隱睪症因腹股溝嵌閉性疝氣併發睪丸壞死

Incarcerated Inguinal Hernia with Testicular Infarction in an Undescended Testis

10.7023/TJFM.200312.0191

徐慶玶(Ching-Ping Hsu)；蔡悅琪(Yueh-Chi Tsai)；王念陸(Nien-Lu Wang)；鍾嫈嫈(Jin-Jin Tjung)

undescended testis ； incarcerated inguinal hernia ； testis necrosis ； orchiectomy

台灣家庭醫學雜誌

13卷4期（2003 / 12 / 01）

191 - 200

繁體中文

新生兒隱睪症（undescended testis）的盛行率約為3.7-10%，因為新生兒的血管及組織結構均非常纖細，若太早手術，手術上的困難度、危險性及術後併發症的發生率皆高，因此建議在6個月或1歲左右接受手術。但若是隱睪症合併嵌閉性腹股溝疝氣（incarcerated inguinal hernia）時則應該提早手術矯正，以免導致睪丸壞死（testis necrosis）。本病例報告一個幾乎造成醫療糾紛的隱睪症，病患在出生時就被診斷為右側隱睪症，兩個月大時發生疝氣嵌閉現象，雖然立即開刀，然而發現睪丸已經壞死，只好同時進行睪丸切除術（orchiectomy），家屬質疑出生即發現隱睪症但沒有及時處理，加上嵌閉性腹股溝疝氣病發當天轉診的延遲，造成睪丸的壞死，導致睪丸必須切除，因而與院方發生醫療爭執。我們提出這個病例，希望讓基層醫師對這個疾病有全面性的了解，並且在接觸這樣的病患時，可以對家長適當的解釋、即時的轉診，減少醫療糾紛的發生。

The prevalence of undescended testis in new born babies is about 3.7% to 10%. Due to the newborn's very delicate anatomic structures, orchiopexy early in the neonatal period is a difficult and high-risk procedure. Therefore, it is recommended that the procedure be delayed until the child is about 6 month to 1 year old. However, there is a risk of testicular ischemia if a child with an undescended testis has an incarcerated inguinal hernia, and so surgery should be performed as early as possible. We report such a case that had legal ramifications. A newborn was diagnosed with a right inguinal hernia assosciated with a right undescended testis. At the age of 2 months, the hernia became incarcerated and he underwent emergency surgery. The right testis was ischemic, and right herniorrhaphy and orchiectomy were performed. The family was concerned about the delay in transferring the child to surgery from the emergency room. We discuss this issue so that family physicians will be more familiar with the risks of such a case and will avoid a delay in the timely referral to surgery.