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你好，我是林鼎淯醫師
Hello, I am Dr. Lin Dingyu.

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接下來為大家報告常常以為是疝氣
Next, I will report on conditions often mistaken for hernias.

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結果不是疝氣的一個情形
Cases that turn out not to be hernias.

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容易病人呢
Patients often…

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在這個自己了解症狀的時候
When trying to understand their symptoms,

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會有點搞不清楚
Can get a bit confused.

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接下來我為大家做一個整理
Next, I’ll summarize for everyone.

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在男生常見的精索靜脈曲張
Common in men is varicocele,

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輸精管發炎
Vasitis,

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陰囊積液
Scrotal hydrocele,

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或睪丸扭轉
Or testicular torsion.

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這些症狀都有可能會被以為是疝氣
All these conditions can be mistaken for hernias.

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或者是淋巴結腫大以為是疝氣
Or swollen lymph nodes mistaken for hernias.

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在女生呢
In women,

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巴氏腺體囊腫以為是疝氣
Bartholin’s cyst can be mistaken for a hernia.

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在腹股溝腹壁肌肉拉傷
Groin muscle strains,

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男女都有可能
Possible in both men and women,

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以為是疝氣
Can be mistaken for hernias.

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或者是腹股溝的腫瘤
Or tumors in the groin area,

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或者是這個腹腔骨盆腔
Or symptoms caused by diseases in the abdominal or pelvic cavity,

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後腹腔的疾病引起的症狀
Or the posterior abdominal cavity,

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會被以為是疝氣
Can be mistaken for hernias.

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接下來再深入跟大家報告
Next, I’ll delve deeper into the topic.

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在精索靜脈曲張
In the case of varicocele,

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會被以為是疝氣
It can be mistaken for a hernia.

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因為精索靜脈曲張在陰囊的地方
Because varicocele in the scrotum,

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也會有腫啊
Can also cause swelling.

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腫脹、腫大
Swelling, enlargement.

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它的這個腫大跟疝氣是不太一樣的
Its enlargement is different from that of a hernia.

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第一個是位置不一樣
Firstly, the location is different.

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精索靜脈曲張
Varicocele,

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它的這個鼓起來的位置
Its protruding location,

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是在陰囊的地方
Is in the scrotum,

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特別是左邊的陰囊
Especially on the left side.

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那它呢
And it,

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外觀上看起來是會有一條一條的
On the outside, looks like it has lines.

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曲張的這個靜脈，那疝氣呢
Varicose veins, while hernias,

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它的這個腫脹是從這個下腹部
Their swelling starts from the lower abdomen,

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沿著腹股溝往下那麼凸起來
Protruding down along the groin.

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跟陰囊比較低的
Lower compared to the scrotum.

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這個位置的陰囊腫脹呢
The swelling in this location of the scrotum,

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是位置不一樣
Is in a different position.

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那當然腹股溝疝氣久了
Of course, if an inguinal hernia persists for a long time,

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它也會往陰囊的地方來延伸
It can also extend to the scrotum.

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那看起來會有一點像靜脈曲張
It might look a bit like varicocele.

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所以在門診的時候要做一下區隔
So, during the clinic visit, differentiation is necessary.

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那另外呢是常常被忽略的
Another often overlooked condition is,

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就是輸精管發炎
Vasitis.

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在腹股溝的這個位置也會腫脹疼痛
It can cause swelling and pain in the groin area.

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壓起來也會痛
It’s painful to the touch.

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那也會被以為是疝氣
It can also be mistaken for a hernia.

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那通常疝氣
Usually, hernias,

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是不太容易有這樣的一個疼痛的程度
Don’t usually cause this level of pain.

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疝氣通常在平躺的時候就縮回去了
Hernias typically retract when lying flat.

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輸精管發炎在平躺的時候呢
Vasitis, when lying flat,

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它不會縮回去
Doesn’t retract.

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那個壓痛感都還是在
The tenderness remains.

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這可以做一個區隔
This can be differentiated.

