彩色多普勒超声在睾丸不全扭转治疗中的应用价值

目的深入研究睾丸不全扭转的血流动力学改变，探讨彩色多普勒超声（CDU）在睾丸不全扭转治疗中的应用价值。 方法对37例睾丸扭转患者和30例健康自愿者的阴囊高频CDU表现进行分析，对比研究睾丸的二维图像和血流动力学的变化，36例经手术证实。 结果37例睾丸扭转中，有10例为不全扭转，其中3例睾丸实质回声均匀，有2例血流信号减少，1例血流信号无减少，动脉血流频谱均呈低阻型，这3例施行松解固定术后睾丸均存活；另7例睾丸实质出现片状低回声，血流信号明显减少并多位于睾丸边缘，动脉血流频谱呈高阻型，5例施行松解固定术，1例行睾丸切除术，随访6例睾丸均萎缩。正常睾丸穿隔动脉及睾丸下极动脉的血流频谱可呈高阻型。 结论睾丸不全扭转，在睾丸内出现大片状低回声后即使仍有血流信号显示，术中也不宜松解精索、而应直接切除睾丸。了解睾丸动脉血流频谱形态的改变有助于对扭转后睾丸血流灌注状态的判断。     

睾丸扭转临床诊治分析

目的总结睾丸扭转的临床诊治方法 ,提高诊治水平。方法 2008年11月2009年10月,收治睾丸扭转患者15例。年龄14～28岁,平均18岁。15例均有睾丸疼痛症状,Prehn征阳性10例。术前行彩超检查,显示阴囊内睾丸、附睾位置改变,睾丸内血流减少或消失。术中探查睾丸,发现左睾丸扭转11例（73%）,右睾丸扭转4例（27%）。如恢复血供行睾丸固定术,坏死则行睾丸切除术。结果行睾丸复位固定术7例（47%）,睾丸切除术8例（53%）。4例12h以内手术者,睾丸均存活;5例12～24h手术者,2例睾丸存活;6例超过24h手术者,1例睾丸存活。睾丸扭转90～360°者7例,复位后存活5例;扭转360～720°者5例,存活2例;扭转〉720°者3例,均无存活。结论彩超对睾丸扭转的诊断具有重要意义,对睾丸扭转处理的关键是提高认识和早期诊断,早期手术治疗能明显提高睾丸存活的机率。     

彩色多普勒超声和超声造影检测睾丸扭转的诊断价值

目的 探讨彩色多普勒超声（CDU）和超声造影（CEUS）对睾丸扭转的诊断价值.方法 对17例睾丸扭转患者首先用二维超声显示双侧睾丸附睾形态、结构及内部回声,再用彩色多普勒观察血供状况,其中11例再用SonoVue肘静脉团注法进行超声造影.所有病例均经手术病理证实.结果 彩色多普勒显示16例患者睾丸内血流信号明显减少或消失,超声诊断睾丸扭转结果正确;1例患者睾丸内血流较丰富,超声误诊为急性睾丸附睾炎.超声诊断符合率为94.1%.11例超声造影均显示睾丸实质内造影剂充填缺损,诊断符合率为100%.结论 彩色多普勒超声和超声造影诊断睾丸扭转有较高的敏感性和特异性,应作为诊断睾丸扭转的首选方法.     

新生儿睾丸扭转的超声诊断特征并文献复习

目的探讨新生儿睾丸扭转的超声诊断特征。 方法回顾性分析成都市妇女儿童中心医院泌尿外科于2019年5月8日收治的1例睾丸扭转患儿的临床资料,对超声检查睾丸的位置、大小、形态、回声、血流等图像资料进行分析,并复习相关文献。 结果患儿出生6 h后无明显诱因出现哭吵,右侧阴囊肿胀,皮肤明显青紫,有触痛,以阴囊上部明显,抬举时疼痛无明显变化,透光实验见阴囊内有积液,右侧腹股沟精索走行区有轻度压痛,左侧阴囊未查及明显异常。超声表现：右侧睾丸实质欠均匀,可见放射状无回声,实质内未探及明显血流信号,右侧附睾头增厚,回声欠均匀,可见线状无回声,右侧睾丸鞘膜腔内无回声;左侧睾丸实质回声均匀,血流分布未见明显异常,左侧附睾未见明显异常。右侧精索增粗,回声欠均匀,内可见点状血流。超声提示右侧阴囊睾丸扭转可能。 结论通过超声检查能够对新生儿睾丸扭转进行准确的诊断,有利于为患儿的治疗提供准确依据。     

