婴幼儿继发性睾丸缺血性病变的超声诊断及临床意义

Ultrasonographic diagnosis of secondary testicular ischemia in infants and toddlers

目的探讨婴幼儿继发性睾丸缺血性病变的超声声像图特征及临床意义。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中,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态变化过程,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消失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。睾丸缺血声像图呈动态变化过程,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。

Objective To analyze the sonographic diagnosis and clinical significance of secondary testicular ischemia in infants. Methods A total of 1305 children with aeute scrotal diseases were retrospectively studied during a 2-year period （January 2006 to March 2008）. The sonographic images and the possible causes and prognosis for testicular ischemia were reviewed and analysed. Results Of the 1305 children, 62 had incarcerated inguinal hernia, of whom 25 （ 1.92% ） had testiclar ischemia, including 4 testicular atrophy. 12 （0.92%） case of torsion of testis, of whom 4 had orchectomy, 3 had testicular atrophy. No tes- ticular ischemia was found in hydrocele testis, slide inguinal hernia and orchiepididymitis. Sonographic images of secondary testicular ischemia consisted of： stages 1, testis enlargement; stage 2, uneven internal echo in testis; stage 3, testicular colliquation; stage 4, testicular atrophy. The 3 stages of testicular atrophy in color Doppler flow imaging （CDFI） were nornlal blood distribution or slightly increased, decreased without blood flow. Conclusions The most comnmn cause of secondary testicluar ischemia is incarcerated inguinal hernia. The testicular atrophy in testicle-without blood flow CDFI was possible. The sonographic images are changing continuously and a 3-month follow-up is necessary.