Yu Kechi,Li Ning,Yin Ye,et al.Surgical procedures of acute suppurative scrotal infection in neonates[J].Journal of Clinical Pediatric Surgery,2025,(04):372-376.[doi:10.3760/cma.j.cn101785-202401069-013]
新生儿阴囊化脓性感染的外科治疗
- Title:
- Surgical procedures of acute suppurative scrotal infection in neonates
- Keywords:
- Scrotum; Infections; Suppuration; Debridement; Neonate
- 摘要:
- 目的 总结新生儿阴囊化脓性感染的发病特点及外科诊治经验。方法 回顾性收集2016年1月至2023年6月华中科大学同济医学院附属同济医院小儿外科收治的新生儿阴囊化脓性感染病例作为研究对象,分析患儿临床表现、辅助检查、手术方式及预后。结果 共收治14例阴囊化脓性感染新生儿,手术时日龄12~28 d,体重3 500~4 600 g,病变位于左侧7例、右侧5例、双侧2例。14例C反应蛋白升高,其中7例血液白细胞计数增高。临床表现为阴囊红肿触痛、哭闹和易激惹等,从阴囊红肿到手术时间(time interval,TI)≤72 h者12例,共累及14侧阴囊,彩超提示阴囊壁水肿、睾丸鞘膜囊内浓稠积液伴絮状沉淀物、睾丸血流信号丰富,行睾丸鞘膜脓肿切开引流术;TI＞72 h且病程＞7 d者2例,病初在外院保守治疗时彩超提示阴囊化脓性感染(睾丸血流正常),来本院复查彩超提示睾丸血流减少,行坏死睾丸切除+睾丸鞘膜脓肿切开引流术。14例术中留取阴囊脓液送微生物培养,其中13例为大肠埃希菌、1例为铜绿假单胞菌,术后静脉使用有效抗生素治疗,均痊愈出院。患儿均获随访,随访时间6~24个月,2例行睾丸切除的患儿彩超提示健侧睾丸代偿性增大,其余患儿阴囊及睾丸未见异常。结论 新生儿阴囊化脓性感染发病隐匿,进展迅速,需密切观察阴囊局部变化,并及时复查超声,早期行睾丸鞘膜囊腔脓肿切开引流可取得良好的效果。
- Abstract:
- Objective To summarize the clinical manifestations,diagnoses,surgical treatments of acute suppurative scrotal infection and avoid irreversible testicular injury in neonates.Methods From January 2016 to June 2023.The relevant clinical data were retrospectively reviewed for 14 neonates with acute suppurative scrotal infection.Results Age range was (12-28) day and body weight (3500-4600) gram.The involved side was left (n=7),right (n=5) and bilateral (n=2).The clinical manifestations included redness,swelling and tenderness of scrotum,crying and irritability.Both leucocyte count (n=7) and C-reactive protein (10.59±8.74) mg/L) became elevated.Typical color Doppler ultrasonography revealed scrotal wall and testicular edema,hydrocele and cord-like flocculent sediment in scrotum,testicular and epididymal spermatic cord swelling with rich blood flow.Time interval of an onset of scrotal infection and surgical exploration was <72 h (n=12) undergoing testicular exploration and scrotal drainage; >72 h (n=2) undergoing orchidectomy.The results of microorganism culture included Escherichia coli (n=13) and Pseudomonas aeruginosa (n=1).All of them recovered.Follow-up period was (6-24) month.Ultrasonography revealed compensatory enlargement of contralateral testis with unilateral loss of testis (n=2).Conclusions Emergency ultrasonography is essential for managing acute scrotal infection in neonates.Early operation should be performed timely to avoid testicular necrosis.
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备注/Memo
收稿日期:2024-1-31。
基金项目:国家自然科学基金(81601265)
通讯作者:李宁,Email:lining207@foxmail.com