彩色多普勒超声在附睾结核治疗中的应用价值

Significance of color Doppler ultrasonography in therapy of tuberculous epididymitis

目的探讨附睾结核的彩色多普勒超声分型及其在治疗中的价值。方法对33例附睾结核患者的彩色多普勒超声表现及手术所见进行对比分析。结果对33例附睾结核患者超声正确诊断29例,诊断符合率为87.9%。3例附睾呈弥漫性病变,血供丰富;13例附睾内见结节病灶,其中3例结节内有液性无回声区,3例内有点状高回声区,7例呈低回声;17例阴囊内多发病灶,其中11例附睾表现为弥漫肿大、回声不均、血供增多。附睾结核依发生部位可将超声表现分为弥漫型、结节型、复杂型,其中结节型依回声及病理表现又分为脓性结节、钙化结节和干酪结节。结论弥漫型附睾结核容易累及睾丸,应早期手术;脓性结节以手术治疗为主;钙化结节无需手术;干酪结节先药物治疗,如效果不佳应手术治疗;复杂型必须手术治疗。超声首诊怀疑附睾结核时,系统扫查泌尿系有助于发现无症状的泌尿系结核。

Objective To study the clinical value of color Doppler ultrasonography in typing tuberculous epididymitis. Methods The appearances of color Doppler ultrasound and the findings on operation were analysed in 33 patients with tuberculous epididymitis. Results Of the 33 patients, epididymis appeared as diffusely and heterogeneously enlarged lesions with increased flow in 2 cases, appeared as nodular lesions in 13 cases including nodi with echofree space in 3 cases, nodi with high-level echo patches in 3 cases, and low echo-level nodi in 7 cases. Multiple lesions in scrotum were detected in 17 cases, of whom epididymis up to 11 cases appeared as diffusely enlarged heterogeneous lesions with flow increased. The sonographic appearancs of tuberculous epididymitis could be divided into 3 types：diffusion type, nodus type and complicated type. Nodus type included 3 subtypes： purulence type, calcification type, and cheese type. The accuracy rate of ultrsound diagnosis was 87.9%. Conclusions Testis is easy to be involved when epididymitis appears as diffusion type, so surgical treatments should be early. Purulence type and complicated type need surgical treatments while calcification type does not. Antitubereulous drug treatments can be tried before surgical treatments in cheese type. Sonography of urinary system is helpful for the diagnosis of asymptomatic tubercu- losis in urinary system when tuberculous epididymitis is first suspected on sonography.