先天性输精管缺如近段输精管道超声声像图特征分析

Ultrasonographic features of proximal deferent duct in congenital absence of vas deferens

目的:探讨先天性输精管缺如(congenital absence of the vas deferens, CAVD)近段输精管道超声声像图的特异性改变及超声诊断价值。方法:应用高频超声经阴囊观察先天性输精管缺如患者的近段输精管道,其中先天性双侧输精管缺如(congenital bilateral absence of the vas deferens, CBAVD)58例,先天性单侧输精管缺如(congenital unilateral absence of the vas deferens, CUAVD)12例,并回顾性分析其超声声像图改变。结果:所有128条先天性发育异常的输精管道超声检查均可见异常声像图,仅探及附睾头的占32.81%(42/128);探及附睾头及部分附睾体尾部的37.50%(48/128),其中附睾体尾部截断的占34.38%(44/128),呈条索样改变的占3.13%(4/128);探及附睾全程而未探及输精管阴囊段的占24.22%(31/128);探及附睾全程及部分输精管阴囊段,但输精管截断的占5.47%(7/128)。CAVD患者的附睾管均有扩张,其扩张程度大于对照组的正常男性附睾管(P<0.01)。附睾尾-输精管环缺失伴附睾管扩张是CAVD的特征性改变,超声检查中通过判断附睾尾-输精管环结构缺失,来诊断CAVD的灵敏度为94.53%,特异度97.00%。结论:经阴囊高频超声能显示近段输精管道的结构,评估其形态、回声及特征性扩张方式,为临床诊断CAVD和判断其缺失部位提供极有价值的信息。

Objective: To investigate the specific ultrasonographic changes of proximal deferent duct and diagnostic value of ultrasonography in patient with congenital absence of vas deferens(CAVD). Methods: Fifty eight cases with congenital bilateral absence of vas deferens(CBAVD) and 12 cases with congenital unilateral absence of vas deferens(CUAVD) were observed by high frequency scrotal ultrasonography, and the ultrasonographic features of proximal deferent duct were analyzed retrospectively. Results: All 128 proximal deferent ducts exhibited abnormal ultrasonography. In 42(32.81%) cases only epididymal head was visible. Epididymal head along with partial body and tail were found in 48(37.50%) cases, in which 44(34.38%) cases showed abrupt tapering and 4(3.13%) showed cord-like changes. Vas deferens were not found in 31(24.22%) cases with whole process of epididymal head observed, body and tail. Whole epididymis along with partial vas deferens were observed in 7(5.47%). Tubular ectasia of epididymis were found in CAVD, and the degree of dilation was greater than that of normal epididymis(P<0.01). The absence of epididymal tail-vas deferens ring accompanied with epididymal tubular ectasia was a characteristic change of CAVD. By taking the absence of epididymal tail-vas deferens ring into account, the sensitivity and specificity of scrotal US for diagnosing CAVD were94.53% and 97.00%, respectively. Conclusions: High frequency scrotal ultrasound demonstrated well the structure of proximal deferent duct, and it is proved to be useful in evaluating the morphology, echo and characteristic dilatation of epididymis. It can provide valuable information for the clinical diagnosis of CAVD and judgment of the missing parts.