Knight P J, Vassy L E
Ann Surg. 1984 Nov;200(5):664-73. doi: 10.1097/00000658-198411000-00019.
Diagnosing acute scrotal pain and swelling in children and adolescents is urgent and often difficult. A review of 395 boys hospitalized with acute scrotal pain and/or swelling shows that a useful approach is to divide these patients into four groups--those with intermittent but recurrent episodes of pain, those with pathognomonic physical findings, those with definite epididymitis, and a remaining group with nonspecific swelling and tenderness. Five per cent of boys in this series presented with recurring episodes of scrotal pain; these boys should undergo a simple scrotal operation that yields excellent results. Eight per cent had pathognomonic physical findings; treatment in these boys is straightforward. Eighteen per cent had a definite diagnosis of acute epididymitis (i.e., three nonpathognomonic but suggestive findings of acute epididymitis or two suggestive findings plus a radionuclide scan showing bilateral perfusion); nonoperative therapy is indicated in this group. In the remaining boys, scrotal exploration is the diagnostic (and usually therapeutic) procedure of choice.
诊断儿童和青少年的急性阴囊疼痛和肿胀情况十分紧急且往往颇具难度。一项针对395名因急性阴囊疼痛和/或肿胀而住院的男孩的回顾研究表明，一种有效的方法是将这些患者分为四组——有间歇性但反复疼痛发作的患者、有特征性体格检查结果的患者、确诊为附睾炎的患者，以及其余有非特异性肿胀和压痛的患者。在该系列研究中，5%的男孩出现反复的阴囊疼痛发作；这些男孩应接受简单的阴囊手术，效果极佳。8%的男孩有特征性体格检查结果；对这些男孩的治疗很直接。18%的男孩被明确诊断为急性附睾炎（即三项非特征性但提示急性附睾炎的表现或两项提示性表现加上放射性核素扫描显示双侧灌注）；该组患者应采用非手术治疗。在其余男孩中，阴囊探查是首选的诊断（通常也是治疗）方法。
