一、睪丸脹痛的起因
一、睪丸扭轉
睪丸(wan)扭轉(zhuan)是陰(yin)囊內(nei)常見急癥之一。一般(ban)發(fa)病(bing)前幾(ji)小(xiao)時(shi)(shi)有(you)劇(ju)烈(lie)活動(dong)，或睪丸(wan)受過外(wai)力。睡眠或安(an)靜時(shi)(shi)突然(ran)發(fa)生睪丸(wan)劇(ju)烈(lie)疼痛，這(zhe)是此病(bing)首發(fa)的癥狀，也是其主要診斷依據之一，部分(fen)病(bing)人伴有(you)惡心嘔吐(tu)、陰(yin)囊腫脹、觸(chu)痛明顯。
二、睪丸損傷
睪(gao)(gao)(gao)(gao)丸(wan)在陰(yin)囊(nang)內的活動性較大，且有(you)(you)堅韌的白(bai)膜保護，發(fa)生閉合性損(sun)傷的機會較小，睪(gao)(gao)(gao)(gao)丸(wan)損(sun)傷大多(duo)與(yu)遭受暴力(li)、車(che)禍等(deng)有(you)(you)關，受傷后(hou)睪(gao)(gao)(gao)(gao)丸(wan)劇烈疼痛(tong)伴惡心、嘔吐，甚至發(fa)生昏厥或休克，體檢時有(you)(you)睪(gao)(gao)(gao)(gao)丸(wan)腫脹、輪廓不清或陰(yin)囊(nang)淤(yu)血，壓痛(tong)明(ming)顯，B超和CT不但(dan)有(you)(you)助于(yu)本病的診斷(duan)，而且可明(ming)確睪(gao)(gao)(gao)(gao)丸(wan)損(sun)傷的部(bu)位和范(fan)圍。
三、睪丸缺血性疼痛
睪(gao)丸(wan)缺血性疼痛(tong)多見(jian)于老年(nian)人(ren)，疼痛(tong)較劇烈(lie)，活動時加重，休息(xi)時緩(huan)解，前列腺液鏡檢正常，常因為睪(gao)丸(wan)動脈硬化致動脈狹窄。睪(gao)丸(wan)動脈粥(zhou)樣硬化往(wang)往(wang)是全身性血管病(bing)變(bian)的局部(bu)表現，多為單側病(bing)變(bian)，左(zuo)側較右側多見(jian)。
四、睪丸炎
睪丸(wan)位于陰囊內，左右各一，睪丸(wan)分泌男(nan)性激(ji)素，對(dui)男(nan)性生殖(zhi)器官(guan)的(de)發育和成熟(shu)以及對(dui)男(nan)性第二性征的(de)出現(xian)起(qi)重(zhong)要作用。引(yin)起(qi)睪丸(wan)炎的(de)原因(yin)非常多，如流行性腮腺(xian)(xian)炎患者(zhe)，可(ke)并發睪丸(wan)炎，出現(xian)睪丸(wan)疼(teng)痛(tong)、腫大；淋病是目前發病率最高的(de)性傳播疾病，嚴重(zhong)時(shi)可(ke)引(yin)起(qi)睪丸(wan)炎；慢性前列腺(xian)(xian)炎也可(ke)引(yin)起(qi)睪丸(wan)疼(teng)痛(tong)，表現(xian)為(wei)單側疼(teng)痛(tong)，多為(wei)鈍(dun)痛(tong)或牽拉痛(tong)，呈持續性，患者(zhe)多為(wei)青壯年，老年人少見。
二(er)、睪丸脹痛(tong)的檢查項目有哪些
常見的睪(gao)丸(wan)炎有非特異性和腮腺炎性睪(gao)丸(wan)炎。任何化膿(nong)(nong)性敗血(xue)癥均可并發(fa)急性化膿(nong)(nong)性睪(gao)丸(wan)炎，甚至引起睪(gao)丸(wan)膿(nong)(nong)腫，致病菌多為大腸桿菌、鏈球菌、葡(pu)萄球菌及(ji)綠膿(nong)(nong)桿菌。睪(gao)丸(wan)炎的重要臨床表現即是睪(gao)丸(wan)脹(zhang)(zhang)痛(tong)(tong)，當發(fa)生睪(gao)丸(wan)炎合并睪(gao)丸(wan)脹(zhang)(zhang)痛(tong)(tong)時，應及(ji)時檢查，及(ji)時治(zhi)療，睪(gao)丸(wan)脹(zhang)(zhang)痛(tong)(tong)的檢查項目有：
1.睪丸自檢(jian)。先洗個熱水澡，使(shi)陰囊松弛，以便(bian)摸到(dao)硬(ying)塊(kuai)和異(yi)常。檢(jian)查時，雙(shuang)腳(jiao)站(zhan)立，摸摸是(shi)否有腫塊(kuai)或其他異(yi)常。正常睪丸呈卵圓形，表(biao)面光滑，中等硬(ying)度。
