手術を施行した急性陰嚢症の臨床的検討

Abstract

急性陰嚢症の手術症例102例(年齢0-51歳)を対象に, 主疾患の臨床的特徴について検討を行った。術後診断は精索捻転症50例(49.0%), 精巣付属器捻転症29例(28.4%), 急性精巣上体炎13例(12.8%), その他10例(9.8%)であった。精索捻転症のうち約半数の24例が11-15歳に集中し, 年齢階層別頻度では0-5歳の62%, , 11-15歳の63%, 16-20歳の60%が精索捻転症であった。急性精巣上体炎は年齢階層別頻度では21歳以上で50%を占めた。精巣付属器捻転症は年齢階層別頻度では6-10歳で69%を占めた。精索捻転症の精巣温存例は年齢が比較的高い傾向で, 摘出例より手術までの時間が有意に短かった。発症より8時間以内の手術例は全例が精巣温存が可能であったことより, 精索捻転症の可能性がある場合は早期の手術が必要である。

Between July 1986 and March 2006, 102 patients underwent an operation for acute scrotum. Median age was 12.0 years old (range 0-51). Post-operative diagnosis revealed 50 cases (49%) of spermatic cord torsion, 29 cases (28%) of epididymal appendix torsion, and 13 cases (13%) of acute epididymitis. Spermatic cord torsion was most frequent in the age between 0 and 5, and 11 and 20, while epididymal appendix torsion was most frequent between 6 and 10. Moreover, acute epididymitis was most frequently seen in the age over 20. There were no apparent differences in the clinical symptoms such as scrotal pain, scrotal swelling, and abdominal pain. In the physical examinations, pyuria was the only finding to indicate acute epididymitis. In case of spermatic cord torsion, 'golden time' is defined as the time from onset to operation when testicular function can be expected for preservation. In this study golden time was defined as 8 hours because the testes was preserved in all 23 patients receiving the operation within 8 hours, but in only 10 (37%) out of 27 patients receiving the operation after 8 hours. Moreover, the operation within 24 hours saved the testes in approximately 90% of the patients. In patients with acute scrotum, emergency operation should be performed as speedily as possible for preservation of testicular function.