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那常見輸精管發炎
Common vasitis,

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跟泌尿道的發炎
Is related to urethritis,

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或攝護腺肥大引起的這個
Or symptoms caused by an enlarged prostate.

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症狀是有有關係的
These symptoms are related.

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那在這個門診的時候要做一下區隔
So, during the clinic visit, differentiation is necessary.

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另外就是陰囊積液在陰囊的地方
Another condition is scrotal hydrocele in the scrotum.

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因為包住睪丸有一層膜
Because there’s a membrane surrounding the testicle,

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那這層膜它會分泌一點水分
This membrane secretes some fluid,

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維持這個睪丸在陰囊裡面的這個潤滑
Maintaining lubrication for the testicle inside the scrotum.

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跟這個旋轉的時候有一個像
And when it rotates, it’s like,

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類似關節腔保護的構造
A protective structure similar to a joint cavity.

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這一層膜的這個生成跟吸收
The production and absorption of this membrane,

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它是有一個平衡
Is balanced.

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如果這個平衡破壞的時候，生成比較多
If this balance is disrupted, with more production,

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那吸收比較慢
And slower absorption,

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就有可能變成陰囊會積液在那邊
It can result in fluid accumulation in the scrotum.

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一樣是陰囊腫起來
The scrotum swells in the same way,

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會以為是疝氣
And can be mistaken for a hernia.

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看起來不太一樣
It looks a bit different,

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就這一包在躺下的時候
This swelling, when lying down,

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是不會不見的
Doesn’t disappear.

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陰囊還是一包在那裡
The scrotum remains swollen,

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那摸起來硬硬的
And feels hard to the touch.

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那疝氣在通常平躺的時候
Usually, when lying flat with a hernia,

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那個延伸下來的這個腸子
The protruding intestines,

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這些回到腹腔之後
Return to the abdominal cavity,

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就不會再繼續腫脹
And no longer continue to swell.

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這可以做一個區隔
This can be distinguished.

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那另外睪丸扭轉特別要小心
Moreover, testicular torsion needs special attention.

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就是在青少年或年輕人
Especially in teenagers or young men,

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男性的時候會以為是疝氣
Who might mistake it for a hernia.

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因為在腹股溝
Because in the groin area,

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在往下陰囊這個位置也會有疼痛
And further down to the scrotum, there can be pain.

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那腫脹但是呢又不是腫的太厲害
There’s swelling, but it’s not too severe.

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會想到
One might think,

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可能疝氣掉下來一點點引起的疼痛
That a slight hernia drop causes the pain.

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那其實
But in reality,

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已經
It’s already

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是一個比較危險的(需要)急診的一個情況
A more dangerous situation that requires emergency care.

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那它是(因為)睪丸呢
It’s because the testicle,

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因為這個提睪肌
Due to the cremaster muscle,

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在青少年或是年輕人
In teenagers or young men,

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他提睪肌比較肥厚
Has a relatively thick cremaster muscle.

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旋轉的角度比較大的時候
When there’s a larger rotation angle,

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引起睪丸本身這個動脈的
It can cause the testicle’s own artery

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血液的這個供應不夠
To have insufficient blood supply.

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所以變成疼痛
Leading to pain.

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而它疼痛有時候是急性很痛
The pain can sometimes be acute and very painful,

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有時候又是一個慢性疼痛
Or sometimes a chronic pain.

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跟這個疝氣的一個區隔又不太一樣
Which is different from the pain caused by a hernia.

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那有些人以為是疝氣
Some people might think it’s a hernia,

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就反而耽誤了
And thus delay,

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睪丸扭轉的一個急救的時間
The crucial time for emergency care for testicular torsion.

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好，所以這個也是必須呢
Okay, so it’s essential

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要盡早就醫做一下判斷跟區隔
To seek medical attention early for diagnosis and differentiation.

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那接下來是在
Next, regarding

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腹股溝的地方的淋巴結腫大
Swollen lymph nodes in the groin area,

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很多人來以為說腹股溝這邊有一包
Many people think there’s a lump in the groin,

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硬硬的甚至是兩邊
That’s hard, even on both sides,

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以為是疝氣
Assuming it’s a hernia.

