超聲成像技術(shù)在無精子癥患者病因診治中的應(yīng)用價值
發(fā)布時間：2018-09-05 15:43
【摘要】：目的：①探討經(jīng)陰囊及經(jīng)直腸超聲診斷無精子癥病因的價值。②應(yīng)用實(shí)時超聲彈性成像技術(shù)評估梗阻性無精子癥(OA)與非梗阻性無精子癥(NOA)附睪硬度的差異,初步探討實(shí)時超聲彈性成像技術(shù)在無精子癥病因診斷及鑒別診斷的臨床應(yīng)用價值。③應(yīng)用經(jīng)陰囊及經(jīng)直腸超聲為臨床篩選輸精管與附睪管吻合術(shù)適應(yīng)癥提供可靠的影像學(xué)依據(jù)。 方法：研究對象為2013年5月-2014年4月間就診于我院男性科及生殖科的不育癥患者,不育時間在2年-7年,均經(jīng)臨床診斷為無精子癥,共77例,年齡22歲-45歲,平均(34.4士4.5)歲。使用儀器為Hitachi preirus彩色多普勒超聲診斷儀,具有實(shí)時超聲彈性成像功能及彈性應(yīng)變率比值與彌散定量分析軟件。經(jīng)陰囊常規(guī)超聲檢查及實(shí)時超聲彈性成像檢查使用探頭型號均為L-74M,頻率為5MHz-13MHz;經(jīng)直腸腔內(nèi)常規(guī)超聲檢查探頭型號為V-53W,頻率為4MHz-8MHz。(1)經(jīng)陰囊常規(guī)超聲檢查時分別多切面觀察雙側(cè)睪丸、附睪、精索靜脈、近端輸精管的二維灰階圖像及彩色血流超聲圖,測量睪丸大小并計算睪丸體積(mL),判斷睪丸是否縮��；測量附睪各部分厚徑并判斷附睪管是否擴(kuò)張；判斷精索靜脈是否曲張并進(jìn)行分級；測量輸精管內(nèi)徑并判斷是否擴(kuò)張。(2)經(jīng)直腸常規(guī)超聲檢查時分別多面掃查前列腺、兩側(cè)精囊、射精管及輸精管壺腹部,觀察其形態(tài)、內(nèi)部回聲情況,并測量前列腺及精囊大��；觀察射精管是否擴(kuò)張并測量其長徑及內(nèi)徑；測量輸精管壺腹部最大內(nèi)徑。(3)附睪超聲彈性成像及定量分析方法：分別對附睪頭部及尾部進(jìn)行超聲彈性成像檢查,由彌散定量分析軟件自動測算硬度指數(shù)SI值,重復(fù)測量5次記錄并取平均值。(4)輸精管附睪吻合術(shù)(VE)適應(yīng)癥超聲篩查方法即有以下陽性發(fā)現(xiàn)者認(rèn)為具有手術(shù)適應(yīng)癥：①睪丸體積≥15ml。②附睪管擴(kuò)張,呈“網(wǎng)格樣”改變,內(nèi)徑3mm。③睪丸網(wǎng)擴(kuò)張,呈“網(wǎng)格樣”改變。④輸精管擴(kuò)張,內(nèi)徑1mm。⑤精囊、射精管、前列腺未見明顯異常。⑥附睪無先天異常。其中①、⑤和⑥項(xiàng)為必須標(biāo)準(zhǔn)。所有患者均與睪丸活檢及手術(shù)結(jié)果對照。統(tǒng)計方法：收集所有數(shù)據(jù)后采用SPSS17.0統(tǒng)計軟件進(jìn)行數(shù)據(jù)分析處理,使用卡方及Fisher檢驗(yàn)對OA與NOA共同病因檢出病變能力進(jìn)行評估；彈性成像SI值采用均數(shù)±標(biāo)準(zhǔn)差(x±S)表示；OA與NOA兩組間SI值的比較先進(jìn)行Dunnett T3兩兩比較,再采用單因素方差分析及獨(dú)立樣本T檢驗(yàn)；分別選取OA與NOA的附睪頭SI值及附睪尾SI值繪制受試者工作特征曲線(ROC曲線),以ROC曲線下面積(Az)來判斷SI指標(biāo)對診斷無精子癥的準(zhǔn)確性。 結(jié)果：(1)超聲提示精道梗阻者37例(歸為OA組),占總數(shù)的48.0%(37/77)；無精道梗阻者21例(歸為NOA組),占總數(shù)的27.3%(21/77),超聲檢出OA組病因高于NOA組病因,且差異有統(tǒng)計學(xué)意義。