高频彩超诊断附睾炎的价值

目的 :探讨附睾炎的彩色多普勒超声声像特征。　方法 :4 2例附睾炎病人以高频彩色多普勒超声进行检查 ,2 1例健康者作为对照组。　结果 :① 92 %的病例患侧附睾头、体、尾部均增厚 ;② 81%的病例双侧附睾病变 ;③血流超声显示附睾内血流信号较丰富 ,血流色彩明亮 ,多呈条束形 ;④ 93%的病例并发睾丸鞘膜积液 ;⑤病史较长的病人常合并睾丸炎。　结论 :高频彩色多普勒超声对于附睾炎具有重要的诊断价值。     

干酪样坏死性附睾结核声像图特征分析

目的:总结干酪样坏死性附睾结核高频彩色多普勒声像图特征,提高其超声诊断准确率。方法:对12例经手术及病理证实的干酪样坏死性附睾结核高频彩色多普勒检查结果及临床资料进行回顾性分析,同时与28例附睾炎资料对比并进行文献复习。结果:①12例患者结核菌素(PPD)试验阳性67%,患肺结核42%。②干酪样坏死性附睾结核高频声像图特征:附睾局部或全部肿大,外形失常,病变处呈不规则、不均质中等偏强或低回声,兼有局限性较小的不规则、均质低或无回声区,边界不清;高频彩色多普勒能量图:部分患者(33%)病灶见丰富或较丰富以动脉为主的动、静脉血流信号。③继发改变:干酪样坏死性附睾结核者患侧睾丸肿大,内回声增强,可有睾丸鞘膜积液,无阴囊壁增厚及腹股沟淋巴结肿大,不伴有精索静脉曲张。结论:干酪样坏死性附睾结核高频彩色多普勒声像图具有一定特征,超声对其诊断及鉴别诊断具有重要临床意义。     

高频彩色多普勒超声对睾丸扭转的诊断价值

目的 探讨高频彩色多普勒超声对睾丸扭转的诊断价值.方法 对经手术证实的32例睾丸扭转患者的超声诊断结果及其彩色多普勒声像图特点进行回顾性分析.结果 超声首诊符合31例,诊断符合率96.88%.二维超声和彩色多普勒血流成像相结合,有助于对睾丸扭转的正确诊断.结论 高频彩色多普勒超声对睾丸扭转的诊断具有重要价值.     

彩色多普勒超声在输精管病变诊断中的应用

目的:探讨彩色多普勒超声在输精管病变诊断中的应用价值。方法:利用高频超声及经直肠超声联合检查患者输精管,发现病变,并观察其声像图表现。结果:超声可清晰显示输精管结构,明确输精管病变位置及相关病因,并且具有典型的声像图特征。结论:超声可清晰显示输精管睾丸段、精索段、腹股沟段及壶腹段病变,是输精管疾病检查的首选方法。     

阴囊及直肠腔内彩色多普勒超声在无精子症诊断分型中的价值

目的分别应用经阴囊及直肠腔内彩色多普勒超声进行无精子症的精确诊断分型,探讨两者在分型中的价值。方法收集2010年1月至2013年6月于中山大学附属第三医院就诊且临床初步诊断为无精子症的男性不育症患者496例,所有患者均行经阴囊及经直肠腔内彩色多普勒超声检查。根据文献资料及临床特点,我们提出无精子症的6种分型:Ⅰ型,超声检查均未见异常;Ⅱ型,睾丸源性病变引起的非梗阻性无精子症;Ⅲ型,输精管道先天畸形所致梗阻性无精子症;Ⅳ型,其他病变可疑与梗阻性无精子症相关;Ⅴ型,混合型,同时存在非梗阻及梗阻原因;Ⅵ型,精索静脉曲张。结果Ⅰ型,19例;Ⅱ型,睾丸体积<10 ml,63例;Ⅲ型,235例,其中附睾缺如30例,输精管缺如76例,精囊缺如59例,精囊萎小或发育不良20例,输精管缺如并精囊缺如38例,附睾、输精管及精囊均缺如12例;Ⅳ型,87例,其中附睾头囊肿16例,精囊囊肿5例,前列腺中部囊肿41例,附睾炎7例,输精管钙化5例,精囊钙化13例;Ⅴ型,6例;Ⅵ型,86例。结论结合经阴囊高频及经直肠腔内彩色多普勒超声行无精子症的精确诊断分型,其中Ⅱ型、Ⅲ型及Ⅵ型超声能相对明确诊断。     