睾丸扭转九例误诊原因分析与防范对策

目的探讨睾丸扭转的临床特征及延误诊断原因。方法对首诊延误诊断9例睾丸扭转的临床资料进行回顾性分析。结果本组因突发阴囊区疼痛、肿胀就诊8例,因阴囊外伤就诊1例。6 h内就诊3例,12~24 h内就诊4例,超过24 h就诊2例。首诊误诊为急性附睾睾丸炎7例,睾丸肿瘤及阴囊损伤各1例。误诊时间2~7 d,平均2.3 d,后经彩色多普勒超声检查确诊睾丸扭转5例,MRI检查、核素扫描各确诊2例。均行手术治疗,手术探查复位后恢复血供3例,术中发现睾丸呈灰暗至紫黑色,复位后无变化,行患侧睾丸、附睾切除6例。结论首诊医师对睾丸扭转认识不足及不熟悉本病的诊治流程是误诊的主要原因,提高对睾丸扭转的认识是早期明确诊断的关键。     

术前超声预判儿童睾丸扭转后不同转归

目的 探讨术前超声预判睾丸扭转患儿转归的应用价值。方法 回顾性分析45例儿童睾丸扭转的临床及超声资料。按不同转归分为存活组(手术复位后随访睾丸存活)及失睾组(因缺血、坏死接受患侧睾丸切除术或手术复位后随访患侧睾丸萎缩),对比观察两组声像图特征,包括患侧睾丸大小改变、轴向改变、内部回声、血流改变及鞘膜积液。并进行统计学分析,选取组间差异有统计学意义的声像图特征,建立Logistic 回归模型预判患侧睾丸转归。结果 45例患儿均为单侧扭转,其中左侧27例,右侧18例;最终纳入存活组11例,失睾组34例。失睾组34例中,32例患侧睾丸回声不均匀,2例回声尚均匀;33例患侧睾丸实质内未探及血流信号,1例探及少量血流信号;6例患侧睾丸周边可见"环岛"征。存活组11例中,9例睾丸实质内回声均匀,2例回声不均匀;9例患侧睾丸实质内血流较健侧减少,2例未探及血流信号。两组间内部回声及血流改变差异有统计学意义(P均<0.05),患侧睾丸大小改变、轴向改变及鞘膜积液差异均无统计学意义(P均≥0.05)。Logistic 回归模型结果显示,术前超声的阳性(失睾)预测值为97.10%,阴性(存活)预测值为81.80%,预判睾丸扭转患儿转归的准确率为93.30%。结论 术前超声对预判儿童睾丸扭转的转归具有较高准确率,声像图中患侧睾丸内部回声及血流改变可作为预判指标。     

高频超声、彩色血流图及能量图在阴囊急症诊断中的临床价值

目的 探讨应用高频超声、彩色血流图及能量图在阴囊急症诊断中的临床价值。方法 选择连续观察、追踪随访临床确诊的阴囊急症87例。其中阴囊外伤13例，急性睾丸扭转12例，急性附睾炎32例，急性睾丸炎7例，急性睾丸一附睾炎15例，急性睾丸附件扭转8例。用高频二维超声观察左、右睾丸、附睾的形态大小及内部回声等；用彩色血流图及能量图观察血供信息。结果 以睾丸一附睾内无血供诊断睾丸扭转，敏感性、特异性和准确性均为100％。以睾丸或／和附睾肿大及高血供诊断急性睾丸或／和附睾炎，敏感性94．4％、特异性97％和准确性95．4％。结论 高频超声、彩色血流图及能量图在阴囊急症诊断中有重要的临床价值，尤其是在鉴别急性睾丸扭转、急性睾丸附件扭转和急性睾丸或／和附睾炎方面有快速、准确的意义。     

超声在青少年男性睾丸扭转诊疗中的应用

目的分析23例青少年男性扭转患者声像图,探讨超声检查在青少年睾丸扭转的临床价值。方法收集23例青少年男性睾丸扭转者声像图表现及术后病理结果。结果睾丸扭转后,睾丸组织的缺血坏死程度与其具体扭转时间关系密切,并且不同时间段的声像图也不相同。结论超声检查能够向临床提供睾丸扭转后不同时期的血供情况,为睾丸能否存活提供准确信息,并预测扭转复位后睾丸存活的可能性。     

