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超声诊断新生儿与小婴儿睾丸扭转的临床价值
曹洪霞,汪代杰,钟芳芳,敖建平
0
(泸州市人民医院超声科;泸州市人民医院全科医学科;西南医科大学附属医院小儿科;泸州市人民医院小儿外科)
摘要:
目的 探讨新生儿及1岁以内小婴儿睾丸扭转的临床特点及超声诊断价值。方法 回顾性分析2004~2015年40例新生儿及小婴儿(≤1岁)睾丸扭转的临床特点及超声声像图特征。结果 新生儿组21人:19例于阴囊或腹股沟区扪及包块,其中16例质硬肿块(其中10例新生儿于出生时即发现患侧阴囊内质硬肿块),3例质软包块;4例表现为烦躁不安;5例为鞘外扭转,该组未见隐睾伴扭转(P=0.002)。小婴儿组19人:11例于阴囊或腹股沟区扪及质软包块;8例小婴儿表现为烦躁不安;7例为阴囊患侧或腹股沟区红肿;7例为隐睾伴扭转; 8例为鞘内扭转(P=0.003)。新生儿及小婴儿睾丸扭转超声声像图均主要表现为患侧睾丸大小失常,回声尚均质或不均质,内可见少许或未见明显血流。部分睾丸周围可见无回声区,阴囊壁增厚。新生儿特有的征象环形“串珠样”或“蛋壳样”强回声和(或)放射状低回声。所有患儿均行手术治疗,新生儿及小婴儿予以手术切除患睾P=0.056)。患儿术后行超声随访,新生儿组47%及小婴儿组368%患睾得以挽救(P=0.017)。结论 小婴儿睾丸扭转以鞘内扭转为主,新生儿以鞘外扭转为主,同时小婴儿隐睾伴扭转的概率为36.8%。超声诊断新生儿及小婴儿睾丸扭转的敏感性和特异性较高,且两组各有其特征性。小婴儿睾丸扭转的切除率低于新生儿,且其睾丸获救率较高。
关键词:  睾丸扭转坏死  小婴儿  新生儿  高频彩色多普勒超声
DOI:
基金项目:四川省科技厅创新苗子项目(Z16007)
Clinical value of ultrasonic diagnosis of testicular torsion in infants
CAO Hongxia,WANG Daijie,ZHONG Fangfang,AO Jianping
(Department of Ultrasound, Luzhou People`s Hospital;General Medicine, Luzhou People`s Hospital;Pediatric Department, The Affiliated Hospital of Southwest Medical University;Pediatric Surgery Department, Luzhou People`s Hospital)
Abstract:
Objective To compare the clinical features and high frequency colour Doppler ultrasound’s diagnostic value in testicular torsion between neonates and infants under 1 year old.Methods We collected 40 cases of testicular torsion aged less than 1 year old from 20042015, and analyzed the clinical characteristics and the imaging features of high-frequency colour Doppler ultrasound, respectively.Results 21 neonates were collected. The mass of scrotum or inguinal area were found in 19 cases. 16 cases were solid mass (10 neonates were found solid, nontender scrotal mass when were born ). 3 cases were soft mass. 4 neonates showed restlessness. 5 cases were extrathecal torsion. No cryptorchidism with torsion were observed in this group (P=0.002). For infants group, 19 cases were collected. 11 soft mass of scrotum or inguinal area were found. 8 infants showed restlessness. The scrotal redness or swelling in the affected side or inguinal area were observed in 7 cases. The cryptorchidism with torsion in 7 cases, and intravaginal torsion in 8 cases (P=0.003). The main presentations of the ultrasonic images in neonates and infants were testicular swelling or shrinking. The parenchymal echo was homogeneous or not. The peripheral anechoic areas in some testicles, and the presentations of colour Doppler flow imaging (CDFI) showed that there was no or a few blood flow signals. The circular “string of beadslike” or “eggshelllike” hyperechoic areas was the characteristic of neonatal testicular torsion only can be seen in neonates. All neonates and infants undertook a surgery. The orchiectomy was performed in neonates and infants (P=0.056). In the follow up of neonates and infants by ultrasound after operation, the testicular torsion were healed in 4.7% of the neonates and 368% of the infants (P=0.017). Conciusion Intravaginal torsion were more often seen in infants, and extravaginal torsion were more often seen in neonates. The morbidity of undescendent testes in infants was 368%. The ultrasound has a high sensitivity and specificity in diagnosis of testicular torsion in neonates and infants, and there were some significant different characteristics in the two groups. Orchiectomies was performed less in the infant group.
Key words:  Testicular torsion necrosis  Infant  Neonate  High frequency color Doppler sonography

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