目的 探讨p16/Ki-67染色、HPV E6/E7mRNA和联合检测对HSIL+病变诊断的临床价值。方法 募集2017年3月—2020年8月期间,于中山市博爱医院妇产科就诊,组织学证实为宫颈炎患者209例、LSIL患者169例、HSIL患者131例和宫颈癌患者86例作为研究对象,回顾分析研究对象术前细胞学样本p16/Ki-67染色、HPV E6/E7mRNA检测结果,纵向比较p16/Ki-67染色、HPV E6/E7mRNA和联合检测在不同级别宫颈病变的阳性率的差异,横向比较p16/Ki-67染色、HPV E6/E7mRNA和联合检测在相同宫颈病变的阳性率的差异,综合评估p16/Ki-67染色、HPV E6/E7mRNA和联合检测诊断HSIL+病变效能的差异。结果 ①纵向比较:p16/Ki-67染色、HPV E6/E7mRNA和联合检测阳性率随宫颈病变程度的加重呈趋势性升高(p16/Ki-67染色:χ²=374.34,P<0.001;HPV E6/E7mRNA检测:χ²=289.21,P<0.001;联合检测:χ²=343.90,P<0.001)。②横向比较:在宫颈炎、LSIL、宫颈癌组,p16/Ki-67染色、HPV E6/E7mRNA和联合检测阳性率之间差异均不具有统计学意义(均P>0.05)。在HSIL组,p16/Ki-67染色和联合检测之间阳性率差异有统计学意义(χ²=8.09,P=0.004); HPV E6/E7mRNA和联合检测之间阳性率差异有统计学意义(χ²=11.30,P=0.001)。③p16/Ki-67染色、HPV E6/E7mRNA和联合检测诊断HSIL+的灵敏度,总体差异有统计学意义(χ²=7.69,P=0.021)。p16/Ki-67染色与联合检测法之间的灵敏度差异有统计学意义(χ²=7.29,P=0.007);HPV E6/E7mRNA检测与联合检测法之间的灵敏度差异有统计学意义(χ²=4.84,P=0.028)。p16/Ki-67染色、HPV E6/E7mRNA和联合检测诊断HSIL+的特异度及符合率的总体差异不具有统计学意义(χ²₁=5.38,P₁=0.068;χ²₂=0.93,P₂=0.628)。结论 p16/Ki-67染色、HPV E6/E7mRNA 和联合检测均可有效筛出HSIL+病变,但是联合检测能显著提高HSIL+病变诊断的灵敏度,降低漏诊率,同时保持了较好的特异度和符合率,建议将p16/Ki-67染色和HPV E6/E7mRNA联合检测作为早期诊断HSIL+病变的策略。

