精索扭转的彩色多普勒超声诊断

为研究精索扭转的彩色多普勒超声（ＣＤＵ）表现及其诊断价值，采用彩色多普勒电脑声像仪对１３例精索扭转、１７例急性睾丸附睾炎及７２例正常睾丸进行检查。异常３０例中，１０例进行手术治疗，其余病例经随访得到诊断结果。ＣＤＵ诊断精索扭转敏感性为９２．３％，特异性为１００％。研究表明，ＣＤＵ能够发现精索扭转并评价其程度，可帮助临床医师迅速准确地作出诊断     

实时精索团块在超声诊断睾丸扭转中的价值

目的 探讨实时精索团块在超声诊断睾丸扭转中的价值。方法 经超声检查的睾丸扭转患者42例,分析其阴囊的二维及彩色多普勒超声表现,仔细研究精索的走行,寻找有无实时精索团块。结果 所有病例均经手术证实。37例为完全扭转,二维及彩色多普勒上均可见精索团块,精索团块及其远端无血流信号。5例为不完全扭转,二维及彩色多普勒上均可见精索团块,精索团块内血流减少。结论 实时精索团块是诊断睾丸完全、不完全扭转最敏感、最特异的超声表现。     

不同程度精索扭转的超声诊断与临床对照分析

【目的】提高超声检查在精索扭转的诊断价值。【方法】分析50例经临床手术证实的不同程度精索扭转患者彩色多普勒超声图像特征。【结果】150例精索扭转患者中,48例因扭转程度不同,出现不同的精索二维声像图改变,40例彩色多普勒显像出现睾丸内血流改变异常,20例出现睾丸内二维声像图改变,敏感性分别为96％、80％、40％,特异性分别为100％、100％、67％。【结论】不同程度的精索扭转可出现不同的彩色多普勒超声改变,超声可作为临床首选的无创检查手段。     

彩色多普勒超声诊断睾丸扭转价值的分析

目的：评价彩色多普勒超声诊断睾丸扭转的价值。方法：对21例经手术证实睾丸扭转患者与彩色多普勒超声检查结果对比,以探讨彩色多普勒超声在睾丸扭转诊断中的价值。结果：20例彩色多普勒超声检查报告均提示有睾丸扭转,表现出超声检查结果与手术探查结果具有相当一致性。结论：彩色多普勒超声能较准确地诊断睾丸扭转及判断睾丸扭转的程度及病情发展,对手术方案的选择有较大的指导价值。应作为睾丸扭转的首选检查方法之一。     

精索扭转的诊断及治疗--附14例报告

目的:探索精索扭转发生的原因,提高对该病的认识水平,以减少误诊的发生.方法:回顾性分析14例精索扭转患者的临床资料.结果:14例中8例术前行彩色多普勒超声检查予以协诊,并经手术证实结果一致,其中6例扭转时间短(6小时以内)或不全扭转者经手术复位保留睾丸,7例因睾丸坏死而予切除,1例保守治疗.结论:对青少年突发的阴囊疼痛应考虑到本病的可能.彩色多普勒超声检查是诊断急性精索扭转的可靠方法.早期诊断及手术治疗可提高睾丸存活率.     

高频彩色多普勒超声诊断睾丸附件扭转的价值

目的:探讨高频彩色多普勒超声诊断睾丸扭转的价值.方法:回顾性分析我院采用高频超声诊断的23例睾丸附件扭转的超声图像及临床相关资料.比较患者患侧以及健侧睾丸、附睾、精索、阴囊壁及鞘膜腔的大小、形态、回声及内部血流情况的差异,分析高频彩色多普勒超声对睾丸附件扭转的诊断价值.结果:23例患者均通过手术或保守治疗证实.睾丸附件扭转有特征性的声像图表现,患者患侧睾丸或是附睾头旁(多例为附睾头与附体之间)均见块状回声,同时超声检查均未查见血流信号,同时也可伴有附睾头的增大,鞘膜积液及阴囊壁水肿.结论:高频彩色多普勒超声检查有助于睾丸附件扭转的诊断及鉴别诊断,为临床首选的影像学检查方法.     

彩色多普勒诊断精索静脉曲张的价值

目的:探讨彩色多普勒超声诊断精索静脉曲张的价值。方法:彩色多普勒超声测量不同曲张程度的精索静脉管径及流速,进行统计学处理。结果:精索静脉曲张程度的彩色多普勒反映的指标差异均有统计学意义(P<0.001)。结论:彩色多普勒超声诊断精索静脉曲张以血管管径与彩色血流情况相结合为诊断标准。     

彩色多普勒超声诊断卵巢扭转的价值再探讨

目的探讨彩色多普勒超声对卵巢扭转的诊断价值。方法应用彩色多普勒超声对经手术后病理证实的13例卵巢扭转进行综合分析。结果3例为单纯性卵巢扭转,超声均准确诊断;10例为卵巢肿物伴扭转,超声准确诊断9例,1例误诊为卵巢黄体血肿。诊断符合率92．3％。结论彩色多普勒超声诊断卵巢扭转有较高的敏感性和特异性,具有较高的临床应用价值。     

