彩色多普勒超声在诊断精索静脉曲张中的应用

目的：探讨彩色多普勒超声诊断男性不育症患者精索静脉曲张的检测指标及精索静脉曲张导致睾丸变小的情况。方法：采用彩色多普勒超声对46例正常对照者的精索静脉及178倒男性不育患者左侧曲张的精索静脉进行了检测。结果：①健康对照组双侧平静呼吸时精索静脉最大内径（DR）、Valsalva试验时精索静脉最大内径（D。）、最大返流速度（Vmax）、返流持续时间（TR）及睾丸体积差别均无显著性意义（P〉0．05）；②精索静脉曲张组与对照组及各级精索静脉曲张组间DR、DV、VR比较的差别具有显著性意义（P〈0．001）；③各精索静脉曲张组左侧睾丸体积小于右侧（P〈0．01）及对照组（P〈0．001），精索静脉曲张Ⅱ、精索静脉曲张Ⅲ组右侧睾丸体积小于对照组（P〈0．05），精索静脉曲张Ⅲ组左侧睾丸体积小于亚临床型精索静脉曲张组（P〈0．05）。结论：①彩色多普勒超声可为男性不育精索静曲张患者提供精确的精索静脉内径、血流动力学及睾丸大小等客观指标，有助于男性不育症病因的筛选；②单侧精索静脉曲张可引起双倒睾丸体积变小，以左侧为甚，亚临床型及临床型精索静脉曲张均可导致患侧睾丸体积缩小，且精索静脉曲张愈严重，睾丸体积愈小。

Application of Color Doppler Ultrasound in Make Infertility with Varicocele

Objective：To investigate the objective indexes of the diagnosis in male infertility with vaficocele by high frequency sonography, and the volume change of testis resulted from varicocele. Methods： Fourty - six heslthy msle volunteers and 178 infertile men with left varicocele were detected by high frequency sonography. Results：（1）The differences in spermatie vein diameter at rest （ DR ）, diameter at v alsalva maneuver （ Dv ）, the peak velocity of reflux （ VmaX ）, reflux time（TR） and testis volume between the fight and the left sides were not stastistically significant in the control group （ P 〉 0. 05 ） ; （2）The differences in DR, DV, Vmax and TR between the study group and control group were statisti- cally significant（P 〈0. 001 ）,and the differences between varicocele （VC）groups were also statistically significant in the study group （P 〈 0. 001 ） ; （3）The left testis volume was smaller than the fight one among VC groups and that of control group（P 〈0. 01 ,P 〈 0. 001 ）. The right testis volume in the VX il and VC II groups was significantly smaller than that of control group （ P 〈 0. 05 ）, and the left testis volume in the VC 111 group was significantly smaller than that of SVC group（P 〈0. 05 ）. Conclusions：（1）High frequency ultrasound can provide the accurate internal spermatic vein diameter, hemodynamics and the testis volume to male infertility caused by varicocele, it also can screen the reason of male infertility; （2）Unilateal varicocele can cause bilateral testis volume to decrease especially the left volume. Both unilateral SVC and VC can cause testicular atrophy, and the bigger VC size is, the higher testicular atrophy rate is.