Objective To investigate the clinical value of p16/Ki-67 staining E6/E7 mRNA and combined detection in the diagnosis of HSIL+ lesions. Methods From March 2017 to August 2020,209 cases of cervicitis,169 cases of LSIL,131 cases of HSIL and 86 cases of cervical cancer confirmed by histology were selected as the research objects. The results of p16/Ki-67 staining and HPV E6/E7 RNA detection of the preoperative cytological samples were retrospectively analyzed and the p16/Ki-67 staining and HPV E6/E7 mRNA detection results were compared longitudinally. The positive rates of E6/E7mRNA and combined detection in different grades of cervical lesions were compared.The positive rates of p16/Ki-67 staining,HPV E6/E7 mRNA and combined detection in the same cervical lesions were compared horizontally.The differences in the diagnostic efficacy of p16/Ki-67 staining,HPV E6/E7 mRNA and combined detection in the diagnosis of HSIL+lesions were comprehensively evaluated. Results ①Longitudinal comparison:the positive rates of p16/ Ki-67 staining, HPV E6/E7mRNA and combined detection increased with the severity of cervical lesions(p16/Ki-67 staining:χ²=374.34,P<0.001;HPV E6/E7 mRNA detection:χ²=289.21,P<0.001;joint detection:χ²=343.90,P<0.001). ②Transverse comparison: in cervicitis, LSIL and cervical cancer groups,there were no significant differences in the positive rates of p16/Ki-67 staining, HPV E6/E7 mRNA and combined detection (all P>0.05). In the HSIL group,there was significant difference in the positive rate between p16/Ki-67 staining and combined detection (χ²=8.09,P=0.004)and the difference between HPV E6/ E7 mRNA and combined detection was statistically significant(χ²=11.30,P=0.001). ③The sensitivity of p16/Ki-67staining,HPV E6/E7 mRNA and combined detection in the diagnosis of HSIL+ was statistically significant(χ²=7.69,P=0.021). The sensitivity difference between p16/Ki-67 staining and combined detection was statistically significant(χ²=7.29,P=0.007);the sensitivity difference between HPV E6/E7 mRNA detection and combined detection method was statistically significant (χ²=4.84,P=0.028). There was no significant difference in the specificity and coincidence rate of p16/Ki-67 staining,HPV E6/E7 mRNA and combined detection in the diagnosis of HSIL+(χ²₁=5.38,P₁=0.068;χ²₂=0.93,P₂=0.628). Conclusion P16/Ki-67 staining,HPV E6/E7 mRNA and combined detection may effectively screen out HSIL+ lesions,reduce the missed diagnosis rate, but the combined detection may significantly improve the sensitivity of diagnosis of HSIL+ lesions, while maintaining good specificity and coincidence rate.It is suggested that p16/Ki-67 staining and HPV E6/E7 mRNA detection should be used as a strategy for early diagnosis of HSIL+ lesions.

目的 探讨宫颈病变诊断中HPV联合TCT(薄层液基细胞学)检测的预测价值。方法 本文将2019年2月—2020年2月收治的宫颈病变患者90例作为研究对象,对所有患者实施HPV检测、TCT检测及阴道镜活检,将阴道镜检查结果作为金标准,统计分析TCT检测与病理结果比较、HPV检测与病理结果比较、联合检测与病理结果比较及诊断准确率。结果 90例患者经病理检查显示宫颈正常27例、CINⅠ期27例、CINⅡ期11例、CINⅢ期14例、宫颈癌11例;TCT检测显示宫颈正常19例、ASCUS 33例、LSIL 22例、HSIL 12例、SCC 4例。经HPV检测显示阳性73例,阴性17例;联合检测显示阳性88例,阴性2例;联合检测准确率与病理结果之间差异无统计学意义,P＞0.05。结论 HPV检测联合TCT检测在宫颈病变中具有较高的预测价值,准确度较高且具有无创性,可有效降低阴道镜活检的概率或者手术探查的概率,患者医疗负担相对较轻,可将其应用于宫颈病变的大规模筛查中。

Objective To investigate the predictive value of HPV combined with TCT (thinprep cytology test) in the diagnosis of cervical lesions. Methods 90 patients with cervical lesions from February 2019 to February 2020 were selected as the research objects. HPV detection, TCT detection and colposcopy biopsy were carried out for all patients. The colposcopy results were taken as the gold standard. The comparison of TCT detection and pathological results, HPV detection and pathological results, joint detection and pathological results comparison and diagnostic accuracy were statistically analyzed. Results Pathological examination showed that 27 cases of normal cervix, 27 cases of CIN Ⅰ, 11 cases of CIN Ⅱ, 14 cases of CIN Ⅲ and 11 cases of cervical cancer; TCT showed 19 cases of normal cervix, 33 cases of ASCUS, 22 cases of LSIL, 12 cases of HSIL and 4 cases of SCC. HPV test showed that 73 cases were positive and 17 cases were negative; 88 cases were positive and 2 cases were negative by combined detection; there was no significant difference between the accuracy of combined detection and pathological results, P>0.05. Conclusion HPV detection combined with TCT detection in cervical lesions has high predictive value, high accuracy and non-invasive. It can effectively reduce the probability of colposcopy biopsy or surgical exploration. It makes patients with relatively light medical burden, may be applied to large-scale screening of cervical lesions.