(2)無精子癥OA組病因包括慢性附睪炎伴附睪管擴(kuò)張、輸精管結(jié)扎術(shù)后伴附睪管擴(kuò)張、射精管囊腫及射精管狹窄；NOA組包括睪丸發(fā)育不良、隱睪、精索靜脈曲張及單側(cè)睪丸發(fā)育不良并精索靜脈曲張；兩組患者共同病因包括附睪管擴(kuò)張、附睪囊腫及精索靜脈曲張,其中附睪管擴(kuò)張及精索靜脈曲張在OA組中出現(xiàn)的頻率高于NOA組,附睪囊腫在NOA組出現(xiàn)頻率高于OA組,差異均有統(tǒng)計學(xué)意義；(3)附睪彈性成像結(jié)果顯示：OA組附睪頭SI值略高于NOA組附睪頭SI值,二者差異無統(tǒng)計學(xué)意義(P0.05)；OA組附睪尾SI值高于NOA組附睪尾SI值,二者差異有統(tǒng)計學(xué)意義(P0.05)。OA組與NOA組附睪頭SI=2.46為診斷閾值時,其敏感性為95.9%,特異性為16.7%,二者的差異無統(tǒng)計學(xué)意義(P=0.968)；OA組與NOA組附睪尾SI=2.57為診斷閾值時,其敏感性為95.9%,特異性為25%,二者的差異無統(tǒng)計學(xué)意義(P=0.069)。OA組及NOA組附睪頭部及附睪尾部SI值的ROC曲線下面積(Az)分別為0.502、0.594,說明診斷準(zhǔn)確性較低,即SI值用于診斷無精子癥可靠性低。(4).超聲篩查VE手術(shù)適應(yīng)癥的準(zhǔn)確率為92.85%,占7.14(1/28)。 結(jié)論：(1)應(yīng)用經(jīng)陰囊超聲及經(jīng)直腸超聲檢查技術(shù)可對無精子癥病因做出診斷或方向性提示,對臨床診斷及治療方法提供有價值的影像學(xué)依據(jù)。(2)經(jīng)陰囊及經(jīng)直腸超聲檢查技術(shù)對非梗阻性無精子癥患者病因診斷的準(zhǔn)確率高于梗阻性無精子癥患者,但其病變檢出率低于梗阻性無精子癥；在鑒別診斷梗阻性與非梗阻性無精子癥共同病因檢出能力的差異作用較弱。(3)超聲實(shí)時組織彈性成像彌散定量分析技術(shù)對梗阻性無精子癥及非梗阻性無精子癥附睪尾的硬度改變有一定診斷價值；(4)硬度指數(shù)SI值對梗阻性無精子癥及非梗阻性無精子癥附睪硬度的鑒別診斷準(zhǔn)確性低,其價值有待研究；(5)經(jīng)陰囊及經(jīng)直腸超聲檢查技術(shù)在梗阻性無精子癥患者輸精管附睪吻合術(shù)前篩選手術(shù)適應(yīng)癥有較高價值。
[Abstract]:Objective: To investigate the value of transscrotal and transrectal ultrasonography in the diagnosis of azoospermia. 2. To evaluate the difference of epididymal stiffness between obstructive azoospermia (OA) and non-obstructive azoospermia (NOA) by real-time ultrasound elastography, and to explore the clinical response of real-time ultrasound elastography in the etiological diagnosis and differential diagnosis of azoospermia. Value. 3. Transscrotal and transrectal ultrasonography provide reliable imaging basis for screening the indications of vas deferens and epididymis anastomosis.
