彩色多普勒超声检查对小儿急性睾丸附件扭转的诊断及鉴别诊断价值

The ultrasonic diagnosis of acute testicular appendage torsion in children

目的探讨彩色多普勒超声检查对小儿急性睾丸附件扭转的诊断及鉴别诊断价值。方法回顾性分析2010年1月至2012年1月上海市儿童医院收治的因急性阴囊肿痛而行彩色多普勒超声检查的262例患儿的超声声像图特征,并与手术病理、临床最终诊断结果相比较。结果 262例患儿最终诊断为急性睾丸附件扭转78例,超声诊断为小儿急性睾丸附件扭转76例,诊断符合率为97.43%(76/78),2例误诊为附件炎。78例患儿(100%,78/78)睾丸上极上方或睾丸上极与附睾头间见类圆形或椭圆形结节,呈高回声或低回声不等,内部回声不均匀,伴有患侧附睾头肿大;22例患儿(28.21%,22/78)患侧精索增粗;16例患儿(20.51%,16/78)伴睾丸肿大;11例患儿(14.10%,11/78)阴囊壁水肿。彩色多普勒血流成像示扭转的附件内均未见血流信号。78例急性睾丸附件扭转患儿左侧扭转54例,右侧扭转24例;其中32例接受手术探查,均手术切除,余46例接受保守治疗,治疗后症状、体征逐步改善、消失。急性睾丸扭转25例,超声诊断符合率100%(25/25),23例为完全扭转,2例不完全扭转。急性附睾炎56例,超声诊断符合率100%(56/56),右侧附睾炎30例,左侧附睾炎26例。腹股沟疝103例,超声诊断符合率100%(103/103),右侧腹股沟疝51例,左侧腹股沟疝39例,双侧腹股沟疝3例。结论彩色多普勒超声检查对小儿急性睾丸附件扭转具有较高的诊断及鉴别诊断价值,是临床首选的影像学检查方法。

Objective To explore the diagnostic and differential value of color Doppler ultrasound in children's acute torsion of the testicular appendage. Methods A retrospective analysis was made on the color Doppler ultrasound sonographic features of 262 cases of children with acute scrotal swelling and pain in Children's Hospital of Shanghai from January 2010 to January 2012. And the ultrasound findings were compared with the surgical pathological,and clinical diagnoses. Results In the study,acute testicular torsion of appendix were confirmed in 78 cases. Among them,76 cases were successfully diagnosed by ultrasound with 2 cases misdiagnosed as adnexitis. The diagnostic accuracy ratewas 97. 43% ( 76/78) . The ultrasonographic features included: a circular or oval nodule attached on the testis' s upper pole with inhomogeneous echotexture and various echogenic level,the ipsilateral epididymal head enlargement( 100% ,78 /78) ,the ipsilateral spermatic cord thickening( 28. 21% ,22 /78) ,the swollen testis( 20. 51% ,16 /78) and the scrotal edema( 14. 10% ,11 /78) . CDFI showed no blood flow signals in the torsional appendage. Of 78 cases,54 cases occurred in left side and the rest 24 cases in the right side. A total of 32 patients underwent a surgical exploration and their necrotic testis and appendage were surgically removed. The rest 46 patients received medical treatment and got recovered. There were 25 cases of acute testicular torsion with ultrasound diagnostic rate of 100% ( 25 /25) . Of them,23 cases were complete type and the rest two cases were incomplete type. There were 56 cases( 30 on right and 26 on left side) of acute epididymitis with ultrasound diagnostic rate of 100% ( 56 /56) . There were 103 cases( 51 on right side,39 on left side and 3 on bilateral sides) of inguinal hernia with ultrasound diagnostic rate of 100% ( 103 /103) . Conclusion Color Doppler ultrasound is the most useful and convenient imaging modality in diagnosis of children's acute torsion of testicular appendage.