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那結果不是
But it’s not.

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可能是這個淋巴結腫大、免疫的關係
It might be due to swollen lymph nodes, related to immunity,

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或者是這個疾病，傳染性疾病
Or an infectious disease.

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引起的
Causing

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淋巴結在腹股溝的地方的腫大
The lymph nodes in the groin to swell.

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腫脹
Swelling

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它位置跟一般的疝氣又稍微不一樣
Its location is slightly different from a typical hernia.

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那這個是需要在門診的時候做區隔
This needs to be differentiated during a clinic visit.

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好
Okay.

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特別淋巴結腫大是什麼
What’s special about swollen lymph nodes?

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平躺的時候腫大的區域還是在
When lying flat, the swollen area is still there,

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那疝氣腫脹
But the hernia swelling,

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平躺的時候腫脹就不見了
When lying flat, disappears.

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接著在女性
Next, in females,

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大陰唇那麼靠近那個陰道
The labia majora, close to the vaginal opening,

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開口的位置
Has

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這個地方有一個巴氏腺體
A Bartholin’s gland.

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巴氏腺體一般會分泌一些液體、水分
The Bartholin’s gland typically secretes some fluid,

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好保持這個會陰部的保護作用
To maintain the protective function of the perineum.

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巴氏腺體有時候它會發炎
Sometimes, the Bartholin’s gland can become inflamed,

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所以造成這個大陰唇
Causing the labia majora

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甚至往上
And even further up,

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到腹股溝的地方也會腫脹起來跟疼痛
To the groin area, to swell and become painful.

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會被以為是女性的疝氣
It might be mistaken for a female hernia.

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通常女性的疝氣位置會稍微再高一點
Usually, a female hernia is slightly higher,

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從下腹部腹股溝的地方
Starting from the lower abdomen and the groin area,

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再延伸到大陰唇的位置
Extending to the labia majora.

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那巴氏腺體囊腫
The Bartholin’s gland cyst,

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它是會先從這個下方一點
Starts a bit lower,

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那往上延伸
And then extends upwards.

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所以這個在發生的時候
So, when it occurs,

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這個順序角度高度不太一樣
The sequence and angle are different.

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一個是由上往下一個是由下往上
One is from top to bottom, and the other is from bottom to top.

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那巴氏腺體囊腫通常
The Bartholin’s gland cyst usually

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也會非常的疼痛
Is also very painful.

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那麼跟疝氣的這個卡住
And compared to the trapped hernia,

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是不太一樣的
It’s quite different.

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所以這個也可以做一下這個區隔
So, this can also be differentiated.

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好
Okay.

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另外就是腹股溝或者腹壁肌肉拉傷
Additionally, there’s the groin or abdominal muscle strain.

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那麼拉傷之後要愈合
After a strain, it takes time to heal,

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的很慢
And it’s slow.

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特別是現在大家流行到健身房健身
Especially now, as many people frequent gyms,

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健身的時候有時候是肌肉拉傷的
Sometimes they strain their muscles during workouts.

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那拉傷之後
After the strain,

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一段時間之後那個地方會有一些鈣化
Over time, there might be some calcification in that area,

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甚至硬化
Or even hardening.

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摸起來會有一個塊狀
It feels like a lump,

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凸凸的一個情況
Protruding.

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會有硬甚至稍微微凸
It can be hard and slightly raised.

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00:05:41,700 –> 00:05:44,266
這個情況會被以為是不是疝氣
This might be mistaken for a hernia,

170
00:05:44,266 –> 00:05:46,600
特別用力的時候那個地方又怪怪的
Especially when exerting force, it feels odd.

171
00:05:46,666 –> 00:05:49,400
所以這個也要做一下鑒別的診斷
So, this also requires differential diagnosis.