METHODS: Seventy-seven infertile men (22-45 years old, average age 34.4 Shi 4.5 years) with two to seven years of clinical diagnosis of azoospermia were selected from May 2013 to April 2014. The instrument was Hitachi preirus color Doppler ultrasound diagnostic instrument with real-time ultrasonic elasticity. The probe type was L-74M and the frequency was 5 MHz-13 MHz for routine ultrasound examination of scrotum and real-time ultrasound elastography. The probe type was V-53W and the frequency was 4 MHz-8 MHz for routine ultrasound examination of scrotum. The size of testis was measured and testicular volume (mL) was calculated to determine whether the testis was reduced; the thickness of each part of epididymis was measured and whether the epididymal duct was dilated; the varicocele was judged and graded; the diameter of vas deferens was measured. (2) The prostate, bilateral seminal vesicles, ejaculatory ducts and ampulla of vas deferens were scanned by transrectal ultrasonography to observe their morphology, internal echo, and the size of prostate and seminal vesicles, to observe whether the ejaculatory ducts were dilated and to measure their length and internal diameter, and to measure the maximum internal diameter of vas deferens ampulla. (3) Appendix. Ultrasonic elastography and quantitative analysis of the epididymis: the head and tail of the epididymis were examined by ultrasonic elastography, the SI value of the hardness index was calculated automatically by the diffusion quantitative analysis software, and the SI value was measured five times repeatedly and the average value was obtained. (4) Vasoepididymostomy (VE) indications for ultrasound screening method that there are the following positive findings considered to have. Indications: 1. Testicular volume (> 15ml). 2. The epididymal duct was dilated in a "mesh" shape with an inner diameter of 3mm. 3. The testicular reticulum was dilated in a "mesh" shape. 4. The vas deferens was dilated with an inner diameter of 1mm. _seminal vesicle, ejaculatory duct and prostate were not abnormal. _There were no congenital abnormalities in the epididymis. Testicular biopsy and operation results were compared. Statistical methods: All data were collected and analyzed by SPSS17.0 statistical software. Chi-square test and Fisher test were used to evaluate the ability of detecting lesions of common cause of OA and NOA; SI value of elastography was expressed by mean (+S); SI value between OA and NOA was first compared. Dunnett T3 was compared by one-way ANOVA and independent sample T test, and the SI values of the epididymal head and tail of OA and NOA were selected to draw the ROC curve, and the area under the ROC curve (Az) was used to judge the accuracy of SI index in the diagnosis of azoospermia.
Results: (1) Ultrasound showed that 37 cases of semen obstruction (OA group), accounting for 48.0% (37/77); 21 cases of azoospermia obstruction (NOA group), accounting for 27.3% (21/77). The etiology of OA group was higher than that of NOA group, and the difference was statistically significant. (2) The etiology of azoospermia OA group included chronic epididymitis with epididymal duct dilatation, vasectomy ligation. The NOA group included testicular dysplasia, cryptorchidism, varicocele and unilateral testicular dysplasia with varicocele; the common causes of the two groups included dilatation of the epididymal duct, epididymal cyst and varicocele, including dilatation of the epididymal duct and varicocele in the OA group. The frequency of occurrence of epididymal cyst in NOA group was higher than that in NOA group, and the frequency of occurrence of epididymal cyst in NOA group was higher than that in OA group, the difference was statistically significant. (3) The results of epididymal elastography showed that the SI value of the head of epididymis in OA group was slightly higher than that of the head of epididymis in NOA group, and the difference was statistically significant (P 0.05). The sensitivity and specificity were 95.9% and 16.7% respectively in OA group and NOA group when SI = 2.46 was the diagnostic threshold (P = 0.968), and 95.9% and 25% respectively in OA group and NOA group when SI = 2.57 was the diagnostic threshold (P = 0.069). The area under the ROC curve (Az) of SI value of head and tail of epididymis was 0.502 and 0.594 respectively, indicating that the diagnostic accuracy was low, that is, the SI value was used to diagnose azoospermia with low reliability. (4) The accuracy rate of ultrasound screening for VE operation indication was 92.85%, accounting for 7.14 (1/28).
