彩色多普勒超声在青少年阴囊急症中的应用价值

摘要

Objective To explore the application value of color Doppler ultrasonography in adolescents with acute scrotum. Methods The clinical data of 48 adolescents with acute scrotum from January 2013 to October 2014 were retrospectively analyzed, including 13 cases of testicular torsion (testicular torsion group), 16 cases of epididymi-tis (epididymitis group), 7 cases of orchitis (orchitis group), and 12 cases of testicular trauma (testicular trauma group). All patients underwent color Doppler ultrasonography. Blood flow signals, characteristics of ultrasound imag-es and diagnosis results of the four types of acute scrotum were compared. Results The peak systolic velocity (Vmax) was significantly higher in the epididymitis group and orchitis group than the testicular torsion group and testicular trauma group. The vascular resistance index (RI) was significantly lower in the epididymitis group and orchitis group than thetesticular torsion group and testicular trauma group. The Vmax in the testicular trauma group was significantly higher than that in the testicular torsion group. The RI in the testicular trauma group was significantly lower than that in the testicular torsion group. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of ultrasound diagnosis were 92.3%, 97.1%, 89.4%, 92.3%, 97.1% for testicular torsion, 92.3%, 88.6%, 80.9%, 75.0%, 96.7% for epididymitis, 55.6%, 94.7%, 50.5%, 71.4%, 90.2% for orchitis, 84.6%, 97.1%, 81.7%, 91.7%, 94.4%for testicular trauma. Conclusion Color Doppler ultrasonography is useful to identify testicular inflammation, testicular trauma, and testicular torsion. However, it is difficult to identify epididymitis and orchitis only according to blood flow signals, and the diagnosis should be based on clinical symptoms, blood flow, and internal morphology.%目的：探讨彩色多普勒超声在青少年阴囊急症中的应用价值。方法回顾性分析我院2013年1月至2014年10月收治的48例青少年阴囊急症患者的临床资料，经手术、药物及临床症状确诊为睾丸扭转13例、附睾炎16例、睾丸炎7例、睾丸外伤12例，所有患者均进行多普勒超声检查，比较4种不同类型阴囊急症的血流信号、超声图像特点及诊断结果。结果附睾炎组和睾丸炎组患者的收缩期最大血流速度(Vmax)均明显高于睾丸扭转组和睾丸外伤组患者，附睾炎组和睾丸炎组患者的血流阻力指数(RI)明显低于睾丸扭转和睾丸外伤组，睾丸外伤组患者的Vmax明显高于睾丸扭转组，RI明显低于睾丸扭转组，以上各项指标两两比较差异均具有统计学意义(P<0.05)；超声诊断睾丸扭转的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为92.3%、97.1%、89.4%、92.3%、97.1%，附睾炎分别为92.3%、88.6%、80.9%、75.0%、96.7%，睾丸炎分别为55.6%、94.7%、50.5%、71.4%、90.2%，睾丸外伤分别为84.6%、97.1%、81.7%、91.7%、94.4%。结论彩色多普勒可有效鉴别睾丸炎症、睾丸外伤及睾丸扭转，但对于附睾炎及睾丸炎仅凭血流信号鉴别诊断较难，应结合患者的临床症状、血流信号、睾丸内部形态学做出判断。