Weber D M, Rösslein R, Fliegel C
Department of Pediatric Surgery, Children's University Hospital, Basel, Switzerland.
Eur J Pediatr Surg. 2000 Aug;10(4):235-41. doi: 10.1055/s-2008-1072366.
Evaluation of acute painful scrotum is difficult and imaging studies have been reported to be unreliable in detecting testicular torsion. In order to assess the value of color Doppler sonography in acute scrotal disease, the authors reviewed 65 consecutive boys, ranging in age from 1 to 16 years. The study demonstrated absent or diminished flow signals in 11 patients. All of them had a surgical intervention, and in 8 of them, a testicular torsion was confirmed. 54 boys had a symmetrical or increased flow signal on the affected side. Just 5 boys among this group underwent surgical exploration. On follow up, none of the 54 patients with good flow signals proved to have a testicular torsion. Sonography and color Doppler sonography helped to differentiate epididymitis and torsion of a testicular appendage as a basis for further investigations and correct conservative therapy. In detecting a testicular torsion, color Doppler sonography yielded a positive predictive value of 73%, a sensitivity of 100% and a negative predictive value of 100%. We therefore conclude, that Doppler sonography can reliably rule out testicular torsion so that routine scrotal exploration in cases of acute scrotum is no longer necessary. By reducing the number of emergency operations and hospitalization days, color Doppler sonography can cut down the total cost of managing acute painful scrotum in boys.
评估急性阴囊疼痛颇具难度，据报道影像学检查在检测睾丸扭转方面并不可靠。为了评估彩色多普勒超声在急性阴囊疾病中的价值，作者回顾了65例年龄在1至16岁之间的连续男孩病例。研究显示，11例患者出现血流信号缺失或减弱。他们均接受了手术干预，其中8例确诊为睾丸扭转。54例男孩患侧血流信号对称或增强。该组中仅有5例男孩接受了手术探查。随访发现，54例血流信号良好的患者均未发生睾丸扭转。超声检查和彩色多普勒超声有助于鉴别附睾炎和睾丸附件扭转，为进一步检查和正确的保守治疗提供依据。在检测睾丸扭转时，彩色多普勒超声的阳性预测值为73%，敏感性为100%，阴性预测值为100%。因此，我们得出结论，多普勒超声能够可靠地排除睾丸扭转，从而不再需要对急性阴囊病例进行常规阴囊探查。通过减少急诊手术数量和住院天数，彩色多普勒超声可以降低男孩急性阴囊疼痛治疗的总成本。
