Jefferson R H, Pérez L M, Joseph D B
Department of Surgery, University of Alabama at Birmingham, Children's Hospital 35233, USA.
J Urol. 1997 Sep;158(3 Pt 2):1198-200. doi: 10.1097/00005392-199709000-00134.
We assessed the significance of the clinical presentation of boys who underwent surgical exploration for acute scrotum.
We retrospectively analyzed the records of 115 consecutive boys who underwent surgical exploration for acute scrotum between October 1986 and January 1996. We divided the children into group 1-83 with spermatic cord torsion a mean of 14.4 years old, group 2-27 with torsion of a testicular appendage a mean of 9.4 years old and group 3-5 with epididymo-orchitis a mean of 14.1 years old. Particular attention was given to nausea and vomiting, patient age and duration of pain.
Nausea and vomiting occurred in 69 and 60% of the boys in group 1, 8 and 4% in group 2 and none in group 3. Nausea and vomiting had positive predictive values of 96 and 98%, respectively, for spermatic cord torsion. Only 6 of the 83 boys (7%) with spermatic cord torsion were younger than 11 years, whereas 15 of the 27 (56%) with torsion of a testicular appendage were younger than 11 years. Of the 83 boys with spermatic cord torsion the testes were salvaged in 51 (61%) and the duration of pain was 40 minutes to 12 hours (mean 4 hours). The testes were not salvaged in any patient with greater than 12 hours of pain.
We believe that any boy 11 years old or older with scrotal pain less than 12 hours in duration that is associated with nausea or vomiting should be considered to have torsion of the spermatic cord. In this day of cost-effective medical management it is not necessary to perform imaging in this subset of boys before surgical exploration.
我们评估了因急性阴囊而接受手术探查的男孩临床表现的重要性。
我们回顾性分析了1986年10月至1996年1月期间连续115例因急性阴囊而接受手术探查的男孩的记录。我们将这些儿童分为三组：第一组83例，精索扭转，平均年龄14.4岁；第二组27例，睾丸附件扭转，平均年龄9.4岁；第三组5例，附睾睾丸炎，平均年龄14.1岁。特别关注恶心和呕吐、患者年龄及疼痛持续时间。
第一组男孩中分别有69%和60%出现恶心和呕吐，第二组为8%和4%，第三组无恶心和呕吐。恶心和呕吐对精索扭转的阳性预测值分别为96%和98%。83例精索扭转男孩中只有6例（7%）年龄小于11岁，而27例睾丸附件扭转男孩中有15例（56%）年龄小于11岁。83例精索扭转男孩中，51例（61%）的睾丸得以挽救，疼痛持续时间为40分钟至12小时（平均4小时）。疼痛超过12小时的患者中，睾丸均未保住。
我们认为，任何年龄11岁及以上、阴囊疼痛持续时间少于12小时且伴有恶心或呕吐的男孩应被考虑为精索扭转。在当今注重成本效益的医疗管理时代，对于这部分男孩在手术探查前无需进行影像学检查。
