음낭외상에서 조기수술의 중요성
Importance of Early Exploration in Blunt Scrotal Trauma
이흥엽, 오창규, 김재성,
소속 상세정보
이흥엽 ( )
가톨릭대학교 의과대학 비뇨기과학교실
오창규 ( )
가톨릭대학교 의과대학 비뇨기과학교실
김재성 ( )
가톨릭대학교 의과대학 비뇨기과학교실
KMID : 0358319970380080808
Abstract
결론
본 조사의 결과, 외상에 의한 고환파열의 진단에 있어서 임상 증상과 경과 관찰에 세심한
관심이 요구되며, 술전 시행한 초음파 검사와 수술소견을 비교해 본 결과 시험개복에서는
고환파열이 있었으나 초음파 검사에서 파열된 백막부위를 볼 수 있었던 경우가 38.5%뿐이
었던 점으로 보아, 초음파 검사에서 파열부위가 보이지 않더라도 다량의 혈종이 있거나 고
환의 형태가 심하게 변형되어 있다면 시험개복을 통해 파열 유무를 확인해 볼 필요가 있다
고 생각된다. 또한 파열된 고환을 장기간 방치할 경우, 조기에 수술을 시행했다면 파열된 백
막의 단순 봉합이나 고환 부분절제로 고환의 기능과 형태를 어느 정도 유지할 수 있었음에
도 불구하고, 심한 염증반응이나 조직의 괴사로 고환적출을 하게 될 확률이 높으므로 고환
파열의 조기진단과 조기수술이 중요하다고 생각된다.
#초록#
Early diagnosis and prompt surgical exploration in blunt scrotal trauma is mandatory
to save the affected testis and decrease the morbidity. We reviewed 25 cases of blunt
scrotal trauma evaluated with ultrasonography as a result of violence, sports, traffic
accident from March, 1989 to February, 1997.
The right side was affected slightly more often than the left side. Sonography
identified scrotal hematocele in 21 out of 25 cases and 4 cases had no evidence of
scrotal hematocele. In 7 out of 21 cases with scrotal hematocele, ultrasonography
showed rupture sites of the tunica albuginea (5) and intratesticular radiolucency
displacing the normal echogenicity of the testicular parenchyina (2). In the other 14
cases ultrasonography showed no evidence of rupture. In 4 cases without scrotal
hematocele, one was diagnosed as traumatic orchitis due to testicular enlargement and
two had focal intratesticular hematoma so that these cases didn't undergo explorations.
And 1 case had rupture of the tonics albuginea combined with testicular torsion at the
time of exploration.
Surgical explorations were performed in 19 (76.0%) out of 25 cases, who showed
definitive rupture sites of the tunica albiginea (8), large hematoma and/or persistent
severe pain without being seen rupture sites of the tunica albuginea (11) on
ultrasonography and their operative methods were orchiectomy in 9 (36.0%), evacuation
of the hematocele in 6 (24%), partial orchiectomy in 2 (8.0%) and simple closure of the
tunica in 2 cases (8.0%).
There was a direct relationship between salvageability and early surgery. In 13 out of
19 cases who underwent explorations within 3 days after trauma, the surgical
managements comprised evacuation of the hematocele in 5 (38.5%), orchiectomy in 4
(30.8%), partial orchiectomy in 2 (15.4%), and simple closure of the tunica in 2 cases
(IS.4%). However, in 6 cases who underwent explorations 4 days later after trauma, the
surgical managements comprised orchiectomy in 5 (83.3%) and evacuation of the
hematoma in 1 case (16.7%). In comparison with operative findings, 5 of the 14 cases,
in which ultrasonography showed large hematocele without rupture of the tunica, had
rupture of the tunica. Also, 7 cases, in which ultrasonography showed rupture of the
tunica, all had rupture of the tonics.
All patients with a history of blunt scrotal trauma, followed by a large hematocele
without lure of the tunica or severely distorted testis on ultrasonography should have
early surgical exploration to exclude injury to the testicle. A delayed treatment decreases
the salvage rate due complications, such as ischemic necrosis and severe inflammatory
reaction.
키워드
Scrotal injury; Ultrasonography; Surgery;
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