超声精索血管检查在手法复位治疗精索扭转中的意义(附32例报告)

Detection of spermatic cord vessels with color Doppler ultrasound for manual detorsion in cure of testicular torsion(Report of 32 cases)

目的：评价超声精索血管形态学检查在手法复位治疗精索扭转中的临床价值。方法：2011年6月~2014年4月我院共收治精索扭转患者32例,复位前均行精索封闭。研究分为两组,试验组18例,手法复位后睾丸血供恢复,超声检查证实无精索血管扭转则复位成功,不再行手术探查,否则立即手术探查。对照组14例,先行手法复位,再行手术探查。结果：两组患者的年龄、发病时间、复位时间、扭转度数、扭转方向等差异均无统计学意义（均P〉0.05）。试验组复位成功16例,急诊手术2例。术中证实1例睾丸坏死,1例复位不完全。对照组中13例复位后超声证实复位完全,并在术中证实均复位成功（100%）,另1例术中证实复位不完全。对照组术后4例发生睾丸萎缩,明显高于试验组（0例）（P〈0.05）。结论：超声精索血管形态学检查可能有助于准确判断扭转睾丸是否完全复位,提高睾丸挽救率和避免手术探查。

Objective： To investigate the clinical value of spermatic cord vessels detection with color Doppler ultrasound in manual detorsion for testicular torsion. Method： From June 2011 to April 2014, 32 cases of testieu- lar torsion were treated in our hospital. All 32 candidates underwent manual detorsion under the guide of color Doppler ultrasound after spermatic cord block with lidocaine and dexamethasone. Sixteen cases in experimental group didn＇t undergo surgical exploration, while 14 cases in control group underwent surgery after manual detor- sion. The previous color Doppler ultrasound diagnosis was verified in control group during exploration. Result： There was no difference between the groups in terms of age, duration from onset, degree of torsion, torsion direc- tion, time for manual detorsion （all P〈0.05）. There were two cases undergoing immediately surgery after failing to determine total detorsion in experimental group. One underwent orchiectomy, and the other received orchidope- xy. Thirteen cases （100%） determined total detorsion with color Doppler ultrasound before surgery were con- firmed no residual or opposite torsion in control group during exploration. One underwent orchidopexy in control group. None suffered from testicle atrophy after manual detorsion in experimental group, but four cases developed atrophy in subsequent follow-up after surgical intervention in control group （ P 〈0.05）. Conclusion： Ultrasonog- raphy of spermatic cord vessels can contribute to determining total spermatie cord detorsion, and might avoid dam- age from residual/opposite torsion and surgical exploration.