彩色多普勒超声对精索扭转早期诊断及扭转睾丸术后存活力预测的临床价值

Clinical value of color Doppler ultrasound in early diagnosis and prediction of postoperative ritality of testicular torsion

目的探讨彩色多普勒超声(CDU)对精索扭转早期诊断及扭转睾丸术后存活力预测的临床价值。方法50例精索扭转患者,术前均经CDU诊断,测定患侧与健侧睾丸的最大径、睾丸动脉的最大流速(PSV)及阻力指数(RI),分别做比较,并根据其二维超声表现及血流供应情况将患侧睾丸术前活力分为1~4级,根据活力情况选择手术方式。根据睾丸体积比(C)及CDU检查情况将随访的术后睾丸存活力分为A^C级,A^B级睾丸存活,C级睾丸萎缩。结果50例精索扭转患者中45例超声诊断与手术结果相符,准确率90%。患侧睾丸的最大径[(5.2±1.2)cm]较健侧[(3.6±0.6)cm]大,患侧睾丸动脉PSV[(2.9±1.9)cm/s]较健侧[(7.8±2.2)cm/s]高,患侧睾丸RI[(0.69±0.06)]较健侧[(0.48±0.03)]高(P<0.05)。5例经睾丸扭转切除术切除睾丸,40例经睾丸扭转复位术保留睾丸,A级存活力者20例,术前活力分别为1级8例,2级10例,3级2例;B级存活力者17例,术前活力分别为2级1例,3级16例;C级存活力者3例,术前活力分别为3级活力2例,4级活力1例。CDU预测的睾丸术前活力与其术后随访时的存活力具有明显相关性(r=0.824,P<0.001)。结论CDU检查对精索扭转的早期诊断具有较高的敏感性及特异性,对扭转睾丸复位后存活力的预测有重要价值。

Objective To investigate the clinical value of color Doppler ultrasound (CDU) in the early diagnosis of testicular torsion and postoperative vitality prediction. Methods Fifty patients with testicular torsion were diagnosed by color Doppler ultrasound before operation to determine the maximum diameter, peak systolic velocity (PSV), and resistance index (RI) of both affected and normal testicles, and to divide the preoperative vitality of affected testicles into 1-4 levels according to the ultrasound manifestations and blood flow supply.Operation methods were determined according to the preoperative vitality of testicles.According to the testicular volume ratio (C) and CDU results, the postoperative vitality of testicles was divided into A-C level, A-B levels indicating testicular survival and C-level indicating testicular atrophy. Results The ultrasound diagnosis results of 45 cases were consistent with the results of operation, with an accuracy rate of 90%.The maximum diameter of the affected testicles [(5.2±1.2) cm] was larger than that of the normal testicles [(3.6±0.6) cm], the PSV of the affected testicles [(2.9±1.9) cm/s] was higher than that of the normal testicles [(7.8±2.2) cm/s], and the RI of the affected testicles (0.69±0.06) was higher than the normal testicles (0.48±0.03, P <0.05).Respectively 5 cases received testicular torsion resection and 40 cases retained testicles by testicular torsion reduction.There were 20 cases with A level vitality of testicles, whose preoperative vitality of testicles were graded into level 1 ( n =8), level 2 ( n =10), and level 3 ( n =2);17 cases with B level vitality of testicles, whose preoperative vitality of testicles were graded in to level 2 ( n =1) and level 3 ( n =16);and 3 cases with C level vitality of testicles, whose preoperative vitality of testicles were graded into level 3 ( n =2) and level 4 ( n =1).There was a significant correlation between the preoperative vitality of testicles and the postoperative follow-up vitality of testicles ( r =0.824, P <0.001). Conclusion CDU is highly sensitive and specific to the early diagnosis of testicular torsion, and has important value in predicting the vitality of torsional testis after reduction.