2.醫生仔(zi)細(xi)檢查雙側陰囊(nang)內腫(zhong)塊后，大致(zhi)可區(qu)分良惡性病變。懷疑睪丸腫(zhong)瘤后，不宜作睪丸腫(zhong)瘤局部穿刺活檢，因較輕易引起腫(zhong)瘤轉移。確診睪丸腫(zhong)瘤性質(zhi)需依靠(kao)手(shou)術后的病理報告。
3.B超(chao)檢查，可較準確測定睪丸的大小(xiao)、形(xing)態及有無腫(zhong)瘤發生(sheng)。非凡(fan)是隱(yin)睪患者(zhe)，可了解(jie)睪丸發育情況(kuang)及是否(fou)腫(zhong)大、惡變等。
4.抽(chou)血化(hua)驗腫瘤標記物人絨毛膜促性腺激素(HCG，正(zheng)常值
5.胸(xiong)部X線(xian)檢查，包括透視或(huo)拍(pai)胸(xiong)片，以了解有無肺部轉移。
6.計算機斷層(ceng)掃描(CT)和磁(ci)共振成像(MRI)，可較為精確地了解腹膜(mo)后有無轉移，對尚未行隱睪摘除(chu)、可能已惡變的患者尤為有益。
三、男(nan)性(xing)睪丸脹痛的分(fen)類是(shi)什么
急(ji)(ji)性(xing)睪(gao)(gao)丸(wan)(wan)(wan)(wan)疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)睪(gao)(gao)丸(wan)(wan)(wan)(wan)炎(yan)(yan)和睪(gao)(gao)丸(wan)(wan)(wan)(wan)損(sun)傷是引(yin)起(qi)急(ji)(ji)性(xing)睪(gao)(gao)丸(wan)(wan)(wan)(wan)疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)的(de)(de)常見因(yin)(yin)素。睪(gao)(gao)丸(wan)(wan)(wan)(wan)炎(yan)(yan)時(shi)(shi)(shi)(shi)，睪(gao)(gao)丸(wan)(wan)(wan)(wan)腫(zhong)大疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)，患者體溫(wen)增高、怕冷、嘔吐、頭痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)及小腹(fu)疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)。睪(gao)(gao)丸(wan)(wan)(wan)(wan)損(sun)傷一般由(you)外傷引(yin)起(qi)，劇(ju)烈運動或房(fang)事、暴力有(you)(you)時(shi)(shi)(shi)(shi)可引(yin)起(qi)提(ti)睪(gao)(gao)肌(ji)的(de)(de)強烈收縮，使睪(gao)(gao)丸(wan)(wan)(wan)(wan)發(fa)生扭轉并(bing)(bing)引(yin)起(qi)劇(ju)痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)。急(ji)(ji)性(xing)睪(gao)(gao)丸(wan)(wan)(wan)(wan)疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)臨(lin)床癥(zheng)狀較為明顯，易(yi)于診(zhen)斷。慢(man)(man)性(xing)睪(gao)(gao)丸(wan)(wan)(wan)(wan)疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)慢(man)(man)性(xing)睪(gao)(gao)丸(wan)(wan)(wan)(wan)疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)可能(neng)由(you)炎(yan)(yan)癥(zheng)引(yin)起(qi)，疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)較輕，具有(you)(you)放射(she)性(xing)疼，遷延(yan)日(ri)久(jiu)，不(bu)(bu)容(rong)易(yi)判斷炎(yan)(yan)癥(zheng)的(de)(de)確(que)切位置。