以腹痛为首发症状的围青春期男性睾丸扭转

目的:提高对以腹痛为首发症状的睾丸扭转的诊治水平.方法:回顾分析26例围青春期男性睾丸扭转病例,按首发症状分为腹痛(A组)和阴囊痛(B组)两组,比较其诊治特点.结果:A组7例(27％),平均年龄18(12～25)岁,其中5例(72％)因缺血坏死行睾丸切除术,1例(14％)睾丸萎缩,1例(14％)局部睾丸坏死;B组19例(73％),平均年龄17(13～22)岁,其中9例(47％)因缺血坏死行睾丸切除术、1例(5％)睾丸萎缩.结论:以腹痛为首发症状的睾丸扭转更容易延误诊治而导致睾丸切除.对腹痛的围青春期男性,应将睾丸扭转列为鉴别诊断疾病之一,并常规检查阴囊.     

彩色多普勒超声对睾丸扭转与急性附睾-睾丸炎的鉴别诊断

目的 :探讨彩色多普勒超声对睾丸扭转与急性附睾 -睾丸炎鉴别诊断中的价值。方法 :首先用二维超声显示 14例睾丸扭转与急性附睾 -睾丸炎的睾丸、附睾的位置、大小、形态、回声 ,继之用彩色多普勒(CDFI)观察睾丸、附睾内的血供情况 ,其诊断均经手术或临床证实。结果 :4例睾丸扭转患侧睾丸、附睾内血供减少或消失 ,10例急性附睾 -睾丸炎血供增多。 1例超声检查过程中自行复位后的血供增多 ,易误诊为急性附睾 -睾丸炎。结论 :CDFI作为一种经济、实用、准确、无创性的检查手段 ,是目前鉴别睾丸扭转与急性附睾炎的首选方法。     

Testicular torsion: a twist to the tale

Testicular torsion is a surgical emergency that requires prompt exploration if testicular viability is to be maintained. Although rare, it is essential to be aware that it may occur despite previous fixation (orchidopexy). Testicular torsion occurring after previous orchidopexy is rare, but recognition of this possibility is essential to prevent testicular infarction and subsequent orchidectomy. During scrotal exploration a wide variety of methods for orchidopexy exist. We present a case of testicular torsion despite previous fixation and discuss the merits of various techniques available for orchidopexy.     

Sonographic prediction of viability in testicular torsion: preliminary observations

This study was performed to determine if sonography can assist in predicting testicular viability in the setting of testicular torsion. Sixteen patients with sonographically diagnosed and surgically proved testicular torsion were studied. The preoperative sonograms were reviewed retrospectively to determine testicular echogenicity and homogeneity, testicular size and vascularity, scrotal skin thickness and vascularity, and the presence or absence of a hydrocele. These findings were correlated with the viability of the testis at surgery. All nine patients with normal homogeneous testicular echogenicity had viable testes at surgery. All seven patients with hypoechoic or inhomogeneous testes had nonviable testes at surgery and pathologic evidence of necrosis. The other findings were less helpful in predicting viability. In the setting of testicular torsion, normal testicular echogenicity is a strong predictor of viability. Immediate surgical detorsion in these patients carries a very high likelihood of salvaging the affected testis.     

Infantile scrotal pyocele simulating missed testicular torsion on sonography

We present the case of a neonate with idiopathic infantile pyocele. Scrotal sonography revealed a complex fluid collection within the left scrotal sac containing septations and a fluid-fluid level. The dependent region of the collection had moderate echogenicity, the slightly hypoechoic testis was not well defined, and the scrotal wall was thickened. Color Doppler sonography revealed mild hypervascularity in the thickened scrotal wall but no vascularity inside the testis. The sonographic findings suggested missed testicular torsion, but surgery revealed a pyocele, for which no source was identified. Radiologists should be aware that idiopathic infantile pyocele can mimic the Doppler sonographic findings in missed testicular torsion.     

Duration of symptoms is the only predictor of testicular salvage following testicular torsion in children: A case-control study

ObjectiveTesticular torsion (TT) is an emergency requiring a prompt diagnosis and surgery to avoid irreversible changes and a complete loss of testis. The present study aimed to identify potential factors that may be predict a testicular salvage after TT in pediatric patients.MethodsConsecutive medical records of all children ≤16 years old with surgically confirmed TT over a period of five years (2011–2016) were collected. Patients were divided into 2 groups according to testicular viability and the type of treatment: Orchidectomy and orchidopexy. The differences between the two groups and potential predictors of testicular salvage were analyzed.ResultsThirty-one boys with TT met the inclusion criteria and were included in the study. The mean age was 13.6 years (range, 10 days - 15.8 years). Testicular salvage was possible in 18 (58.1%) patients. The duration of symptoms and a lesser degree of torsion indicated a testicular salvage in children and adolescents with testicular torsion, but in multivariate analysis only duration of symptoms (time to surgical detorsion) was significantly associated with the risk of non-salvage. At follow-up, testicular atrophy affected 73.3% of the patients treated with orchidopexy.ConclusionDuration of symptoms is the only predictor of successful testicular salvage following testicular torsion in children. It is associated with a substantial risk of testicular loss and atrophy.     