目的 分析经胸超声心动图在Stanford A 型主动脉夹层的直接征象、间接征象和优缺点,探讨超声心动图在其诊断及预后评估中的应用价值。方法 回顾性收集2018年9月—2020年6月在我院诊治的A型主动脉夹层患者的临床资料,分析超声心动图的应用价值,以及住院期间发生不良预后的高风险因素。结果 经胸超声心动图直接征象诊断 A 型主动脉夹层的敏感性低于CTA,但对受累主动脉瓣结构及其功能评价优于CTA。 院内不良预后的发生率为42%, A型夹层的病因多与高血压相关,主动脉瓣返流、心包积液、手术时间长等是其高风险因素。结论 经胸超声心动图对A型主动脉夹层的早期诊断有较高的初筛价值,在局限于主动脉窦部夹层及观察主动脉瓣是否受累及有独特的优势,对于手术方式的选择和预后的判断有指导意义。

Objective To analyze the direct signs, indirect signs, advantages and disadvantages of transthoracic echocardiography in Stanford A-type aortic dissection, and explore the application value of echocardiography in its diagnosis and prognostic evaluation. Methods Retrospectively collect the clinical data of patients with type A aortic dissection diagnosed and treated in our hospital from Sept 2018 to Jun 2020, and analyze the application value of echocardiography and the high-risk factors for poor prognosis during hospitalization. Results The direct signs of transthoracic echocardiography were less sensitive than CTA in the diagnosis of type A aortic dissection, but it was better than CTA in evaluating the structure and function of the affected aortic valve. The incidence of poor prognosis in the hospital was 42%. The cause of type A dissection was mostly related to hypertension. Aortic regurgitation, pericardial effusion, and long operation time were high-risk factors. Conclusion Transthoracic echocardiography has a higher initial screening value for the early diagnosis of type A aortic dissection. It has unique advantages in confining to the aortic sinus dissection and observing whether the aortic valve is involved, the choice of surgical methods and the judgment of prognosis has guiding significance.

目的 分析重症流感相关性脑病患儿的临床特点及诊治要点。方法 回顾性分析2017年5月—2020年4月收入我院PICU的17例重症流感相关性脑病患儿的临床资料进行回顾性分析。结果 17例患儿中男性10例、女性7例,起病年龄3(2～5)岁。所有患儿均出现发热,1(0～3.5)天后出现神经系统症状,包括惊厥发作(88%)和昏迷(88%)。头颅影像学检查病变主要分布在丘脑、脑干、髓质脑室周围白质,呈对称性和多灶性改变。经颅多普勒检查出现脑血流速度减慢呈震荡波、钉子波的5例患儿均死亡。16例患儿予机械通气,2例予连续性肾替代治疗,死亡8例,存活者出院前均遗留不同程度神经系统损害。结论 儿童重症流感相关性脑病以发热、惊厥和昏迷为主要表现,头颅影像学及脑电图、经颅多普勒等检查有助于早期诊断和预后判断,早期联合应用甲强龙冲击及IVIG的有效性仍需进一步研究。

Objective To analyze the characteristics, diagnosis and treatment of severe influenza-associated encephalopathy in children. Methods The clinical data of 17 children with severe influenza-associated encephalopathy admitted to PICU from May 2017 to April 2020 were retrospectively analyzed. Results Among the 17 cases, 10 were male and 7 were female, and the onset age was 3 (2-5) years old. All children developed fever, and neurological symptoms 1 (0-3.5) days later, including seizures (88%) and coma (88%). The lesions were mainly distributed in the thalamus, brainstem and medullary ventricular white matter, showing symmetry and multifocal changes. All the 5 cases with slowed cerebral blood flow velocity and presented shock wave or nail wave died. 16 children were on mechanical ventilation, 2 with continuous renal replacement therapy, and 8 died. All the survivors had varying degrees of neurological damage before discharge. Conclusion Severe influenza-associated encephalopathy of childhood is mainly characterized by fever, convulsions and coma. Cranial imaging, EEG, TCD and other examinations are helpful for early diagnosis and prognosis judgment. The effectiveness of early combined application of methylprednisolone and IVIG still needs further study.