睪(gao)(gao)丸(wan)(wan)(wan)(wan)的(de)(de)疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)不(bu)(bu)一定與(yu)炎(yan)(yan)癥(zheng)的(de)(de)輕重(zhong)程度(du)成(cheng)正(zheng)比，與(yu)個人的(de)(de)神經敏(min)感(gan)(gan)程度(du)有(you)(you)關系。慢(man)(man)性(xing)睪(gao)(gao)丸(wan)(wan)(wan)(wan)疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)也可能(neng)系精索靜脈曲張或其(qi)他部(bu)位的(de)(de)疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)放射(she)而來。這時(shi)(shi)(shi)(shi)應進行(xing)相應的(de)(de)檢查，仔(zi)細鑒別真正(zheng)的(de)(de)原因(yin)(yin)，以便對癥(zheng)治(zhi)療。不(bu)(bu)同(tong)原因(yin)(yin)引(yin)起(qi)的(de)(de)睪(gao)(gao)丸(wan)(wan)(wan)(wan)疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)癥(zheng)狀也有(you)(you)所不(bu)(bu)同(tong)。感(gan)(gan)染(ran)導致的(de)(de)患者睪(gao)(gao)丸(wan)(wan)(wan)(wan)疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)較劇(ju)烈。甚至如(ru)刀割樣，還會伴(ban)有(you)(you)發(fa)勢惡寒等(deng)全身癥(zheng)狀，這時(shi)(shi)(shi)(shi)候陰(yin)囊又紅又腫(zhong)，觸碰睪(gao)(gao)丸(wan)(wan)(wan)(wan)則疼痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)更(geng)加明顯。當(dang)患有(you)(you)結核(he)感(gan)(gan)染(ran)時(shi)(shi)(shi)(shi)，多(duo)伴(ban)有(you)(you)泌尿系統或其(qi)他部(bu)位的(de)(de)結核(he)病史，表(biao)現為睪(gao)(gao)丸(wan)(wan)(wan)(wan)隱隱作痛(tong)(tong)(tong)(tong)(tong)(tong)(tong)、小腹(fu)有(you)(you)墜脹感(gan)(gan)并(bing)(bing)伴(ban)有(you)(you)陰(yin)囊腫(zhong)脹，嚴重(zhong)時(shi)(shi)(shi)(shi)會流出膿液，當(dang)用手摸及這些病變部(bu)位時(shi)(shi)(shi)(shi)，有(you)(you)凹(ao)凸不(bu)(bu)平(ping)的(de)(de)結節，質硬，并(bing)(bing)常常可與(yu)陰(yin)囊皮(pi)膚粘連。
四、睪丸脹痛治療方法
1、受傷！選擇冰塊
如(ru)果你的(de)睪丸受到嚴重(zhong)撞(zhuang)擊，請立刻(ke)冰敷(fu)(fu)：放些冰塊在塑膠袋內，用(yong)橡皮筋綁緊，然后(hou)用(yong)毛巾包起來，冰敷(fu)(fu)15分(fen)鐘，休(xiu)息10分(fen)鐘，再(zai)重(zhong)復(fu)幾(ji)(ji)次，如(ru)果幾(ji)(ji)小時后(hou)疼痛沒有(you)消失，或(huo)甚至更痛，應該馬上看醫(yi)生，這可能是有(you)內出血。
2、平靜下來
受傷(shang)時不(bu)要做過于劇烈的運動或(huo)慢(man)跑，并盡量避免陰囊撞(zhuang)擊到大腿。
3、使用懸架裝置
有一種(zhong)稱為陰(yin)囊懸帶(dai)的(de)裝(zhuang)置(zhi)，能(neng)夠在走路時(shi)固定(ding)睪丸。這個裝(zhuang)置(zhi)有點類似(si)運動托器(qi)但是(shi)沒有那么緊，而(er)且運動托器(qi)會提供壓力反而(er)會使疼痛惡化(hua)。”