172
00:05:49,600 –> 00:05:51,266
另外比較少見的
Another less common issue is,

173
00:05:51,266 –> 00:05:54,766
是腹股溝的地方產生腫瘤
Tumors in the groin area,

174
00:05:54,766 –> 00:05:58,900
比如說脂肪瘤或者是說一些神經瘤
Like lipomas or neuromas.

175
00:05:58,900 –> 00:06:00,466
這非常少見的
These are very rare.

176
00:06:00,666 –> 00:06:03,133
通常腫瘤本身它會變大
Usually, the tumor itself will grow,

177
00:06:03,600 –> 00:06:06,400
逐漸變大而且是不會消失
Gradually increasing and not disappearing,

178
00:06:06,400 –> 00:06:07,566
躺平不會消失
Even when lying flat.

179
00:06:07,566 –> 00:06:09,300
好，所以這個是少見
Okay, so this is rare.

180
00:06:09,300 –> 00:06:11,866
但是門診也是要做一個區隔
But in outpatient clinics, differentiation is needed.

181
00:06:12,066 –> 00:06:14,400
接下來是腹腔骨盆
Next is the pelvic cavity,

182
00:06:14,733 –> 00:06:17,666
或者是後腹腔的症狀引起的
Or symptoms caused by the posterior abdominal cavity,

183
00:06:17,666 –> 00:06:19,700
腹股溝的這邊的腫啊脹啊
Like swelling or bulging in the groin area,

184
00:06:19,700 –> 00:06:20,766
或者是凸起來
Or protrusions.

185
00:06:20,766 –> 00:06:22,900
比較常見的是肝硬化
Commonly seen in cirrhosis,

186
00:06:23,333 –> 00:06:25,133
那麼引起的腹水
Leading to ascites,

187
00:06:25,133 –> 00:06:26,333
那肚子裡面有水分
With fluid in the abdomen,

188
00:06:26,333 –> 00:06:29,166
它在沿著腹股溝的地方凸起來是疝氣
It can protrude along the groin, resembling a hernia,

189
00:06:29,566 –> 00:06:30,800
或者是它沒有疝氣
Or without any hernia,

190
00:06:30,800 –> 00:06:34,100
但是造成兩邊陰囊整個的腫脹起來
But causing both testicles to swell,

191
00:06:34,300 –> 00:06:36,000
或腹股溝的地方的腫脹
Or swelling in the groin area.

192
00:06:36,100 –> 00:06:37,566
他會以為是疝氣
It might be mistaken for a hernia,

193
00:06:37,666 –> 00:06:38,733
有這個情況的時候
In such cases,

194
00:06:38,733 –> 00:06:40,366
也要做一下這個鑒別的診
Differential diagnosis is also needed.

195
00:06:40,366 –> 00:06:42,400
斷在臨床上我也遇過
I’ve encountered this in clinical practice,

196
00:06:42,400 –> 00:06:45,766
說在後腹腔的腫瘤或後腹腔的出血
Like tumors or bleeding in the posterior abdominal cavity,

197
00:06:45,766 –> 00:06:46,700
往下延伸
Extending downwards,

198
00:06:46,700 –> 00:06:49,733
造成下腹部的腹股溝的地方腫脹起來
Causing swelling in the lower abdomen and groin area.

199
00:06:50,066 –> 00:06:51,566
就以為是疝氣
Mistaken for a hernia,

200
00:06:51,566 –> 00:06:54,333
那麼原來是這個後腹腔的這個腫瘤
But it’s actually a tumor in the posterior abdominal cavity.

201
00:06:54,333 –> 00:06:56,400
那麼引起的這個情況
Causing this condition,

202
00:06:56,566 –> 00:06:58,900
以上的情況就是說原來不是疝氣
All the above situations mean it’s not actually a hernia,

203
00:06:58,900 –> 00:07:00,000
那麼在門診的時候呢
So, during outpatient visits,

204
00:07:00,000 –> 00:07:01,966
必須要做一下鑒別的診斷
Differential diagnosis is essential.

205
00:07:01,966 –> 00:07:04,666
那麼給大家做一個參考，謝謝
This is for your reference. Thank you.