Acute epididymo-orchitis: staging and treatment
Acute epididymo-orchitis: staging and treatment
复制标题
DOI：
10.5173/ceju.2012.03.art8
复制
发表时间：
2012-01-01
影响因子：
1.2
通讯作者：
Shulyak, Alexander
中科院分区：
文献类型：
--
作者：
Banyra, Oleg;Shulyak, Alexander
导言。急性附睾性睾丸炎(AEO)是一种急性附睾炎性疾病，常见于同侧睾丸。确诊后应立即开始治疗，包括抗生素、止痛药，如有必要，还应进行手术。诊断为AEO后，患者接受了镇痛剂和抗生素的保守治疗。如果在保守治疗的前48-72小时内没有观察到临床改善，患者将接受手术治疗。根据检查结果，254名患者(分)分为三组：1)附睾部与睾丸明显不同(E/T+)，既无鞘膜积液、局部软化(软化)，也无附睾部或睾丸脓肿；2)E/T+，无软化，有鞘膜积液，附精/睾丸内无、1个或少数小脓肿；3)附精与睾丸无掌部分化，有或无软化，有无鞘膜积液，无、1个或多个大小脓肿。我们分析了每组的临床结果。第一组患者均成功应用抗生素治疗。第二组保守治疗有效70例。(占本组的85.4%)，但其他12分。(14.6%)患者临床症状无明显改善，行保留器官手术。第三组的大多数患者在最初的48-72小时内对抗菌治疗没有表现出客观的反应，因此接受了手术。根据检查结果和临床结果，我们制定了AEO的分类系统，将AEO分为三个阶段，并提出了治疗方法。我们的分类能够使AEO患者的治疗方法系统化。
Introduction. Acute epididymo-orchitis (AEO) is an acute inflammatory disease of the epididymis and ipsilateral testis. Treatment should be started immediately after diagnosis and includes antibiotics, analgesics, and, if necessary, surgery.Materials and methods. After AEO diagnosis, patients were treated conservatively with analgesics and antibiotics. If no clinical improvement was observed within the first 48-72 hours of conservative treatment, patients underwent surgery. Depending on examination results, 254 patients (pts.) were divided into three groups: 1) with palpable differences between the epididymis and testis (E/T+), and without neither hydrocele, local softening (malacia), nor abscess of the epididymis or testis; 2) with E/T+, absence of malacia, presence of hydrocele, and none, one, or a few small abscesses within the epididymis/testis and 3) without palpatory differentiation between the epididymis and testis, with or without malacia, with hydrocele, and none, one, or more abscesses of any size. We analyzed the clinical outcomes in each group.Results. All of patients from the first group were successfully treated with antibiotics. In the second group, conservative treatment was effective in 70 pts. (85.4% of this group), but the other 12 pts. (14.6%) did not show clinical improvement and underwent organ-sparing surgery. The majority of patients from the third group did not demonstrate an objective response to antibacterial treatment during the first 48-72 hours and, therefore, underwent surgery. Based on examination results and clinical outcomes we developed a classification system for AEO, which divides AEO into three stages and recommends an approach to its treatment.Conclusions. Our classification is able to systematize treatment approaches in patients with AEO.