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目的:分析小儿阴囊急症的高频超声图像特征,探讨高频彩超对小儿阴囊急症的诊断及鉴别诊断价值。方法:回顾分析我院2014年1月至2016年1月因阴囊急症而行彩色多普勒血流显像(CDFI)检查的256例患儿(起病时间2 h至3 d,年龄2 d至14岁)睾丸的形态、结构、内部回声及血供情况,并与临床手术及病理结果进行对照分析比较。结果:256例阴囊急症患儿中急性睾丸扭转23例,其中16例患儿行坏死睾丸切除术,有12例行对侧睾丸固定术;7例患儿行扭转睾丸复位,予保留并行睾丸固定术。超声特征:患儿患侧睾丸不同程度增大或缩小,内部回声不均匀,可见不规则片状低回声,可伴有睾丸鞘膜积液。CDFI:患侧睾丸内无明显血流信号,周围血流信号丰富。急性睾丸附件扭转116例,超声特征:睾丸上极上方或睾丸上极与附睾头间类圆形或椭圆形异常回声结节,早期为低回声,后逐渐增高,内部回声不均匀,呈“网格样”。附睾增大,可伴有患侧睾丸增大、阴囊壁增厚。CDFI:增大附睾或睾丸血流丰富,结节内未见血流信号。急性附睾炎103例,超声特征:患儿患侧附睾明显不同程度肿大,内部回声不均匀,CDFI:患侧附睾内血流信号丰富。急性睾丸炎6例,超声特征:患侧睾丸肿大,内部回声呈低回声,回声尚均匀。CDFI:患侧睾丸内部血流丰富。腹股沟嵌顿疝15例,超声特征:可见疝囊突入阴囊,阴囊明显增大,其内可见肠系膜及肠管。CDFI:可见血流信号。急性阴囊壁血肿及水肿8例。超声特征:阴囊壁均匀或不均匀增厚。CDFI;阴囊壁可见血流信号。结论:高频彩超对小儿阴囊急症具有较高敏感性及特异性,可为临床医生诊断及鉴别诊断提供可靠的诊断依据,是临床首选的影像学检查方法。
OBJECTIVE: To analyze the characteristics of high frequency ultrasound images of pediatric patients with scrotal urgency and to explore the value of high frequency color Doppler ultrasound in the diagnosis and differential diagnosis of pediatric patients with scrotal urgency. Methods: A retrospective analysis of 256 children with color Doppler flow imaging (CDFI) in our hospital from January 2014 to January 2016 in our hospital from January 2014 to January 2016 (onset time 2 to 3 days, age 2 days To 14 years old) testis morphology, structure, internal echo and blood supply, and compared with clinical surgery and pathological results were compared. Results: Acute testicular torsion in 256 cases of acute scrotal disease in 23 cases, of which 16 cases of children underwent necrotic orchiectomy, 12 cases of contralateral testicular fixation; 7 cases of children with reverse testicular reset, to retain the parallel testicular fixation Surgery. Ultrasound features: ipsilateral testis in children with varying degrees of increase or decrease, the internal echo uneven, showing irregular low echogenic, may be associated with testicular hydrocele. CDFI: ipsilateral testicular no significant blood flow signal, peripheral blood flow signal rich. Acute testicular torsion 116 cases, ultrasound features: the top of the testis or testicular pole and epididymis between the round or oval abnormal echo nodules, early hypoechoic, then gradually increased, the internal echo uneven, was Grid pattern ". Epididymis increases, may be associated with increased ipsilateral testis, scrotal wall thickening. CDFI: increased epididymal or testicular blood flow, nodular no blood flow signal. 103 cases of acute epididymitis, ultrasound features: the affected side of the patient’s epididymis was significantly different degrees of swelling, internal echo uneven, CDFI: ipsilateral ipsilateral blood flow signal rich. Acute orchitis in 6 cases, ultrasound features: ipsilateral testicular swelling, internal echo was hypoechoic, echo is still uniform. CDFI: ipsilateral testicular blood flow inside. Incarcerated inguinal hernia in 15 cases, ultrasound features: visible hernia sac broke into the scrotum, scrotal significantly increased, which can be seen in the mesentery and intestine. CDFI: visible blood flow signal. Acute scrotal hematoma and edema in 8 cases. Ultrasound features: uniform or uneven scrotal wall thickening. CDFI; scrotal wall visible blood flow signal. Conclusion: High-frequency color Doppler ultrasonography has a high sensitivity and specificity for pediatric patients with scrotum emergency. It can provide a reliable basis for diagnosis and differential diagnosis of pediatric patients. It is the first choice of clinical imaging examination.