术前超声预判儿童睾丸扭转后不同转归

Preoperative prediction of different outcomes after pediatric testicular torsion by ultrasound

目的探讨术前超声预判睾丸扭转患儿转归的应用价值。方法回顾性分析45例儿童睾丸扭转的临床及超声资料。按不同转归分为存活组(手术复位后随访睾丸存活)及失睾组(因缺血、坏死接受患侧睾丸切除术或手术复位后随访患侧睾丸萎缩),对比观察两组声像图特征,包括患侧睾丸大小改变、轴向改变、内部回声、血流改变及鞘膜积液。并进行统计学分析,选取组间差异有统计学意义的声像图特征,建立Logistic回归模型预判患侧睾丸转归。结果 45例患儿均为单侧扭转,其中左侧27例,右侧18例;最终纳入存活组11例,失睾组34例。失睾组34例中,32例患侧睾丸回声不均匀,2例回声尚均匀;33例患侧睾丸实质内未探及血流信号,1例探及少量血流信号;6例患侧睾丸周边可见"环岛"征。存活组11例中,9例睾丸实质内回声均匀,2例回声不均匀;9例患侧睾丸实质内血流较健侧减少,2例未探及血流信号。两组间内部回声及血流改变差异有统计学意义(P均<0.05),患侧睾丸大小改变、轴向改变及鞘膜积液差异均无统计学意义(P均≥0.05)。Logistic回归模型结果显示,术前超声的阳性(失睾)预测值为97.10%,阴性(存活)预测值为81.80%,预判睾丸扭转患儿转归的准确率为93.30%。结论术前超声对预判儿童睾丸扭转的转归具有较高准确率,声像图中患侧睾丸内部回声及血流改变可作为预判指标。

Objective To investigate the value of preoperative ultrasonography in predicting different outcomes of pediat- ric testicular torsion. Methods Clinical and ultrasonic data of 45 patients with pediatric testicular torsion were retrospec- tively analyzed. According to different outcomes, the patients were divided into testis survival group （testis survived after orchidopexy） and testis lost group （including orchidectomy cases because of ischemia or necrosis and testicular atrophy ca- ses after orchidopexy）. The ultrasound features, including the change of size and axial, interior echo, blood perfusion and hydrocele were compared between the two groups. And the statistical analysis was performed. The parameters with statis- tical difference were selected to establish Logistic regression model. Results All the 45 cases were unilateral testicular tor- sion. The lesion located on the left side in 27 cases and located on the right side in 18 cases. Totally there were 11 cases in testis survival group and 34 cases in testis lost group. In testis lost group, the testicular echoes of a2 cases were uneven and 2 cases were even. There were 33 cases without detected blood flow in testicular and 1 case with few blood flow. The gar- land-like perfusion around testis was found in 6 cases. In testis survival group, the testicular echoes of 9 cases were even and 2 cases were uneven. There were 9 cases with decreased blood flow in testicular and 2 case without blood flow. There were statistical differences of interior echo and blood perfusion between the two groups （both P〈0.05）. And no statistical difference of hydrocele, the change of size and axial was found （all P≥0.05）. Logistic regression showed that the positive predictive value （PPV） and negative predictive value （NPV） of ultrasonography predicting was 97.10 % and 81.80 %, re- spectively. The accuracy was 93.30%. Conclusion Preoperative ultrasonography has high accuracy the prediction of dif- ferent outcomes after pediatric testicular torsion with high accuracy. The interior echo and blood perfusion raound testis can be used as predicting indexes.