超声造影在卵巢肿瘤及卵巢蒂扭转诊断中的应用

目的探讨超声造影诊断卵巢肿瘤及卵巢蒂扭转的声像学特征及临床应用价值。方法采用对比剂Sonovue及低机械指数成像技术对32例怀疑卵巢肿瘤及卵巢蒂扭转的患者进行超声造影检查,分析其造影特点并与手术病理结果对照。结果 32例患者术后3例卵巢复活成功,其中常规彩色多普勒超声检查2例肿块周边及内部探及少量血流信号,超声造影检查5例病灶内见对比剂充填,表现为增强早期呈不均匀低增强,增强水平低于子宫肌层,增强晚期呈明显低增强。彩色多普勒超声与超声造影两种检查对诊断卵巢肿瘤蒂扭转之间具有一定程度的一致性(κ=0.529,P=0.248)。结论卵巢肿瘤及卵巢蒂扭转超声造影增强模式具有特征性,可显示内部组织缺血坏死的改变,较彩色多普勒对内部有无血供更敏感,为诊断提供更准确的信息,增加诊断信心。     

彩色多普勒超声检查和对比增强超声造影检查对精索扭转的诊断价值——附5例报告

目的：探讨彩色多普勒超声检查（CDU） 和对比增强超声造影检查（CEUS） 对精索扭转的诊断价值.方法：收集5例经手术证实的精索扭转患者的CDU及CEUS结果,并进行对比分析.结果：5例患者二维超声图均示睾丸前后径呈不同程度增大,不均匀内部回声,其中精索轴位偏转1例,合并睾丸鞘膜积液1例;彩色多普勒血流成像示睾丸内无明显血流信号3例,睾丸内见点状血流信号1例（与对侧无明显差异）,睾丸内血流信号减少1例（周边血流信号丰富）.CDU提示为精索扭转2例,未排除精索扭转1例,附睾和（或）睾丸炎2例.5例患者CEUS均示无灌注,提示为精索扭转.结论：CDU对血流改变明显的精索扭转患者具有较高诊断价值,但对于血流改变不明显的患者,及时行CEUS更有助于观察睾丸、附睾的灌注情况.     

彩色多普勒超声对睾丸附件扭转的诊断价值

目的 探讨彩色多普勒超声对睾丸附件扭转的诊断价值.方法 回顾性分析我院经手术或临床随访证实的35例睾丸附件扭转患者的声像图资料.结果 所有患者均可在睾丸上极与附睾头附近探及一非均质高回声结节,结节内未探及血流信号;22例患者同时伴有同侧睾丸及附睾轻度增大,且彩色多普勒血流信号较对侧相对增多;24例患者伴有同侧精索增粗;...     

The acute scrotum

In boys and adolescents, the acute scrotum usually results from one of three diseases: torsion of the spermatic cord, torsion of the appendix testis, or epididymitis. A rapid diagnosis of torsion of the cord, if present, is essential, and as soon as this diagnosis is made, arrangements must be made for timely surgical correction. Although a diagnosis for the acute scrotum in this age group can sometimes be made on the basis of the history, pathognomonic signs, and basic laboratory analysis of the urine and a urethral discharge, in the usual case diagnosis requires a Doppler ultrasound examination (which if positive for torsion makes the diagnosis), a radionuclide scan (for cases negative or indeterminate for torsion on the Doppler examination), or, as a last resort, scrotal exploration. In men, by far the most common cause of the acute scrotum is epididymitis, with the torsions being much less common. In heterosexual young men with epididymitis, N. gonorrhoeae and C. trachomatis are the most likely etiologic organisms; in homosexual men and older men (and boys), E. coli, Pseudomonas sp., and the gram-positive cocci are the most common pathogens. Ceftriaxone plus tetracycline is the initial antimicrobial regimen of choice in heterosexual young men; in the absence of evidence of a sexually transmitted pathogen, one of the antimicrobials effective against common urinary tract pathogens is the initial antimicrobial of choice in all other patients. When torsion of the cord is suspected in adult male patients, the Doppler examination and the radionuclide scan (if the Doppler is negative or indeterminate) can again make the diagnosis or rule it out.     

Torsion of the spermatic cord: sonographic diagnosis

This article describes the ultrasound guidelines for evaluating patients with spermatic cord torsion, including gray-scale, Doppler with spectral analysis, and color and power Doppler sonography. The sonographic and Doppler features of acute, subacute, and chronic torsion of the spermatic cord are demonstrated and discussed.     

