小儿阴囊急症超声诊断研究.doc

小儿阴囊急症超声诊断研究[摘要] 目的 总结小儿阴囊急症超声诊断的经验教训。方法 对47例阴囊急症的临床和超声资料进行分析。结果 超声提示诊断38例,占80.9%,误漏诊9例,占19.1%,手术21例,睾丸切除11例。结论 超声在小儿阴囊急症中具有一定应用价值,但是对早期的睾丸扭转敏感性低,中晚期的诊断对预后保留睾丸功能的意义不大。 [关键词] 阴囊急症;超声诊断 [中图分类号] R697.21[中图分类号] A[文章编号] 1673-9701(2009)24-159-02 The Analysis of Ultrasound Diagnosis on Emergency Scrotum in Children YANG WeiminXING FashuCHEN GuanchunDUAN XueyunCAO YongLUO Liuping Departmentof Ultrasound,Dongguan HoujieHospital,dongguan 523945,China [Abstract] Objective To conclude the empiricism in the diagnosis of emergency scrotum in children by ultrasonography. Methods Clinical and ultrasound materials of 47 patients with emergency scrotum were analyzed. Results 38 cases were diagnosed by ultrasonography. The diagnosis accordance rate is 80.9%. 9 cases couldn?t be diagnosed by ultrasonography. The missed diagnosis and faulse diagnosis rate is 19.1%. 21 patients were treated by operation,among which the testicle of 11 pattients were removed. Conclusion Ultrasonography has some value on the diagosis ofemergency scrotum. But the sensitivity of testiclar torsion in the early stage by ultasonography is low and the diagnosis of testiclar torsion in the middle and late stage has no significance on reducing the excision rate of testicle. [Key Words] Emergency scrotum;Ultrasonography 阴囊急症是指以阴囊急性疼痛为主要症状的一组疾病,是小儿泌尿外科常见急症,发病率较高。高频彩色多普勒超声可显示阴囊皮肤、鞘膜、睾丸、附睾和精索等结构的形态,还可以提供血流供应分布信息,是目前常用的影像诊断方法。为总结小儿阴囊急症超声诊断经验,本文对本院近5年的病例总结如下。 1资料与方法 1.1一般资料 本组收集本院2005年1月～2009年4月阴囊急症住院病例62例,其中15例因故未行超声检查或资料不全,47例于发病1h至4d不等时间内行高频彩超检查1～3次,均为手术、病理证实或治疗验证诊断病例。47例中年龄最小为3个月,最大为14岁。 1.2仪器与方法 应用ALOK-4000、GE-V730、IE-33彩色多普勒超声诊断仪,探头频率为7～10MHz,应用仪器预设的阴囊检查条件。不合作的患儿应用镇静剂。患儿取平卧位,拉起阴茎,充分暴露阴囊,双侧阴囊、腹股沟对比扫查,留存图像。 2结果 小儿阴囊急症超声诊断结果与手术情况见表1。 (1)睾丸扭转11例,超声提示诊断7例,具备睾丸横位、增大、内部回声降低不均匀、少量鞘膜积液等典型表现的5例,均有不同程度血流信号减少(图1),其中1例探及精索和睾丸间的扭转结节。仅有血流信号消失,无明显睾丸回声异常改变1例。另1例行超声造影,显示部分血流灌注缺失,出现“孤岛”现象得以诊断。超声误漏诊4例,均为6h以内检查的病例,2例表现为超极期的血流信号增多,睾丸增大而误诊为急性睾丸炎;2例无任何异常超声改变而漏诊。11例中手术9例,复位成功仅1例,8例行睾丸切除,手术复位成