【摘要】 目的探讨CEUS诊断精索静脉曲张(VC)侧支反流的临床意义。方法对60例单纯左侧VC患者行精索静脉CEUS,观察是否存在开放侧支血管,并用Doppler检测反流情况。根据造影结果将60例VC患者分为无侧支组(A组)和有侧支组(B组)。造影完成后对全部患者行精索内静脉高位结扎术,并于术前及术后6个月检查精液质量、睾丸大小、术后复发及配偶受孕情况,以评价治疗效果。结果 A组41例(41/60,68.33%),B组19例(19/60,31.67%)。B组27支侧支血管开放,其中13例18支侧支血管检测出反流频谱。术后6个月复查,两组患者的左侧睾丸体积较术前均有所增大(P>0.05);与术前比较,术后A组精液质量较B组有明显改善(P<0.05);术后A组无复发病例,B组5例复发;A组7例、B组2例的配偶受孕成功。结论精索内静脉高位结扎术对无开放侧支血管VC的治疗效果好于有开放侧支血管者。侧支反流是术后VC复发的主要原因。CEUS可于术前诊断阴囊段及腹股沟段VC合并侧支反流,为外科选择治疗方案提供依据。更多还原

【Abstract】 Objective To investigate the clinical value of CEUS in diagnosis of collateral vessel reflux in varicocele(VC).Methods CEUS was performed in 60 patients with left VC to observe whether the collateral vessels were opened before surgery.Color Doppler ultrasound was used to detect reflux of the collateral vessels.According to the results of CEUS,60 patients were divided into no collateral circulation group(group A) and collateral circulation group(group B).After CEUS,high ligation of the internal spermatic veins was performed in all patients,and testicular volume,semen quality,postoperative recurrence and pregnancy condition were examined before and 6 months after surgery.Results According to the results of CEUS,there were 41 patients in group A(41/60,68.33%),and 19 patients in group B(19/60,31.67%).Twenty-seven collateral vessels were found in group B,and reflux was indicted in 18 vessels in 13 patients.Six months after surgery,the volume of left testis increased in all patients(P>0.05),the semen quality in group A improved more obviously than in group B(P<0.05).Postoperative recurrence was detected in 5 patients in group B,while the number of spouse’s pregnancy was 7 in group A and 2 in group B.Conclusion The therapeutic effect of high ligation of the internal spermatic veins without collateral circulation is better than those with collateral circulation.Reflux in collateral vessels is the main cause of VC recurrence after operation.Preoperative CEUS can diagnose VC collateral reverse flow,and provide a basis for choosing therapeutic regimen.更多还原