婴幼儿继发性睾丸缺血性病变的超声诊断及临床意义

目的探讨婴幼儿继发性睾丸缺血性病变的超声声像幽特征及临床意义。方法回顾分析我院1305例因阴囊急症就诊患儿的睾丸超声表现,分析睾丸缺血病因,总结其随访结局。结果62例腹股沟嵌顿疝患儿,发生继发睾丸缺血性病变25例（1．92％）,其中4例发生睾丸萎缩;睾丸扭转患儿12例（0．92％）,其中手术切除睾丸4例,随访发现睾丸萎缩3例;鞘膜积液、可复性腹股沟疝及睾丸附睾炎患儿均未发生睾丸缺血性病变。继发性睾丸缺血的声像图表现呈动念变化过程,Ⅰ期睾丸增大,Ⅱ期睾丸回声不均,Ⅲ期睾丸液化,Ⅳ期睾丸萎缩。睾丸萎缩者彩色多普勒血流图呈血流分布自正常或轻度增加到减少至淌失3个阶段。结论腹股沟嵌顿疝是婴幼儿继发性睾丸缺血性病变的主要原因,发生率高于睾丸扭转。睾丸缺血卢像图警动态变化过程,彩色多普勒血流成像显示睾丸无血流信号者,提示发生睾丸萎缩的可能,对这类患儿进行为期3个月的随访有重要的临床意义。     

彩色多普勒超声检测睾丸扭转的临床价值

目的 探讨彩色多普勒对睾丸扭转的诊断价值。方法 首先用二维超声显示１６例疑为睾丸扭转的睾丸附睾形态结构及内部回声,再用彩色多普勒观察血供状况,并全部以手术病理证实,结果 １５例病例侧睾丸血流消失或减少,睾丸内血流阻力指数增高,超声诊断睾丸扭转,与手术病理诊断相符;１例彩超未见血流减少,超声误诊为附睾丸,结论 彩超诊断睾丸扭转正确率高（９３．８％）,具有较高的敏感性和特异性,无创伤,简便易行,且能较     

超声造影对睾丸扭转的实验研究

目的：探讨超声造影（CEUS）在睾丸完全扭转诊断中的价值。方法：将20只雄性新西兰家兔制成睾丸扭转模型，分别观察其扭转前后CEUS表现，观察时刻为扭转前，扭转即刻，延迟期（扭转后3～24h），并进行时间-强度曲线（TICs）分析。结果：①建立扭转侧睾丸模型，扭转前20只新西兰家兔CEUS表现为完全灌注：扭转即刻有18只显示为无灌注，2只为灌注缺损；建立扭转模型后延迟期20只均为无灌注。②与扭转前比较，扭转即刻后显影时间（AT）、峰值强度（PI）、曲线下面积（AUC）减低，达峰时间（TTP）、平均通过时间（MTT）明显升高；延迟期TTP、AT、MTT、PI、AUC减低为零。结论：CEUS在诊断睾丸完全扭转中具重要价值，可观察睾丸内血流灌注情况，并能对少量血流进行半定量分析，提高了睾丸扭转的诊断准确度。     

Torsion of the testicular appendages: sonographic appearance

Torsion of the testis and torsion of the testicular appendages have similar presenting features, namely, acute testicular pain and swelling. The former condition requires urgent surgical intervention to save the testis; the latter condition can be treated conservatively. Despite the frequency of torsion of the appendix testis, which is the most common cause of acute hemiscrotum in the child, only occasional references to this entity are found in the radiological literature. We describe five cases in which an enlarged, homogeneously echogenic appendix testis was seen medial or posterior to the head of the epididymis. All cases were accompanied by hydrocele and thickening of the scrotal wall. Among the five cases, enlargement of the head of the epididymis was seen in four and increased testicular blood flow in two. Scanning in the coronal and transverse planes above the testis was useful in locating the enlarged, twisted appendix.