睾丸肿瘤的彩色多普勒超声特征

目的 :探讨睾丸肿瘤的彩色多普勒超声表现及其特征。　方法 :应用彩色多普勒超声诊断仪 ,对 4 6例经手术病理证实为睾丸肿瘤病人的睾丸声像图和彩色多普勒血流图进行分析和比较。　结果 :4 6例睾丸肿瘤中除 4例为转移性恶性淋巴瘤和 6例睾丸间质瘤外 ,其余均为睾丸生殖细胞瘤。　结论 :彩色多普勒超声诊断睾丸肿瘤具有较高的准确性和特异性 ,是睾丸肿瘤的首选影像学检查方法。     

高频超声在输精管结扎术后附睾淤积症中的临床应用

目的:探讨高频超声在输精管结扎术后附睾淤积症诊治中的临床应用。方法:回顾性分析2002～2010年23例确诊为输精管结扎术后附睾淤积症患者的声像图特点,按照淤积附睾内部回声分为轻度淤积5例、中度淤积11例、重度淤积7例,观察其在临床治疗中的意义。结果:23例患者中14例显示双侧附睾体积增大,6例显示左侧附睾增粗,3例显示右侧附睾增粗,以体、尾增大为主;经过保守治疗,其中5例轻度淤积、11例中度淤积和2例重度淤积患者好转后出院,另外5例重度淤积患者保守治疗后联合输精管复通术症状明显减轻后出院。结论:输精管结扎术后附睾淤积症具有典型的声像图特征,高频超声对其临床分型、诊断和治疗有极为重要的应用价值。     

高频彩色多普勒超声对小儿原发性及继发性肠套叠的诊断价值分析

目的探讨高频彩色多普勒超声诊断小儿原发性或继发性肠套叠的价值。方法收集2015年7月至2017年12月我院确诊的50例原发性或继发性肠套叠患儿临床资料,回顾性分析本组患儿高频彩色多普勒超声资料,分析超声诊断准确率、肠套叠典型超声声像表现及超声检查中肠壁血运情况中的表现。结果本组50例经高频彩色多普勒超声诊断肠套叠的准确率为100.00%。合并肠息肉者2例、合并肠憩室2例、合并肠重复1例、合并淋巴瘤1例;最终复位成功41例,诊断为肠坏死3例。本组患儿可见典型"同心圆"征或"假肾"征,45例患儿病灶位于腹部右侧。肠管壁血流信号无显著变化者12例、血流信号表现增多者34例;经高频彩色多普勒血流显像、能量图显示存在明显血流信号,其中绝大多数表现"棒状"、"条状"等信号,有3例在两种方式中均未见明显血流信号,未能检测出频谱。结论高频彩色多普勒超声结果对于原发性或继发性小儿肠套叠的临床诊断具有良好的参考价值。     

男性乳腺发育症的超声诊断价值

目的:探讨男性乳腺发育症的声像图特点及诊断价值.方法:应用彩色多普勒超声诊断仪对28例临床触及乳头深部有包块的男性患者进行超声检查,并对其声像图特征及彩色多普勒血流情况进行回顾性分析.结果:男性乳腺发育症声像图有特异性.结论:彩色多普勒超声在诊断男性乳腺发育症具有很高的应用价值.     

精索形态观察在睾丸扭转早期诊治中的意义

目的:提高睾丸扭转早期的诊断和治疗水平。方法:回顾性分析49例睾丸扭转的临床资料及睾丸内血流声像图和精索超声特征。结果:49例睾丸扭转患者,彩色多普勒血流显像出现睾丸血流改变42例,其中血流增加3例,睾丸血流无明显改变7例;二维超声检查发现精索形态异常47例。手术复位固定21例,睾丸存活12例。结论:彩色多普勒超声扫描精索形态与睾丸血流变化对睾丸扭转的早期诊断有重要价值,尽早手术探查有助于挽救存活睾丸。     

Polyorchidism: report of three cases and further embryological considerations

We report 3 new cases of polyorchidism. Review of the literature allows two groups of anatomical variations to be identified: (1) where the Wolffian duct is duplicated longitudinally or absent, and (2) where the two testes are drained by the same epididymis and vas deferens. We postulate that the first group results from a primary anteroposterior division of the genital ridge, whereas the second group is the result of a transverse duplication.     

