放射性核素阴囊闪烁显像诊断精索静脉曲张

放射性核素阴囊闪烁显像是诊断精索静脉曲张的一晨侵袭性方法，目前对该方面的研究已从定性，半定量向定量方向发展，可对精索静脉曲张的诊断、分级、预测手术效果提供帮助。     

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。     

不育男性精索静脉曲张的超声诊断(附65例分析)

目的 :探讨不育男性精索静脉曲张的超声诊断及临床意义。方法 :应用彩色多普勒超声筛查 2 6 8例不育男性的精索静脉 ,了解不育男性精索静脉曲张的发病率 ,并比较超声与临床触诊两种不同方法的诊断价值。结果 :2 6 8例就诊的不育男性患者中共发现精索静脉曲张患者 6 5例 ,占总数的 2 4 .3%。其中能通过触诊诊断的临床型患者 39例 ,占总数14 .5 % ( 39/ 2 6 8) ,而不能触诊的亚临床型 2 6例 ,占 9.7% ( 2 6 / 2 6 8)。静脉曲张的超声检出率与触诊相比两者有显著性差异(P <0 .0 5 ) ,与多普勒超声相比 ,静脉曲张触诊的敏感性是 6 0 .0 % ,可靠性是 95 .1% ,特异性是 99.0 %。结论 :不育男性精索静脉曲张的超声筛查十分必要 ,其诊断客观、可信 ,优于临床触诊。     

彩色多普勒超声对部队官兵精索静脉曲张的诊断价值

目的探讨彩色多普勒超声对部队官兵精索静脉曲张(VC)的诊断价值。方法对患有精索静脉曲张的150名部队官兵行彩色多普勒超声检查,按入伍时间分为三组:A组(40例):入伍时间1年;B组(49例):入伍时间2年;C组(61例):入伍时间≥3年;检测平静呼吸时精索静脉最大内径(D0),Valsalva试验时最大内径(D1),反流持续时间(Tr)。组间评价采用单因素的方差分析。结果 (1)随着入伍时间的增加精索静脉曲张的发病率也增加。(2)入伍时间越长VC患者的D0、D1、Tr也随着增加,三组间比较具有统计学意义(P<0.05)。结论彩色多普勒超声对部队官兵精索静脉曲张具有重要的诊断价值。     

腹腔镜精索静脉高位结扎术20例临床应用体会

精索静脉曲张是泌尿外科常见病,发病率在男性人群中为10%~15%,常可导致不育。尽管精索静脉曲张导致不育的机制尚不完全清楚,但精索静脉结扎可有效改善精液质量,因而成为治疗精索静脉曲张的主要方法。我院2004-04~2006-08采用腹腔镜精索静脉高位结扎术治疗精索静脉曲张20例,效果满意,现报告如下。1临床资料1.1一般资料:本组20例,年龄17~40岁,平均(28.25±3.56)岁。左侧16例(其中复发精索静脉曲张1例),双侧4例,其中轻度3例、中度10例、重度7例。患者有明显的阴囊下坠疼痛和肿大,以疼痛为主要症状就诊者12例,不育者4例。诊断依靠体格检查,在阴…     

彩色多普勒超声诊断精索静脉曲张的价值研究

目的：探讨彩色多普勒超声（CDFI）诊断精索静脉曲张的价值。方法：选取临床拟诊精索静脉曲张87例,术前均先采用CDFI检查,再将检查结果与术后确诊情况进行对比分析。结果：二维超声可见精索静脉迂曲、扩张、走行紊乱,甚至呈＂蚯蚓状＂或＂蜂窝状＂;CDFI检测发现无回声暗区内充满红蓝相间血流,Valsalva试验后呈色彩倒转或红蓝交替现象;脉冲多普勒显示正负双向血流频谱,平静呼吸血管最大内径〉2.16 mm,Valsava试验血管最大内径〉1.78 mm,最大反流速度〉4.25 cm/s,反流持续时间〉1.84 s。其中左侧精索静脉曲张82例,双侧5例;全部病例均经手术证实,术后诊断符合率100%。结论：彩色多普勒超声在诊断精索静脉曲张中具有较高的应用价值。     

