張力性睪丸鞘膜積液2例報(bào)告并文獻(xiàn)復(fù)習(xí)

Tension hydrocele：report of 2 cases and literature review

ZHAO Xun¹，WANG Shumin²，QIU Min¹，XU Chuxiao¹，WANG Guoliang¹，ZHANG Shudong¹

（1.Departmentof Urology，2.Department of Ultrasound，Peking University Third Hospital，Beijing 100191，China）

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 40ml 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.

KEY WORDS：testis hydrocele;tension;ultrasound;hydrocelectomy

摘要：目的 分享張力性睪丸鞘膜積液的診療經(jīng)驗(yàn)，提高臨床對(duì)該疾病的診療認(rèn)識(shí)。方法 回顧性分析北京大學(xué)第三醫(yī)院泌尿外科收治的2例張力性睪丸鞘膜積液患者的臨床資料和診治過程。檢索相關(guān)中英文文獻(xiàn)，分析張力性睪丸鞘膜積液的臨床特點(diǎn)。結(jié)果 患者1因“外傷后左側(cè)陰囊腫大伴疼痛1月余、加重1 d”就診。查體示左側(cè)陰囊張力高，透光試驗(yàn)陽性。超聲示左側(cè)睪丸內(nèi)血流信號(hào)消失。急診行手術(shù)探查、睪丸鞘膜翻轉(zhuǎn)術(shù)，術(shù)中未見睪丸扭轉(zhuǎn)跡象。患者2因“右側(cè)睪丸鞘膜積液1年、加重1周”就診。查體示右側(cè)陰囊張力高，透光試驗(yàn)陽性。超聲示右側(cè)睪丸內(nèi)血流信號(hào)減少，抽出40 mL睪丸鞘膜積液后血流信號(hào)恢復(fù)，次日行睪丸鞘膜翻轉(zhuǎn)術(shù)。2例患者隨訪8個(gè)月均未見復(fù)發(fā)。該病國內(nèi)文獻(xiàn)尚未見報(bào)道，國外共報(bào)道11例。結(jié)論 張力性睪丸鞘膜積液是少見的陰囊急癥，應(yīng)盡早手術(shù)或抽液減壓以恢復(fù)睪丸血供，同期或分期行睪丸鞘膜翻轉(zhuǎn)術(shù)以防止復(fù)發(fā)。

關(guān)鍵詞：睪丸鞘膜積液；張力性；超聲；睪丸鞘膜翻轉(zhuǎn)術(shù)

中圖分類號(hào)：R697.22"" 文獻(xiàn)標(biāo)志碼：A

DOI：10.3969/j.issn.1009-8291.2025.01.014

收稿日期：2024-05-17""" 修回日期：2024-06-13

通信作者：

王國良，主任醫(yī)師。E-mail：wangguoliang@medmail.com.cn

作者簡(jiǎn)介：

趙勛，博士研究生，助理研究員。研究方向：腎癌，泌尿系腫瘤。E-mail：1903956675@qq.com

睪丸鞘膜積液是指陰囊內(nèi)鞘膜臟層和壁層之間液體的異常聚集。男性幼兒發(fā)病率為0.7%～4.7%，多在2歲以內(nèi)自行消退，成人相對(duì)少見，發(fā)病率約1%^[1]，常表現(xiàn)為無痛性陰囊腫大，部分患者有陰囊墜脹感。睪丸鞘膜積液張力一般不高，不影響睪丸血供，但壓力急性升高時(shí)會(huì)影響睪丸血供，導(dǎo)致強(qiáng)烈且持續(xù)的疼痛，易誤診為睪丸扭轉(zhuǎn)，處理不及時(shí)可能造成睪丸缺血萎縮，稱為張力性睪丸鞘膜積液。……