目的 探讨甲状腺Bethesda Ⅲ类(AUS/FLUS)结节的诊断原因,以及亚分类在预测结节恶性风险(risk of malignancy,ROM)中的价值。方法 收集356例Bethesda Ⅲ结节患者,对其诊断原因, ROM及亚分类进行总结分析。结果 在97例手术切除标本中,72例恶性肿瘤均为甲状腺乳头状癌(papillary thyroid carcinoma,PTC),Bethesda Ⅲ类的ROM为74.2%。影响PTC诊断的主要原因有病灶小、穿刺细胞量稀少、缺乏乳头状结构及细胞核特征不典型;次要原因有间质显著纤维化或钙化、涂片不合格、固定不当、染色不佳及细胞学诊断经验欠缺等。Bethesda Ⅲ类的亚分类:132例为低风险组,其中12例手术切除,ROM为8.3%;122例为高风险组,其中70例手术切除,ROM为92.9%;102例为中风险组,其中15例手术切除,ROM为40.0%;高风险组和低/中风险组之间的差异有统计学意义(P＜0.05)。结论 Bethesda Ⅲ类的诊断具有一定的主观性和经验性,而对Bethesda Ⅲ类结节进行风险相关的亚分类,有助于实现更好的ROM分层并改善此类病变的临床管理。

Objective To investigate the diagnostic causes of Bethesda Ⅲ (AUS/FLUS) thyroid nodules and the value of subcategories in predicting risk of malignancy (ROM) of thyroid nodules. Methods The data of 356 cases of Bethesda Ⅲ nodules were collected, and the causes, ROM and subcategories were summarized. Results In 97 resected specimens, 72 were diagnosed as papillary thyroid carcinoma (PTC), and the ROM of Bethesda Ⅲ was 74.2%. The main factors affecting the diagnosis of PTC were small lesions, few puncture cells, atypical nuclear features and lack of papillary structure. Secondary factors included significant interstitial fibrosis or calcification, unqualified smear, improper fixation, poor staining and lack of cytological diagnosis experience. According to the subcategories of Bethesda Ⅲ, 132 cases were included in low-risk group, nodules of 12 cases in the group were resected, which ROM was 8.3%; 122 cases were included in high-risk group, nodules of 70 cases were resected, which ROM was 92.9%; 102 cases were included in middle-risk group, nodules of 15 cases were resected, which ROM was 40.0%. The differences between high-risk group and low/medium-risk group were statistically significant (P＜0.05). Conclusion The diagnosis of Bethesda Ⅲ is subjective and empirical in some degree, and the risk related subcategories of Bethesda Ⅲ nodules is helpful to achieve better ROM stratification and improve the clinical management of the disease.

目的 探讨产前超声联合磁共振诊断胎儿部分性胼胝体发育不全的价值。方法 收集产前超声联合磁共振诊断为部分性胼胝体发育不全的胎儿15例,对比出生或引产后的检查结果,分析产前超声特征。结果 产前超声直接征象:胼胝体正中矢状切面相应部位缺失12例(12/15,80.0%)。间接征象:透明隔腔形态异常(80.0%)、侧脑室扩张(73.3%)、大脑纵裂池分离(73.3%)、脑中线丘脑后方囊性包块(26.7%)、侧脑室“泪滴状改变”(26.7%)、胼周动脉走行异常(26.7%),合并颅内或其他系统畸形6例。对比出生或引产后随访结果,诊断准确率:产前超声80.0%,产前磁共振93.3%。结论 超声可以诊断胎儿部分性胼胝体发育不全,更精确的诊断建议结合产前胎儿头颅磁共振检查。