Conclusion: (1) Transscrotal ultrasonography and transrectal ultrasonography can provide valuable imaging evidence for the diagnosis and treatment of azoospermia. (2) Transscrotal ultrasonography and transrectal ultrasonography are more accurate in the etiological diagnosis of non-obstructive azoospermia than obstructive azoospermia. The detection rate of lesions in patients with obstructive azoospermia was lower than that in patients with obstructive azoospermia, and the difference in the detection ability of common etiology between obstructive and non-obstructive azoospermia was weak. (3) Ultrasound real-time tissue elastography diffusion quantitative analysis technique has the effect on the changes of epididymal tail stiffness in obstructive azoospermia and non-obstructive azoospermia. It has certain diagnostic value; (4) SI value of stiffness index is low in the differential diagnosis of obstructive azoospermia and non-obstructive azoospermia epididymal stiffness, and its value needs to be studied; (5) Transscrotal and transrectal ultrasonography in obstructive azoospermia patients before vasoepididymal anastomosis screening surgical indications has higher value.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R698;R445.1
本文編號：2224718
[Abstract]:Objective: To investigate the value of transscrotal and transrectal ultrasonography in the diagnosis of azoospermia. 2. To evaluate the difference of epididymal stiffness between obstructive azoospermia (OA) and non-obstructive azoospermia (NOA) by real-time ultrasound elastography, and to explore the clinical response of real-time ultrasound elastography in the etiological diagnosis and differential diagnosis of azoospermia. Value. 3. Transscrotal and transrectal ultrasonography provide reliable imaging basis for screening the indications of vas deferens and epididymis anastomosis.
METHODS: Seventy-seven infertile men (22-45 years old, average age 34.4 Shi 4.5 years) with two to seven years of clinical diagnosis of azoospermia were selected from May 2013 to April 2014. The instrument was Hitachi preirus color Doppler ultrasound diagnostic instrument with real-time ultrasonic elasticity. The probe type was L-74M and the frequency was 5 MHz-13 MHz for routine ultrasound examination of scrotum and real-time ultrasound elastography. The probe type was V-53W and the frequency was 4 MHz-8 MHz for routine ultrasound examination of scrotum. The size of testis was measured and testicular volume (mL) was calculated to determine whether the testis was reduced; the thickness of each part of epididymis was measured and whether the epididymal duct was dilated; the varicocele was judged and graded; the diameter of vas deferens was measured. (2) The prostate, bilateral seminal vesicles, ejaculatory ducts and ampulla of vas deferens were scanned by transrectal ultrasonography to observe their morphology, internal echo, and the size of prostate and seminal vesicles, to observe whether the ejaculatory ducts were dilated and to measure their length and internal diameter, and to measure the maximum internal diameter of vas deferens ampulla. (3) Appendix. Ultrasonic elastography and quantitative analysis of the epididymis: the head and tail of the epididymis were examined by ultrasonic elastography, the SI value of the hardness index was calculated automatically by the diffusion quantitative analysis software, and the SI value was measured five times repeatedly and the average value was obtained. (4) Vasoepididymostomy (VE) indications for ultrasound screening method that there are the following positive findings considered to have. Indications: 1. Testicular volume (> 15ml). 2. The epididymal duct was dilated in a "mesh" shape with an inner diameter of 3mm. 3. The testicular reticulum was dilated in a "mesh" shape. 4. The vas deferens was dilated with an inner diameter of 1mm. _seminal vesicle, ejaculatory duct and prostate were not abnormal. _There were no congenital abnormalities in the epididymis. Testicular biopsy and operation results were compared. Statistical methods: All data were collected and analyzed by SPSS17.0 statistical software. Chi-square test and Fisher test were used to evaluate the ability of detecting lesions of common cause of OA and NOA; SI value of elastography was expressed by mean (+S); SI value between OA and NOA was first compared. Dunnett T3 was compared by one-way ANOVA and independent sample T test, and the SI values of the epididymal head and tail of OA and NOA were selected to draw the ROC curve, and the area under the ROC curve (Az) was used to judge the accuracy of SI index in the diagnosis of azoospermia.