Polyorchidism with varicocele: a case report and review of literature

Polyorchidism is defined as the presence of more than 2 histologically proven testes. We report the case of a 20-year-old man with polyorchidism, presenting with right scrotal pain and right scrotal ovoid mass. Scrotal examination revealed two ovoid, mobile lumps with testicular sensation in the right side of the scrotum. Scrotal colour Doppler ultrasonography and magnetic resonance imaging confirmed the presence of double testes with common epididymis and common vas. Microscopic varicocele ligation was performed, and then, two ipsilateral testes were sutured together. The testes were then returned to the scrotum with fixation.     

彩色多普勒超声在高龄孕妇中对泌尿系统畸形胎儿的产前诊断价值分析

目的 分析不同类型泌尿系统畸形胎儿的彩色多普勒超声声像图的特征,评价彩色多普勒超声对高龄孕妇在产前诊断泌尿系统畸形胎儿的临床研究和诊断价值.方法 随机选择2014年3月至2016年2月本院接收的1 642例平均年龄为35.2岁且孕周为14~38周的孕妇,进行彩色多普勒常规检查,同时观测孕妇腹中胎儿的健康状况,收集对孕妇以及胎儿的临床资料和彩色多普勒超声声像特征并进行统计分析,并对怀疑为泌尿系统畸形的胎儿进行随访验证.对检测出泌尿系统畸形胎儿、疑似泌尿系统畸形胎儿和漏诊的病例,在分娩后进行彩色多普勒超声诊断和随访,将随访的结果与产前彩色多普勒超声检查的统计结果相对照.结果 通过彩色多普勒超声检测1 642例孕妇,对其超声声像特征的资料进行分析,根据超声声像图特征做出诊断.检测发现有42例泌尿系统畸形的胎儿,包含肾发育不良胎儿4例,占9.5%;多囊性发育不良8例,占19.04%;肾盂扩张15例,占35.7%;肾积水6例,占14.3%;肾缺如7例,占16.7%;巨膀胱1例,占2.4%;尿道下裂1例,占2.4%;进行产前彩色多普勒超声检测的诊断结果与分娩后检查和随访结果一致,其中一例被误诊,产妇分娩后病症消失.结论 产前对高龄孕妇进行彩色多普勒超声检查,诊断出泌尿系统畸形胎儿的准确率较高.利用彩色多普勒超声检测,使得泌尿系统畸形胎儿在产前即可作出诊断,为临床诊断、采取措施和预后评估提供了可靠且重要的依据.     

Polyorchidim: a case report and review of the literature

A 28-year-old male presented with a small painless lump in his left hemiscrotum. A physical examination revealed a non-tender mass that was palpable on the tail of left epididymis, and the testis and spermatic cord were normal. Ultrasonography showed an isoechoic round shaped tumor, 16 mm in diameter. An exploration of the scrotum was performed, based on a preoperative diagnosis of a left epididymal tumor. The tumor was located below the tail of epididymis, and had a whitish capsule, which looked similar to tunica albuginea testis. A frozen section revealed testicular tissue without any malignant change, and therefore polyorchidism was diagnosed. The accessory testis was resected because there was no connection with the epididymis and vas deferens. Polyorchidism is a rare congenital anomaly with 24 cases reported in the Japanese literature. The indications for the resection of an accessory testis are controversial. Patients with intrascrotal polyorchidism might be recommended to undergo a resection of the accessory testes if there are signs of dysplasia during an intraoperative biopsy. Patients must be followed up with regular clinical and ultrasonic examinations when accessory testes are preserved. However, extrascrotal supernumerary testes should be managed by an orchiectomy because of the increased risk of malignancy.     

医源性双侧输精管损伤诊治体会

目的　探讨医源性双侧输精管损伤的病因 ,提高该病的诊治水平。　方法　对 1 995年 2月～ 2 0 0 1年 9月收治的 1 0例患者的临床资料进行回顾性分析。　结果　采用显微外科手术直接行端端吻合或改变输精管行程行端端吻合术 ,8例成功复通 ,其中 4例精液正常者均获生育。　结论　腹股沟斜疝修补术、隐睾下降固定术及精索静脉高位结扎术是引起医源性双侧输精管损伤的主要原因 ,常规的经皮输精管穿刺造影是诊断该病的可靠方法。但彩色多普勒因无损伤可能成为诊断该病的首选方法。显微外科行输精管复通术是该病的理想治疗     

The incidence of spermatic cord structures in inguinal hernia sacs from male children.

