1名男孩被视为复位失败；该患者在试行复位后疼痛难以缓解，超声显示附件有短暂血流，随后迅速消失。在随访超声检查中，11名成功复位患者的阴囊内附件最大直径±标准差从6.1±1.2显著减小至4.0±1.3（P = 0.005）。
超声监测下手法复位似乎是治疗阴囊内附件扭转以立即缓解疼痛的一种可行且有效的方法。