超声普查武警战士精索静脉曲张的价值

 目的评价超声检查对武警战士精索静脉曲张的应用价值,探讨武警战士精索静脉曲张影响因素及其预防措施.方法对新入伍的1 569名武警战士的两侧精索静脉进行超声普查,发现精索静脉内径＞0.20 cm者进行彩色多普勒(CDFI)检查,并测量其睾丸大小.入伍1 a后复查.结果1 569名战士中发现左侧精索静脉内径＞0.20 cm者228例(14.53%),其中CDFI发现静脉内不同程度返流者163例(10.39%)均无明显临床症状,右侧精索内径均＜0.20 cm.1 a后复查,左侧精索静脉内径＞0.20 cm者379例(24.16%),静脉内不同程度返流者203例(12.94%),出现临床症状84例,手术治疗68例.结论超声普查结合CDH对武警战士精索静脉曲张诊断和随访有着重要的价值,长时间站立军事训练是影响武警战士精索静脉曲张的重要因素,对其预防措施提出看法.     

高频彩色多普勒超声诊断精索静脉曲张临床分析

目的:探讨高频彩色多普勒超声在精索静脉曲张(Vc)中的诊断价值。方法:采用高频彩色多普勒超声检测749例Vc患者并对其进行统计分析。结果:亚临床型与临床型Vc发病年龄有极显著差异;临床分型相同时,曲张的精索静脉内径与同侧睾丸最大截面积无相关性;左右侧精索静脉内径、睾丸最大截面积均高度相关。结论:曲张的精索静脉内径大小对同侧睾丸最大截面积无影响;双侧精索静脉曲张患者左右两侧病变关系密切。     

精索静脉曲张的诊断应用多普勒声象法及精索内静脉造影术的比较

在272例左侧精索静脉曲张中(其中74例为双侧),应用多普勒声象法及静脉造影术对精索内静脉的回流作了比较性研究.多普勒声象法是一简单而可靠的诊断回流的方法.静脉造影术是显示精索内静脉功能不全的独特方法.自髂静脉的“远端回流”及“亚临床”精索静脉曲张亦作为问题提出.     

精索静脉曲张的阴囊热象检查

自1970年开始热象仪应用于精索静脉曲张病人的阴囊温度检查，迄今已有20余年历史。作者对20例正常人和81例病人用遥测热象仪进行了阴囊温度检查，以了解精索静脉曲张病人阴囊温度的变化及热象仪在诊断亚临床型精索静脉曲张中的价值。临床资料第一组：正常对照20例，年龄19～45岁，平均29岁。查体：无精索静脉曲张，实验室检查：精液常规正常。第二组：精索静脉曲张患者见例，年龄23～49岁，平均28岁。查体：单侧曲张44例，双侧曲张17例，78侧曲张中I“40例，豆～皿℃38例。实验室检查：本组病例精液常规发现精液质量差，包括精子计数少、活…     

Scrotal scintigraphy in the diagnosis and grading of varicocele

Scrotal scintigraphy with 99mTc-red blood cells has been reported as a useful method for detecting varicocele. In this study we analysed the scintigraphy of 251 infertile males with clinically diagnosed or suspected varicocele, in an attempt to establish a grading system of varicocele. Scintigraphically varicocele was diagnosed in 207 patients on the basis of pooling in hemiscrotum in static images and/or early flow through the spermatic cord vessels in dynamic images; physical examination overlooked 17 of them. Of the 207 patients, all had pooling (153 left-sided, 1 right-sided, and 53 bilateral pooling) and 52 had early flow. The early flow was a less sensitive sign for varicocele than the pooling and invariably accompanied by the intense pooling. The early flow may be related to increased shunt flow through varicocele. According to the scintigraphic findings, varicocele was classified as follows: Grade I (small varicocele with faint early flow or mild localized pooling, n = 103), Grade II (medium varicocele with obvious early flow or curvilinear mottled pooling, n = 67) and Grade III (large varicocele with marked early flow or pooling, n = 37). Clinical assessment (93 small, 68 medium, and 54 large varicocele) supported the scintigraphic classification. Scrotal scintigraphy, therefore, facilitates precise evaluation of varicocele based on its morphology and hemodynamics.     

