睾丸内静脉曲张的彩色多普勒超声研究

Study of intratesticular varicocele by color Doppler ultrasound

目的探讨睾丸内静脉曲张（ITV）的超声表现、病因及临床意义。方法对3098例因不育症、精索静脉曲张（VC）、阴囊肿痛等原因就诊的患者进行阴囊彩色多普勒超声检查，其中发现31例ITV。结合文献对ITV的彩色多普勒超声表现进行分析。结果本组病例中，ITV检出率为1．0％（31／3098），VC组中ITV检出率为2．7％（31/1167），Ⅲ度VC中ITV检出率为8．1％（15/185）。双侧ITV1例，左侧25例，右侧5例。ITV的彩多色普勒超声表现为Valsalva动作时睾丸内单条或多条静脉扩张（内径0．9～5．2mm），并充盈反向血流。ITV的反向血流均来自蔓状静脉丛。结论ITV具有特征性的彩多色普勒超声表现，VC时蔓状静脉丛内静水压升高不是导致ITV的直接原因，VC并发ITV加重了皋丸生精功能的损害。

Objective To study the appearances of the color Doppler ultrasound （CDU）in intratesticular varicocele （ITV） and its pathogenesis and value of clinical application. Methods On period of three years,3098 patients with various scrotal diseases（infertility, extratesticular vericocele,and swelling pain,etc） were examined by CDU with 10-14 MHz linear array transductor, analyzed emphatically the appearances of the CDU in ITV, reviewing the literature. Results ITV was identified in 1.0 % （31/3098） patients with various scrotal diseases,in 2. 7%（31/1167） with extratesticular varicocele,and in 8.1%（15/185） with grade III extratesticular varicocele. Of 31 cases,25 were located in the left testis,5 in the right,and 1 bilateral. The locations of the ITVs were within the testicular parenchyma in 21 ,subcapsular in 6,within the mediastinum in 1, mixable in 4. The shapes of the ITVs were serpentine in 15, tubular in 12,oval in 1, and mixable in 4. Diameter ranged from 0.9 to 5.2 mm （mean, 1.6 mm）. On CDU,spontaneous retrograde flow was showed in 5 and the retrograde flow could be seen only after the Valsalva maneuver in 27. The findings were graded according to the varication extent of the intratesticular veins as Ⅰ-Ⅲ stages. The inverse flows of the ITVs were all from ipsilateral pampiniform plexus. Conclusions ITV has a characteristic CDU appearance. With extratesticular varicocele, the rise of the hydrostatic pressure in the pampiniform plexus could not directly result in ipsilateral ITV. The presence of the ITV in extratesticular varicocele may further impair spermatogenesis.