【作者】 梁荣喜；

【导师】 薛恩生； 林礼务；

【作者基本信息】 福建医科大学 ， 医学影像医学与核医学， 2008， 硕士

【摘要】 目的探讨不同程度急性单侧睾丸血运障碍的灰阶、彩色多普勒及超声造影表现与再灌注后缺血侧睾丸病理变化的相关性。方法将32只大白兔随机分成对照组(假手术组)和缺血组(A、B、C组),每组8只。动态观察睾丸声像图变化, A组,睾丸回声均匀,血流信号轻度减少;B组,回声增强增粗不均,血流信号明显减少;C组,睾丸出现放射状或小片状低回声、血流信号消失,缺血各组在出现上述声像图后分别予以再灌注。术前及再灌注前分别行双侧睾丸超声造影,分析各时段造影参数速度(β)、到达时间(AT)、达峰时间(TTP)、峰值基础强度差(PBD)及1/2消退减半时间(DT/2)变化。饲养1m后观察缺血侧睾丸病理变化并行Johnsen’s评分,并与各组睾丸超声及造影变化进行对照研究。结果超声造影,结扎前双侧睾丸各参数β、AT、TTP、PBD及DT/2之间无明显差异(P> 0.05),呈“同进同退”过程;与对照侧相比较,结扎后A、B组缺血侧睾丸β减低、AT、TTP及DT/2延长,呈“慢进慢退”过程,且B组“进退”得更慢, A组PBD无明显减低,B组PBD明显减低;C组造影无明显充盈。扭转后3～5h,各缺血睾丸体积较结扎前明显增大(P<0.05)。复位后1m,与对照组比, A组缺血侧睾丸大小及病理无明显变化(P> 0.05),Johnsen’s评分(对照组为9.10±0.11,A组为8.70±0.39)无明显减低(P> 0.05),生精功能良好;B组睾丸明显缩小,生精细胞数量明显减少,成熟分化障碍,Johnsen’s评分明显减低(P<0.05),生精功能降低;C组睾丸极显著缩小(P<0.01),生精细胞严重减少或消失,成熟分化严重障碍,Johnsen’s评分(3.16±1.05)严重减低(P<0.001),生精功能极差。结论①急性睾丸血运障碍的灰阶、彩色多普勒及超声造影表现与再灌注后睾丸病理变化明显相关,超声检查能够为缺血再灌注后睾丸的生精功能的预测提供帮助;②超声造影能更准确、敏感地反映不同缺血程度的睾丸组织的血流灌注情况。更多还原

【Abstract】 Objective: To discuss the relationship between the sonographic appearances of experimentally induced acute unilateral testicular hemodynamic disorder with different degree and the histological structure changes after reperfusion.Methods: 32 white male rabbits were used in the study. The animals were randomly divided into 4 groups: control group (sham operation group) and experimental group A、B and C , with 8 in each . The acute testicular hemodynamic disorder models were established in all groups and the experimental groups were dynamic observed by color Doppler ultrasound (CDU). According to the changes in sonographic appearances of all experimental groups, the ischemic testes in group A showed homogeneous echo and slightly decreased in color Doppler flow signals, in group B showed heterogeneous echo and obviously decreased in color Doppler flow signals, in group C showed radial or in fragmentis low echo area and color Doppler flow signals disappeared, then the testes were reperfusion. The contrast-enhanced ultrasonographic (CEUS) was performed before operation and reperfusion in each group .The time-intensity curves were evaluated by using AxiustTM auto-tracking contrast quantification (ACQ) and the parameters includeβ、arrive time(AT)、time-to-peak (TTP)、peak-base indensity (PBD)、half of declining time (DT/2) were analyzed. After 1 month of breeding, all rabbits were sacrificed and the histological structure changes of ischemic testes were observed. Analysis the correlation between histological structure changes in contrast to the sonographic and CEUS appearances of all groups.Results: The CEUS parametersβ、AT、TTP、PBD、DT/2 of bilateral testes showed no significant difference in all groups before operation(P>0.05). After operation , the CEUS parametersβ、AT、TTP、DT/2 of bilateral testes showed significant difference in group A and B(P<0.05).The parameter PBD of bilateral testes showed no significant difference in group A (P>0.05)but significant difference in group B(P<0.05).The CEUS parametersβ、PBD of the ischemic testes is 0 in group C, which shows significant difference compared with the contralateral testes. In all experimental group, the volume of the ischemic testes after operation for 3 to 5 hours showed significant difference compared with preoperative(P<0.05).After 1month of breeding, compared with the control group, the volume and the Johnsen’s score(9.10±0.11 in control group and 8.70±0.39 in group A) of the ischemic testes shows no significant difference in group A(P>0.05),but significant difference in group B(6.01±0.88)(P<0.05) and extremely significant difference in group C(3.16±1.05)(P<0.001).Conclusions:①Sonographic appearances of acute testicular hemodynamic disorder is related to histological structure changes after reperfusion. Ultrasonography is help for the prediction of spermatogenesis function of the ischemic testes after reperfusion.②CEUS has a higher sensitivity and accuracy in reflection the perfusion of the ischemic testes with different degree compared with CDFI.更多还原