摘要
急性附睾炎(acute epididymitis)是致病菌侵入附睾所引起的急性炎症。近年来由于腔内泌尿外科技术的迅速发展,以及性传播疾病的流行,该病的发病率呈上升趋势[1]。回顾性分析吉林大学第一医院泌尿系统疾病诊治中心2006年8月至2010年2月106例急性附睾炎患者的临床资料,得出了如下结论:1)急性附睾炎的诊断应重视病史以及临床表现;2)C反应蛋白的检测简单、快捷、便宜,可做为急性附睾炎诊断的辅助性检查;3)彩色多普勒超声作为一种经济实用、直观、无创并可重复性的检查方法,是目前诊断急性附睾炎的首选,且有着重要的临床应用价值。此次临床资料的分析侧重于C反应蛋白在急性附睾炎中诊断的价值,而C反应蛋白在急性附睾炎的鉴别诊断中也有重要的意义,在今后的临床工作中还需进一步研究。
Object: To improve the diagnosis and treatment of acute epididymitis.
Method: Retrospective analysis of clinical data of 106 patients with acute epididymitis in our department during August 2006 and February 2010. All patients were performed blood routine, urine routine, C-reactive protein (CRP) and Color doppler ultrasound (CDU) examinations before treatment. Blood and urine specimens are tested by the hospital laboratory of ours. Diagnostic criteria refers to Surgery (version 6). First of all, the treatment of all patients were treated with conservative treatment. Medical history and experience were used in antibiotics seleting. Some patients were treated by combination of physical therapy, hot packs,cold compress and other comprehensive treatment. When conservative treatment fails within 48 hours or can not be easily differentiated from testicular torsion, we give surgery to the patient.
Results: 33 cases had dirty sexual history within 1 week. 26 patients had a history of prostatitis. 8 patients had a history of long-term indwelling catheter. 5 patients had a history of transurethral operations. 11 patients had a history of traumatic injury. The remaining 23 cases had no obvious incentive. 32 patients had scrotal pain associated with high fever, and temperature of some patients up to 40 degree centigrade. 25 patients only had partial scrotal pain. 44 patients had scrotal pain associated with urination discomfort. 5 cases were managed with no obvious cause for the clinical manifestations of fever and systemic symptoms are obviously. White blood cell count of 69 cases in blood up to 10.0×109/L (65.1%). white blood cell count of 48 cases in urine up to 5/HPF. All patients were above the normal upper limit of CRP (100%) and CRP test of 98 patients were higher than 3 times of the upper limit of normal (92.5%). CDU showed 106 cases of ipsilateral epididymis tail were increased. Epididymal and scrotal wall of 10 cases came together and the scrotum wall is thickened and the echo become lower. 3 cases of ipsilateral testis increased slightly. 27 cases of ipsilateral spermatic cord became wide and the echo become lower. 12 cases had ipsilateral testis sheath effusion. All patients were treated effectively and the effective rate was 100%. 89 patients achieved clinical cure and the cure rate is 83.96%. 45 cases were treated with combination therapy. 7 patients were invalid after conservative treatment within 48 hours and we give surgery to the patients.8 cases formed abscess in scrotum and we also give surgery to the patients. It is difficult to identify with testicular torsion in 3 cases, and were given operation too. 7 cases had an operation of epididymis resection and 11 cases had an operation of epididymal abscess incision and drainage.
Conclusions:
(1) The diagnosis of acute epididymitis should pay attention to history and clinical manifestations.
(2) CRP testing is simpl, quick and cheap.It can be as a assistant examination of acute epididymitis.
(3) CDU as a economical and practical, intuitive, non-invasive examination methods ,which can be repetitive and is the first choice for diagnosis of acute epididymitis.It has important clinical value in diagnosis of acute epididymitis.
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