アブストラクト
Japanese
| Title | 小児の急性精巣捻転症の病態と超音波診断 |
|---|---|
| Subtitle | 総説 |
| Authors | 藤井喜充, 金子一成 |
| Authors (kana) | |
| Organization | 関西医科大学 小児科 |
| Journal | 日本小児泌尿器科学会雑誌 |
| Volume | 30 |
| Number | 1 |
| Page | 8-16 |
| Year/Month | 2021 / |
| Article | 報告 |
| Publisher | 日本小児泌尿器科学会 |
| Abstract | 「要旨」精巣捻転症は, 精巣の動静脈が捻じれて血流障害をきたした状態で, 新生児期と思春期に多く, 二峰性の年齢分布を示す. 急性陰嚢症の一つで精巣機能温存において, きわめて緊急性が高い. 診断能力の高い検査は超音波検査で, 特徴的所見として, 血流シグナルの消失が知られている. しかし時に血流シグナルが確認される症例が存在する. 本稿では小児の精巣捻転症について, 臨床的特徴と超音波診断のコツについて, 筆者の経験を交えて報告する. 精巣捻転症は突然の陰嚢痛で発症し, 経過とともに陰嚢の腫脹と硬結が出現する. 超音波検査で診断がつき次第, 用手捻転解除または緊急手術で精巣固定術を行って, 精巣機能の温存を試みる. 精巣捻転症は外精筋膜で包まれた精索全体が捻じれる"鞘膜外捻転"と, 精巣鞘膜が精巣と精巣上体を包み込むbell clapper deformityにおいて, 口の部分で捻転する"鞘膜内捻転"に分類される. 鞘膜外捻転はすべての精巣静脈叢が駆血されるが, 鞘膜内捻転は, 内・外精筋膜間の精巣静脈叢は開存しているので, うっ血は相対的に緩徐に進行する. 診断に有用な超音波検査所見としては, Bモードでの精巣の球状腫大化, 精巣内部構造の消失, 低〜高エコーの精巣実質のモザイク構造化, 精巣上体のpseudotumor signとwhirlpool signがあげられる. 特徴的な所見とされる超音波ドプラにおける血流シグナルの有無は, 精巣温存の根拠となるので, 術式選択上は重要であるが, 血流シグナルの存在で精巣捻転症を否定してはならない. |
| Practice | 臨床医学：外科系 |
| Keywords | 超音波診断, 精巣捻転症, 血流シグナル, Ultrasound diagnosis, testicular torsion, blood flow signal |
English
| Title | PATHOPHYSIOLOGY AND ULTRASOUND DIAGNOSIS OF TESTICULAR TORSION IN CHILDREN |
|---|---|
| Subtitle | |
| Authors | Yoshimitsu FUJII, Kazunari KANEKO |
| Authors (kana) | |
| Organization | Department of Pediatrics, Kansai Medical University |
| Journal | Japanese Journal of Pediatric Urology |
| Volume | 30 |
| Number | 1 |
| Page | 8-16 |
| Year/Month | 2021 / |
| Article | Report |
| Publisher | Japanese Society of Pediatric Urology |
| Abstract | [Abstract] Testicular torsion (TT) is a urologic emergency requiring prompt identification and management. TT is usually diagnosed by the absence of the testicular blood flow signal (BFS) on ultrasound. However, diagnosing TT is sometimes difficult because the testicular BFS remains in some cases. This review discusses the clinical features and ultrasound signs of TT in children, together with our own experiences. TT has two peaks in its incidence, i.e., the period in neonates and the one in adolescence. Clinical signs are characterized by the sudden onset of scrotal pain, followed by hard swelling. TT can be classified into two types : extrasellar torsion, in which the entire spermatic cord is wrapped by the external spermatic fascia that is twisted, and intrasellar torsion, in which the tunica vaginalis wraps around the testis and epididymis (bell clapper deformity) and the twist occurs at the mouth of the sac-like structure. In extrasellar torsion, the entire testicular pampiniform vein plexus (TPVP) is ejected, resulting in rapid, severe congestion of the testis and hemorrhagic necrosis. In contrast, in intrasellar torsion, part of the TPVP between the internal and external spermatic fascia remains open, resulting in slower congestion. Diagnostic ultrasound can reveal essential findings, including spherical testis enlargement, loss of internal testicular structures with hypoechoic and hyperechoic mosaicism of the testicular parenchyma, pseudotumor signs of the epididymis, and the whirlpool sign. In particular, testicular BFS is a vital sign regarding surgical procedure selection because it provides a basis for determining whether the testis can be preserved. However, the presence of testicular BFS should not be used to rule out TT because testicular BFS is still present until the tissue pressure within the testicular parenchyma exceeds the arterial pressure. Therefore, TT should be diagnosed with B-mode ultrasound, and the outcome can be assessed using Doppler mode. |
| Practice | Clinical surgery |
| Keywords | Ultrasound diagnosis, testicular torsion, blood flow signal |
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