4、稍為舉起
稍為(wei)提高睪丸(wan)能減輕疼痛。坐(zuo)下(xia)時可(ke)用小毛(mao)巾讓睪丸(wan)靠在上面。
急(ji)性疼痛(tong)多(duo)見(jian)于睪(gao)(gao)丸(wan)炎(yan)和(he)(he)損傷(shang)。睪(gao)(gao)丸(wan)炎(yan)除(chu)血(xue)行感染外(wai)(wai)，更常見(jian)的是細(xi)菌經尿道逆行至附睪(gao)(gao)和(he)(he)睪(gao)(gao)丸(wan)，造成附睪(gao)(gao)炎(yan)、睪(gao)(gao)丸(wan)炎(yan)，臨床可見(jian)附睪(gao)(gao)與睪(gao)(gao)丸(wan)腫脹和(he)(he)疼痛(tong)。睪(gao)(gao)丸(wan)損傷(shang)時有(you)外(wai)(wai)傷(shang)史(shi)和(he)(he)局部的腫脹及(ji)瘀血(xue)。劇烈運(yun)動或房事、暴力有(you)時可引起(qi)提睪(gao)(gao)肌的強烈收(shou)縮，從(cong)而使系帶過長(chang)的睪(gao)(gao)丸(wan)發生扭轉并引起(qi)睪(gao)(gao)丸(wan)的劇痛(tong)。由于睪(gao)(gao)丸(wan)扭轉后(hou)阻斷了(le)睪(gao)(gao)丸(wan)的血(xue)液供應，所以睪(gao)(gao)丸(wan)除(chu)劇痛(tong)外(wai)(wai)并有(you)陰囊腫大(da)、皮(pi)膚水(shui)腫。相對來說，急(ji)性疼痛(tong)的診斷比較(jiao)容易。
慢性(xing)疼(teng)(teng)(teng)(teng)(teng)痛(tong)時，輕(qing)(qing)者遷延日(ri)久。疼(teng)(teng)(teng)(teng)(teng)痛(tong)較(jiao)輕(qing)(qing)、泛(fan)化，具有(you)(you)放射(she)性(xing)疼(teng)(teng)(teng)(teng)(teng)，所以不(bu)容易判斷炎(yan)癥(zheng)的(de)(de)(de)(de)確切部位。睪丸的(de)(de)(de)(de)疼(teng)(teng)(teng)(teng)(teng)痛(tong)不(bu)一(yi)定(ding)與炎(yan)癥(zheng)的(de)(de)(de)(de)輕(qing)(qing)重程(cheng)(cheng)度成正比，有(you)(you)些(xie)人(ren)(ren)的(de)(de)(de)(de)神經敏感程(cheng)(cheng)度很(hen)高，輕(qing)(qing)度炎(yan)癥(zheng)就(jiu)可引(yin)起(qi)較(jiao)嚴重的(de)(de)(de)(de)疼(teng)(teng)(teng)(teng)(teng)痛(tong)感；而有(you)(you)些(xie)人(ren)(ren)比較(jiao)遲緩，自(zi)我感覺(jue)就(jiu)輕(qing)(qing)。有(you)(you)的(de)(de)(de)(de)疼(teng)(teng)(teng)(teng)(teng)痛(tong)發生在性(xing)生活之后，這可能由于性(xing)興(xing)奮(fen)使生殖(zhi)器和生殖(zhi)腺高度充(chong)血所致(zhi)。有(you)(you)的(de)(de)(de)(de)疼(teng)(teng)(teng)(teng)(teng)痛(tong)系(xi)精(jing)索(suo)精(jing)脈曲張或(huo)其他部位的(de)(de)(de)(de)疼(teng)(teng)(teng)(teng)(teng)痛(tong)放射(she)而來，如輸尿管結石引(yin)起(qi)的(de)(de)(de)(de)睪丸放射(she)性(xing)疼(teng)(teng)(teng)(teng)(teng)痛(tong)，這時就(jiu)要(yao)仔細鑒別真正的(de)(de)(de)(de)原因(yin)以便有(you)(you)效的(de)(de)(de)(de)對癥(zheng)處理。
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