Results: (1) Ultrasound showed that 37 cases of semen obstruction (OA group), accounting for 48.0% (37/77); 21 cases of azoospermia obstruction (NOA group), accounting for 27.3% (21/77). The etiology of OA group was higher than that of NOA group, and the difference was statistically significant. (2) The etiology of azoospermia OA group included chronic epididymitis with epididymal duct dilatation, vasectomy ligation. The NOA group included testicular dysplasia, cryptorchidism, varicocele and unilateral testicular dysplasia with varicocele; the common causes of the two groups included dilatation of the epididymal duct, epididymal cyst and varicocele, including dilatation of the epididymal duct and varicocele in the OA group. The frequency of occurrence of epididymal cyst in NOA group was higher than that in NOA group, and the frequency of occurrence of epididymal cyst in NOA group was higher than that in OA group, the difference was statistically significant. (3) The results of epididymal elastography showed that the SI value of the head of epididymis in OA group was slightly higher than that of the head of epididymis in NOA group, and the difference was statistically significant (P 0.05). The sensitivity and specificity were 95.9% and 16.7% respectively in OA group and NOA group when SI = 2.46 was the diagnostic threshold (P = 0.968), and 95.9% and 25% respectively in OA group and NOA group when SI = 2.57 was the diagnostic threshold (P = 0.069). The area under the ROC curve (Az) of SI value of head and tail of epididymis was 0.502 and 0.594 respectively, indicating that the diagnostic accuracy was low, that is, the SI value was used to diagnose azoospermia with low reliability. (4) The accuracy rate of ultrasound screening for VE operation indication was 92.85%, accounting for 7.14 (1/28).
Conclusion: (1) Transscrotal ultrasonography and transrectal ultrasonography can provide valuable imaging evidence for the diagnosis and treatment of azoospermia. (2) Transscrotal ultrasonography and transrectal ultrasonography are more accurate in the etiological diagnosis of non-obstructive azoospermia than obstructive azoospermia. The detection rate of lesions in patients with obstructive azoospermia was lower than that in patients with obstructive azoospermia, and the difference in the detection ability of common etiology between obstructive and non-obstructive azoospermia was weak. (3) Ultrasound real-time tissue elastography diffusion quantitative analysis technique has the effect on the changes of epididymal tail stiffness in obstructive azoospermia and non-obstructive azoospermia. It has certain diagnostic value; (4) SI value of stiffness index is low in the differential diagnosis of obstructive azoospermia and non-obstructive azoospermia epididymal stiffness, and its value needs to be studied; (5) Transscrotal and transrectal ultrasonography in obstructive azoospermia patients before vasoepididymal anastomosis screening surgical indications has higher value.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R698;R445.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 張賢生;夏磊;劉吉雙;郝宗耀;周駿;梁朝朝;;325例男性不育患者陰囊彩色多普勒超聲檢查分析[J];安徽醫(yī)藥;2011年02期
2 游宇光;葛貽瓏;陳衛(wèi)華;任苓;肖文勝;葉軍;;高頻超聲在男性不育癥精索靜脈曲張的應(yīng)用研究[J];贛南醫(yī)學(xué)院學(xué)報;2009年03期
3 謝麗珍;陳衛(wèi)華;楊建勇;王春秀;邱永瑞;謝金鳳;;經(jīng)直腸超聲在男性不育癥射精管梗阻中的應(yīng)用價值[J];贛南醫(yī)學(xué)院學(xué)報;2011年02期
4 黃利;吳嗣澤;張建輝;符川;;睪丸發(fā)育不良與精子生成和男性不育的關(guān)系探討[J];海南醫(yī)學(xué);2011年04期
5 杜啟亙;于丹丹;汪陽;;彩色多普勒超聲在診斷精索靜脈曲張中的應(yīng)用[J];航空航天醫(yī)學(xué)雜志;2011年12期
6 張衛(wèi)星;李松;王瑞;韓廣業(yè);李征;張?zhí)鞓?biāo);;精索靜脈曲張不育患者精液質(zhì)量、外周血生殖激素和精漿生化指標(biāo)檢測[J];鄭州大學(xué)學(xué)報(醫(yī)學(xué)版);2009年03期
7 蘇東露;;高頻超聲診斷隱睪58例體會[J];中外醫(yī)療;2011年24期
8 謝偉;檀大羨;張海英;;附睪囊腫診斷及對梗阻性無精子癥的診斷價值[J];中國計劃生育和婦產(chǎn)科;2011年03期
9 李杰;管琳;李棟;任東;;高頻彩色多普勒超聲診斷男性不育精索靜脈曲張的臨床價值[J];中國中西醫(yī)結(jié)合影像學(xué)雜志;2012年01期
10 劉吉鳳;楊恒;吳新勇;;高頻彩色多普勒超聲對隱睪癥的臨床診斷價值[J];吉林醫(yī)學(xué);2012年03期
，本文編號：2224718
本文鏈接：http://sikaile.net/yixuelunwen/fangshe/2224718.html
最近更新
教材專著