彩色多普勒超声诊断精索病变的价值

目的探讨彩色多普勒超声在精索病变诊断与鉴别诊断中的价值。方法分别在阴囊、阴囊根部及腹股沟部进行超声扫查,观察精索径线的大小、声像图表现及血流情况。结果精索静脉曲张35例、精索炎36例、精索鞘膜积液25例及精索肿瘤3例,各有其声像图特征表现。结论彩色多普勒超声对于精索疾病的诊断与鉴别诊断,具有重要的临床价值。     

Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs

Scrotal ultrasonography (US) is usually the initial imaging modality for evaluating patients who present with acute pathologic conditions of the scrotum. Acute epididymitis, acute epididymo-orchitis, torsion of the spermatic cord (TSC), and other acute scrotal abnormalities may have similar findings at clinical examination. Pain and swelling make the clinical examination difficult, sometimes practically impossible, potentially resulting in management delays. The objective of this review is to summarize the main clinical signs of the TSC and to illustrate and briefly discuss the US features of this entity, including gray-scale imaging, color Doppler with spectral analysis, and power Doppler sonography. Although TSC can occur at any age, it is most common in adolescent boys. The intensity of the symptoms and the US findings vary with the duration of the torsion, number of twists in the spermatic cord (degree of rotation), and how tightly the vessels of the cord are compressed. An enlarged, more spherical, and diffusely hypoechogenic testis without detectable arterial and venous testicular flow at color and power Doppler US is considered diagnostic of acute testicular ischemia. The presence of a color or power Doppler signal in one part of the testis does not exclude TSC. Positive blood flow but significantly diminished, usually near or inside the mediastinum, may be found, mainly in the partial or incomplete TSC. Identification of a large echogenic extratesticular mass distal to the site of the torsion, frequently misinterpreted as a chronic epididymitis, can be the key to the diagnosis of TSC. When a small arterial sign is found a low amplitude waveform is present with an increased resistive index on the affected side due to a diminished, absent, or reversed diastolic flow. Gray-scale imaging, color Doppler, power Doppler and pulsed Doppler with spectral analysis are very effective to make or exclude the diagnosis of TSC.     

超声在小儿睾丸下降不全并发扭转中的诊断价值及其临床意义分析

目的 分析探讨超声在小儿睾丸下降不全并发扭转中的诊断价值及其临床意义。方法 选取我院于2011年4月至2015年11月期间收治的312例睾丸下降不全患儿的病例资料进行回顾性分析,其中有9例患儿经手术治疗后证实有睾丸扭转的手术病理结果存在及其超声像图表现。结果 312例睾丸下降不全患儿病例中筛选出9例（2.9%）合并有睾丸扭转的患儿,其年龄、临床表现、手术结果等各项基本资料见表1。超声未显示正常睾丸声像患儿有1例,只有左侧腹股沟粗大网络样回声出现;声像图显示睾丸实质回声正常的患儿有1例,睾丸血流丰富,与精索连接处有“漩涡状”血流信号出现;超声像图有实质不均匀低回声团出现的患儿有6例,彩色多普勒显示睾丸内无血流信号,睾丸包膜不光滑;出现有睾丸畸胎瘤的患儿有1例。结论 临床上睾丸下降不全的患儿不少,但是同时合并有睾丸扭转的则不多,超声检查对于早期发现这类患儿有着较好的诊断价值和极为重要的临床意义。     

Experimental study of the sonographic diagnosis of testicular torsion.

The sonographic and Doppler features of acute spermatic cord torsion were investigated in eight dogs. Serial sonography following torsion demonstrated unambiguous abnormalities in all experimental subjects within one hour. The observed abnormalities included increase in size of the spermatic cord, testis, and epididymis, decrease in echogenicity of the testis and epididymis, and loss of Doppler signal from the cord. Sonographic abnormalities were clearly visible before any histologic change was detected and well in advance of the onset of cellular necrosis. Since every experimental subject had an abnormal testicle, the identification of a normal testicle in a clinical setting is felt to exclude torsion. Combined gray-scale sonographic and Doppler features appear promising in the diagnosis of acute spermatic cord torsion and its distinction from acute epididymo-orchitis.     

Testicular torsion: a surgical emergency

Testicular torsion is caused by twisting of the spermatic cord, which results in compromised testicular blood flow. The degree of ischemic injury is determined by the severity of arterial compression and the interval between the onset of symptoms and surgical intervention. Torsion usually occurs at puberty, and an anatomic defect known as "bell-clapper" deformity is usually present. Typical symptoms include acute scrotal pain with associated nausea and vomiting. Up to one-half of patients report previous similar episodes. On examination, the testis is high-riding, tender, swollen and firm. Testicular scan or Doppler ultrasound examination can be helpful in distinguishing torsion from acute epididymitis. Prompt surgical treatment is indicated to reduce the torsion, and bilateral orchiopexy is performed to prevent recurrence. Exocrine function, as determined by semen analysis, is often abnormal after unilateral torsion.