彩色多普勒超声对精索扭转早期诊断及扭转睾丸术后存活力预测的临床价值

doi:10.3969/j.issn.2095-378X.2019.02.006

摘要/Abstract

摘要： 目的探讨彩色多普勒超声(CDU)对精索扭转早期诊断及扭转睾丸术后存活力预测的临床价值。方法 50例精索扭转患者,术前均经CDU诊断,测定患侧与健侧睾丸的最大径、睾丸动脉的最大流速(PSV)及阻力指数(RI),分别做比较,并根据其二维超声表现及血流供应情况将患侧睾丸术前活力分为1~4级,根据活力情况选择手术方式。根据睾丸体积比(C)及CDU检查情况将随访的术后睾丸存活力分为A~C级,A~B级睾丸存活,C级睾丸萎缩。结果 50例精索扭转患者中45例超声诊断与手术结果相符,准确率90%。患侧睾丸的最大径[(5.2±1.2) cm]较健侧[(3.6±0.6) cm]大,患侧睾丸动脉PSV[(2.9±1.9) cm/s]较健侧[(7.8±2.2) cm/s]高,患侧睾丸RI[(0.69±0.06)]较健侧[(0.48±0.03)]高(P<0.05)。5例经睾丸扭转切除术切除睾丸,40例经睾丸扭转复位术保留睾丸,A级存活力者20例,术前活力分别为1级8例,2级10例,3级2例;B级存活力者17例,术前活力分别为2级1例,3级16例;C级存活力者3例,术前活力分别为3级活力2例,4级活力1例。CDU预测的睾丸术前活力与其术后随访时的存活力具有明显相关性(r＝0.824,P＜0.001)。结论 CDU检查对精索扭转的早期诊断具有较高的敏感性及特异性,对扭转睾丸复位后存活力的预测有重要价值。

关键词: 超声, 彩色多普勒血流图, 精索, 扭转

Abstract: Objective To investigate the clinical value of color Doppler ultrasound (CDU) in the early diagnosis of testicular torsion and postoperative vitality prediction.Methods Fifty patients with testicular torsion were diagnosed by color Doppler ultrasound before operation to determine the maximum diameter, peak systolic velocity (PSV), and resistance index (RI) of both affected and normal testicles, and to divide the preoperative vitality of affected testicles into 1-4 levels according to the ultrasound manifestations and blood flow supply.Operation Methods were determined according to the preoperative vitality of testicles.According to the testicular volume ratio (C) and CDU results, the postoperative vitality of testicles was divided into A-C level, A-B levels indicating testicular survival and C-level indicating testicular atrophy.Results The ultrasound diagnosis Results of 45 cases were consistent with the Results of operation, with an accuracy rate of 90%.The maximum diameter of the affected testicles [(5.2±1.2) cm] was larger than that of the normal testicles [(3.6±0.6) cm], the PSV of the affected testicles [(2.9±1.9) cm/s] was higher than that of the normal testicles [(7.8±2.2) cm/s], and the RI of the affected testicles (0.69±0.06) was higher than the normal testicles (0.48±0.03,P<0.05).Respectively 5 cases received testicular torsion resection and 40 cases retained testicles by testicular torsion reduction.There were 20 cases with A level vitality of testicles, whose preoperative vitality of testicles were graded into level 1 (n=8), level 2 (n=10), and level 3 (n=2); 17 cases with B level vitality of testicles, whose preoperative vitality of testicles were graded in to level 2 (n=1) and level 3 (n=16); and 3 cases with C level vitality of testicles, whose preoperative vitality of testicles were graded into level 3 (n=2) and level 4 (n=1).There was a significant correlation between the preoperative vitality of testicles and the postoperative follow-up vitality of testicles (r=0.824, P<0.001).Conclusion CDU is highly sensitive and specific to the early diagnosis of testicular torsion, and has important value in predicting the vitality of torsional testis after reduction.

Key words: Ultrasound, Color Doppler flow imaging, Spermatic cord, Torsion

中图分类号:

R445.1
R697

张兵, 王秀艳. 彩色多普勒超声对精索扭转早期诊断及扭转睾丸术后存活力预测的临床价值[J]. 外科研究与新技术, 2019, 8(2): 97-101.

ZHANG Bing, WANG Xiuyan. Clinical value of color Doppler ultrasound in early diagnosis and prediction of postoperative ritality of testicular torsion[J]. Surgical Research and New Technique, 2019, 8(2): 97-101.

参考文献

[1] 易红美,任洪艳,吴小候,等.重庆地区451例睾丸扭转的临床特征分析[J].重庆医科大学学报, 2018,43(11):1500-1503.
[2] Sessions AE, Rabinowitz R, Hulbert WC, et a1.Testicular torsion: direction, degree, duration and disinformation[J].J Urol, 2003,169(2):663-665.
[3] Zhao LC, Lautz TB, Meeks JJ, et al.Pediatric testicular torsion epidemiology using a national database: incidence, risk of rechiectomy and possible measures toward improving the quality of orchiectomy and possible measures toward improving the quality of care[J].J Urol, 2011,186(5):2009-2013.
[4] 姚巍.精索螺旋状扭曲在采用高频超声诊断睾丸扭转中的价值[J].中国医学工程, 2015(1):43.
[5] 张展,方玲,裴勖斌,等.小儿隐睾合并扭转的早期超声诊断[J].中国医学影像学杂志, 2017,25(2):146-147.
[6] Galina P, Dermentzoglou V, Baltogiannis N, et al.Sonographic appearances of the epididymis in boys with acute testicular torsion but preserved testicular blood flow on color Doppler[J].Pediatr Radiol, 2015,45(11):1661-1671.
[7] 谢丽君,薛恩生,林礼务,等.彩色多普勒超声对睾丸扭转后存活力的预测价值[J].中华超声影像学杂志, 2010,19(5):419-422.
[8] 吴朝霞,吴才标,周运专,等.高频多普勒超声在睾丸扭转检查诊断中的应用价值[J].中国性科学, 2017,26(1):18-21.
[9] 王豪,宋嫣,赵新.彩色多普勒超声在睾丸扭转中的应用价值[J].临床超声医学杂志, 2014,16(7):493-494.
[10] 白银莲,项霞青.彩色多普勒超声在儿童腹部肿块诊断中的应用[J].外科研究与新技术, 2016,5(4):274-276.
[11] 张建,阿不力孜·司马义,李九智,等.睾丸扭转长期随访分析(附16例报告)[J].中国男科学杂志, 2017,31(01):46-49.
[12] Gomes DD, Vidal RR, Foeppel BF, et al.Cold weather is a predisposing factor for testicular torsion in a tropical country. A retrospective study[J].Sao Paulo Med J, 2015,133(3):187-190.
[13] 罗圆满,崔子连.睾丸扭转的诊治进展[J].泌尿外科杂志(电子版), 2018,10(4):53-56.
[14] 敬基刚,李永忠,庄华,等.成年男性睾丸扭转的超声表现[J].华西医学, 2017,32(10):1555-1558.
[15] 程晓君.糖尿病下肢血管病变的超声诊断及价值评价[J].外科研究与新技术, 2017,6(4):250-252.