Inguinal herniorrhaphy is a common surgical procedure in children. Controversy exists regarding the usefulness of microscopic examination of hernia sacs, and changes in reimbursement schemes have heightened this controversy. We summarize our experience with histologic examination of these specimens to establish benchmarks for the number of spermatic cord structures in inguinal hernia sacs from male children. A 14 1/2 consecutive calendar year review of pathology reports and histologic sections of hernia sacs was conducted at a tertiary care children's hospital. Of 7,314 males (range newborn to 19 years old), 65% had bilateral and 29% had unilateral herniorrhaphy (6% unknown). Seventeen cases contained vas deferens (0.23%); 22 had epididymis (0.30%); and 30 had embryonal rests (0.41%). Either vas deferens or epididymis was found in 0.53% of patients. No cases contained bilateral vas deferens, bilateral epididymis, or vas deferens in one side with epididymis in the contralateral side. Three hernia sacs contained co-existing vas deferens and epididymis. Our study helps to provide surgeons with information for preoperative counseling regarding potential injury to the vas deferens or epididymis. This study provides baseline comparison data for quality improvement programs. We believe that each institution should weigh the costs, risks, and benefits of performing microscopic examinations on hernia sacs, depending on their own experience and data.     

Intra-abdominal testis with loop-like epididymis and intra-canalicular vas and vessels

A case of intra-abdominal testis with loop-like epididymis and intra-canalicular vas and vessels is presented. A 3-year-old male with left impalpable testis since birth was admitted to our department. Physical examination and ultrasonography were inconclusive. Laparoscopy revealed a small left abdominal testis with surrounding adhesions close to the left-obliterated umbilical artery. The vas deferens and spermatic vessels were entering into the internal inguinal ring. The processus vaginalis was patent. At inguinal exploration the testis was atrophic and the epididymis was loop-like, joining the vas deferens in the inguinal canal. The spermatic vessels continued to the atrophic testis in a loop-like manner. The testis, epididymis and the vas deferens were removed. Histopathological examination of the testis revealed Sertoli cells only. If inguinal exploration had been performed without laparoscopy, the presence of the vas deferens and spermatic vessels in the inguinal canal with the absence of the testis could have been misdiagnosed as vanishing testis. Abdominal testis would thus have been missed, with increased risk of complications, particularly malignancy.     

Arteriovenous haemangioma of the vas deferens: a case report and literature review

Arteriovenous haemangioma of the vas deferens is an extremely rare entity in clinical practice. To date, there have been no clinical or pathological cases reported in Medline, Embase or other published English literature. Herein, a 50-year-old male who presented with right scrotal pain for 4 years after vasectomy was admitted to our hospital. One painful nodule was palpable in the right scrotum on physical examination. Color Doppler ultrasound merely showed dilation of the epididymis and no additional information concerning the painful nodule in the right scrotum. Moreover, the laboratory test results were all within normal limits. Ibuprofen was administered to the patient for 2 months with a poor effect, and then spermatic cord block significantly relieved his symptoms. This patient underwent resection of the right painful nodule of the vas deferens under medical advice. Postoperative pathological examinations showed arteriovenous haemangioma of the vas deferens. There were no obvious complications after arteriovenous haemangioma excision, and the right scrotal pain was significantly relieved 1 month later. This article reminds urologists and oncologists that haemangioma can involve the vas deferens and, in addition to spermatic granuloma, might be a cause of post-vasectomy pain syndrome. Cauterization of the vas deferens might have a potential relationship with haemangioma.     

Polyorchidism with presumed contralateral intrauterine testicular torsion

INTRODUCTION

Polyorchidism was first described by Blasius in 1670¹ during a routine autopsy. We report a child with unilateral polyorchidism and a contralateral absent testis, a combination not reported previously.

PRESENTATION OF CASE

A 2-year-old boy was referred to the outpatient clinic with an impalpable left testis. At laparoscopy, the left vas deferens and testicular vessels ended blindly proximal to a closed internal ring. No gonadal tissue was identified. On the right side, a single vas deferens and testicular vessels were seen entering the internal ring as normal. The right side of the scrotum was explored and two testes were identified within a single tunica vaginalis.

DISCUSSION

Polyorchidism is rare with a literature search identifying approximately 230 reported cases. Whilst prenatal testicular torsion is increasing being recognized and treated as a surgical emergency,⁹ prenatal testicular torsion in association with polyorchidism has not been previously reported.

CONCLUSION

We describe a unique case of a 2-year-old boy with right-sided polyorchidism and an absent left testis associated with a blind ending vas deferens and testicular vessels, presumed secondary to intrauterine testicular torsion.