Ethanol injection for embolization of varicocele

Five patients were treated for varicocele by embolization with the use of ethanol, which has not been used before. The ethanol was injected into the spermatic vein involved in the varicocele by the technique of spermatic venography. Embolization was successful in all five patients. During the follow-up period, the varicocele became smaller or disappeared in four of the five patients. In one patient, catheterization was difficult, and the effect of ethanol was unsatisfactory because of the location of its release. The varicocele appeared again 13 months after embolization. Serious side effects were not found in all patients. Embolization therapy with ethanol is easily performed and is considered to be a safe and effective method.     

腹腔镜精索静脉高位结扎术治疗精索静脉曲张的疗效分析

目的观察腹腔镜精索静脉高位结扎术治疗精索静脉曲张患者的疗效。方法128例原发性精索静脉曲张患者,均经Valsalva试验及阴囊彩色多普勒超声检查证实精索静脉曲张并见反流征,术前精液分析均有不同程度的异常改变。采用腹腔镜精索静脉高位结扎术进行治疗。结果手术顺利,平均手术时间23.9 min,出血量平均约2 mL,无术中并发症发生,平均住院时间2.8 d。术后3个月精液质量明显改善,无复发。结论腹腔镜精索静脉高位结扎术治疗精索静脉曲张具有损伤小、恢复快、并发症少、效果满意的优势,值得临床推广应用。     

Quantitative multilevel mapping of hepatic blood flow by xenon computed tomography using aorta

A noninvasive and quantitative technique has been developed to measure human hepatic blood flow by xenon computed tomography (Xe-CT). Accurate data on time-dependent xenon concentrations in the arterial blood are indispensable for Xe-CT to ensure quantitativeness of measured blood flow. A method has been established by our group to use both aorta and end-tidal data to obtain arterial xenon information. Multilevel (3 levels) maps of arterial blood flow (Fa), portal blood flow (Fp), and partition coefficient (lambda) were created for patients with chronic hepatitis. A method to objectively evaluate Fa, Fp, and lambda values for the whole liver has also been developed by our group.     

精索静脉曲张术后精液参数变化的研究

目的探讨精索静脉曲张(VC)手术对VC患者精子质量的改善作用。方法对48例VC患者,手术前后精液质量以及抗精子抗体指标进行检测。并与10例健康志愿者(正常对照组)进行比较。结果 VC患者术前精子质量均明显降低,与正常对照组比较,差异具有统计学意义(P<0.05)。VC术后3、6和12个月患者的精液质量和抗精子抗体明显改善,与VC术前比较,差异具有统计学意义(P<0.05)。结论 VC手术可以明显改善VC患者的精子质量。     

The role of spermatic venography after surgical high ligation of the left spermatic veins: Diagnosis and percutaneous occlusion

Bilateral spermatic venography was performed in 40 patients who had previously undergone surgical high ligation of the left spermatic vein. Indications included recurrent or persistent varicocele or oligoteratospermia syndrome. Despite the prior surgery, 21 patients had venographic demonstration of a left-sided varicocele. Right-sided varicocele was demonstrated in 19 patients, 9 of whom also had left varicoceles. Only 9 patients did not have a varicocele demonstrated on either side. The various mechanisms of varicocele filling are discussed. Whenever a varicocele was demonstrated, immediate occlusion using steel coils was performed.     

