彩色多普勒超声对睾丸扭转后存活力的预测价值

Prediction of testicular viability after unilateral testicular torsion by ultrasonography

目的 探讨彩色多普勒超声（CDU）预测睾丸存活力的临床价值.方法 比较42例睾丸扭转患者的临床表现、术中所见及手术前后阴囊CDU表现,将术中睾丸活力分为A～D级,保留A～C级活力睾丸,切除D级活力睾丸.将CDU随访的术后睾丸存活力分为Ⅰ～Ⅲ级,Ⅰ～Ⅱ级睾丸存活,III级睾丸萎缩.结果 42例中睾丸复位17例,切除25例.复位组睾丸存活7例,术中睾丸活力分别为A级2例,B级3例,C级2例,术前CDU主要表现为：睾丸实质回声均匀,血供减少或消失;睾丸局部片状或放射状低回声,大部分实质尚存血供.萎缩10例,术中睾丸活力分别为C级8例,D级2例,术前CDU（包括切除组25例）主要表现为睾丸大片放射状低同声或弥漫性明显回声不均匀,无或仅睾丸边缘少量血供.复位组与切除组的健侧睾丸CDU随访无明显异常发现.结论 阴囊CDU检查能够预测复位后睾丸的存活力,CDU评价后及时手术是提高扭转睾丸存活力的关键.

Objective To investigate the value of predicting testicular viability following unilateral testicular torsion by color-Doppler ultrasound （CDU）. Methods The clinical manifestations, intraoperative findings and scrotol CDU appearances before and after operation of 42 cases with testicular torsion were compared. According to a bleeding test intraoperatively, testicular viability was divided into A-D level. Testis of level A-C would be saved .while the level D removed. Testicular viability assessed by follow-up CDU was then classed into Ⅰ-Ⅲ level. In Ⅰ-Ⅱ level, the salvaged testis were recovery ultimatelybut atrophy in level Ⅲ. Results Seventeen cases of the 42 underwent orchidopexy and the remaining 25 cases underwent orchidectomy. As followed up, however, testis in only 7 cases were recovered, including 2 cases in level A,3 cases in level B and 2 cases in level C. respectively. The preoperative scrotal CDU appearances of the recovered testis were mainly as follows： ① Homogeneous parenchyma with decreased or disappeared blood perfusion. ②Sheet or radial hypoechoic in the local testis but with preserved blood perfusion in most area else. Testis in the remaining 10 patients, including 8 cases in level C and 2 cases in level D, respectively, were atrophy finally. And large radial hypoechoic or diffuse inhomogeneous echo with none or a small amount of blood supply on the edge parenchyma were found during their preoperative CDU （similar CDU performance was present in the orchidectomy group. The CDU appearances of contralateral testes both in orchidopexy and orchidectomy group were not obviously abnormal during follow-up. Conclusions The scrotal CDU examination is competent to predict testicular viability after detorsion. In addition, timely operation would be a key to CDU evaluation.