2012 年 03 月 08 日

案例一:李先生,未婚,27歲,騎摩拖車在往淡海的公路上,發生車禍,顱內出血,下肢骨折,氣胸血胸,合併陰囊挫傷,兩側睪丸破裂,被送到醫院,經緊急手術,挽就了一命,但兩側睪丸因破碎太厲害而摘除。在當時那麼大的車禍創傷下,心想只要能活命就不錯了。如今,事過境遷,命雖是撿回來了,但卻常常懷疑自己,〝還是不是一個男人〞,還能不能「舉」,還能不能「生」。只怪自己愛飆車,真是悔恨莫及。

案例二:張同學,未婚,18歲,還是一個學生,周末跟同學去飆車,發生車禍,與卡車相撞。摩拖車幾乎全毀,他則是顱內出血、骨折、陰囊挫傷、經送醫院緊急手術,小命算是撿回來了。但後來出院之後,他發現陰囊內睪丸少了一粒,於是請教泌尿科專科醫師,原來是睪丸移位;因為當時撞擊在陰囊的力量太大,導致睪丸移位到腹股溝。經開刀探查後,睪丸尚完好如初,於是以睪丸固定術把睪丸拉回原位,精液分析也顯示,精蟲數目、形態、活動力均正常。

以上兩案例均是睪丸受傷的例子,也都是年輕人愛飆車,輕忽後果的悲劇,案例一的李先生,非常在乎自己還是不是一個男人,確實〝身體髮膚,受之父母〞,一旦陰囊內少了兩粒東西,心裡上是會很不舒坦的,對新的「身體意象」(body image),很不習慣。針對這點,是有人工睪丸(testis prosthesis)可以植入,植入的睪丸,僅只於美觀,不具有功能。

這種人工睪丸,由最早的合金金屬、有機玻璃一直到聚四氟乙烯等塑料,或因比重過重,或因具有毒性,造成局部組織反應,或致癌性,無法達到令人滿意的效果,不過病人心理會舒坦些。另外也可以定期注射睪固酮,最近有一種以睪固酮藥粒和圭膠融合製成的人工睪丸,可穩定釋放男性荷爾蒙,不過也只能持續三年。至於〝受孕〞,大概很難了,除非是睪丸摘除當時,保留一些睪丸組織,嘗試作卵細胞質內精蟲注射(ICSI),其受孕率約可達6成。如今,事過境遷大概只有〝領養〞一途。至於〝勃起〞功能,應該是不受影響的,但〝性慾〞可能會降低。

第二案例的張同學,算是幸運的,睪丸僅是移位而未破裂,然而,當初的

撞擊和移位,可能影響精蟲的數目及活動力。而這些,在睪丸固定後,或

許可以恢復至某個程度。都卜勒超音波則可以測定移位睪丸之血液以預測其受損傷之程度。

年輕氣盛,血氣方剛,除了飆車之外,睪丸另一個受傷的原因是打鬥,尤其睪丸暴露在外,打架互踢時,極易受傷,而且常會伴隨尿道、膀胱的受傷,不可不慎。

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