腹腔镜手术与开放手术治疗精索静脉曲张的临床对照研究

目的观察腹腔镜手术与开放手术治疗精索静脉曲张的疗效。方法 采用随机分组的方法,将2009年1月～2010年12月间本院收治的83例精索静脉曲张患者分为两组,对照组41例采用开放手术,行腹膜后精索静脉高位结扎,治疗组42例采用腹腔镜精索内静脉高位结扎术。观察并比较两组患者疗效。结果两组手术均获成功,无并发症发生。治疗组单侧精索静脉曲张患者的平均手术时间与对照组无明显差异（P〉0.05）,而双侧的平均手术时间显著短于对照组,差异有统计学意义（P〈0.01）;治疗组的平均住院时间亦显著短于对照组（P〈0.01）。随访3月～2年,两组患者均无复发,两组的症状改善率和精液改善率无明显差异（P〉0.05）。结论腹腔镜精索内静脉高位结扎术治疗精索静脉曲张疗效确切,为治疗精索静脉曲张提供了一种可供选择的方法。     

"Scrotal varicocele, exclude a renal tumour". Is this evidence based?

A scrotal varicocele is a common finding during both a scrotal clinical examination or during the course of a scrotal ultrasound examination and invariably found in the left hemiscrotum. Traditionally when a scrotal varicocele is found, the referring clinician requests a renal ultrasound examination or the sonographer extends the examination to include a renal examination; to exclude a retroperitoneal or renal tumour as the cause for the varicocele. The present article examines the relevance of performing the extended ultrasound examination by reviewing the pathophysiological pathways for the development of a varicocele in the presence of a renal or retroperitoneal tumour; the prevalance of co-existing renal or retroperitoneal tumours and a varicocele; and the male population in whom this extended examination may be necessary. The conclusion from available evidence suggests that a retroperitoneal tumour will manifest in other ways before the development of a varicocele, the young patient with a varicocele will almost never have a retroperitoneal tumour, and only when a varicocele develops in an older patient will an extended examination be relevant. Even then it will be a rare finding and there will be other clinical manifestations of the primary tumour.     

经脐单孔三通道腹腔镜与小切口腹膜后精索静脉高位结扎术疗效比较

目的探讨经脐单孔三通道腹腔镜与小切口腹膜后精索静脉高位结扎术治疗男性精索静脉曲张（Varico-cele,VC）的疗效优缺点。方法采用经脐单孔三通道腹腔镜治疗患者28例,其中左侧8例,双侧20例。采用小切口腹膜后精索静脉高位结扎术治疗患者30例,其中左侧7例,右侧1例,双侧22例。结果 58例患者全部治愈出院,采用腹腔镜治疗双侧VC在平均手术时间少于开放手术（P〈0.05）,而在治疗单侧VC两者无统计学意义（P〉0.05）;采用腹腔镜治疗单双侧VC在平均住院天数和手术时间均优于开放手术（P〈0.05）。结论单孔三通道腹腔镜治疗VC疗效肯定、切口小、恢复快,尤其适合于双侧VC患者。     

Diagnosis of right-sided varicocele: a retrospective comparative study between clinical examination, Doppler findings, US imaging and vascular anatomy at phlebography

Historically varicocele is diagnosed almost exclusively on the left side. The introduction of new imaging techniques has allowed the identification and characterization of right varicocele. This study aims to compare the diagnostic accuracy of various imaging techniques to data obtained using phlebography in the diagnosis of right varicocele. Patients treated for isolated right varicocele between 1992 and 2010 were retrospectively identified. Data from clinical examination, Doppler-USS, Color-Doppler-USS and Retrograde Phlebography were collected for each patient. 133 out of 4305 patients (3.1%) presented with an isolated right varicocele. 34 of these patients (25.6%) presented with palpable right varicocele. Doppler-USS identified various degrees of type I right venous reflux in 90 patients (67.7%). Phlebography showed venous reflux in all the patients (133), although with variability in terms of internal spermatic vein anatomy. Right varicocele is characterized by predictable anatomic features. Identification and characterization of these features is useful in guiding percutaneous treatment, allowing to optimize radiological display and reducing failure rate.