Objective To explore the value of prenatal ultrasound in diagnosis of fetal partial agenesis of corpus callosum. Methods 15 fetuses diagnosed as partial agenesis of corpus callosum by prenatal ultrasound combined with magnetic resonance imaging (MRI) were collected. Results of examination after birth or induction of labor were compared to analyze the characteristics of prenatal ultrasound. Results Direct signs were observed in the prenatal sonographic features: 12 cases (12/15, 80.0%) were missing corresponding parts in the midsagittal section of corpus callosum. Indirect signs: transparent partition morphological abnormalities (80.0%), lateral ventricle expansion (73.3%), separation of longitudinal crack on the brain pool(73.3%), posterior thalamic midline cystic mass (26.7%), “teardrop change” of the lateral ventricle (26.7%), abnormal course of pericallosal artery (26.7%), with intracranial and other system deformity in 6 cases, including multiple anomalies. Compared with the follow-up results after birth or induction of labor, the diagnostic accuracy was 80.0% of prenatal ultrasound and 93.3% of prenatal MRI. Conclusion Ultrasonography may diagnose fetal partial agenesis of corpus callosum properly, and more accurate diagnosis could be finished combining with prenatal fetal cranial MRI.

目的 探讨B超与MRI、宫腔镜联合诊断对宫腔占位性病变的临床意义。方法 选择2017年1月1日— 12月31日我院收治的108例疑似宫腔占位性病变患者为研究对象。所有患者均于宫腔操作前行阴道彩色多普勒超声(以下简称B超)检查、MRI检查及宫腔镜检查。与病理检查结果对比,分别分析其灵敏度、特异度。结果 108例患者中宫腔无病理变化者27例,子宫内膜息肉39例,子宫内膜增生27例,子宫黏膜下肌瘤10例,子宫内膜癌5例。B超、MRI、宫腔镜诊断灵敏度分别为72.84%、71.60%、75.31%,特异度分别为62.96%、85.19%、66.67%。B超+MRI诊断子宫黏膜下肌瘤和子宫内膜癌灵敏度100%,特异度分别为87.76%和99.03%。B超+MRI+宫腔镜诊断子宫内膜增生、子宫黏膜下肌瘤、子宫内膜癌灵敏度均为100%。结论 宫腔占位病变以良性病变居多,B超联合宫腔镜和MRI检查可提高诊断率。对子宫内膜癌高危人群应进行B超与MRI联合检查,宫腔镜定位活检仅在必要时实施。

Objective To explore the clinical significance of B-ultrasound, MRI and hysteroscopy in the diagnosis of uterine space occupying lesions. Methods 108 patients with suspected uterine space occupying lesions admitted to our hospital from January 1 to December 31 2017 were selected as the study objects. All patients were examined by vaginal color Doppler ultrasound, MRI and hysteroscopy before uterine operation. Compared with the results of pathological examination, the sensitivity and specificity were analyzed. Results Among the 108 patients, 27 had no pathological changes in uterine cavity, 39 had endometrial polyps, 27 had endometrial hyperplasia, 10 had submucous myoma, and 5 had endometrial cancer. The sensitivity of B-ultrasound, MRI and hysteroscopy were 72.84%, 71.60% and 75.31% respectively, and the specificity were 62.96%, 85.19% and 66.67% respectively. The sensitivity of B-ultrasound+MRI in the diagnosis of submucous myoma and endometrial carcinoma was 100% and the specificity was 87.76% and 99.03%, respectively. The sensitivity of B-ultrasound+MRI+hysteroscopy in the diagnosis of endometrial hyperplasia, submucous myoma and endometrial carcinoma was 100%. Conclusion Most of the uterine space occupying lesions are benign. B-ultrasound combined with hysteroscopy and MRI may improve the diagnosis rate. The high-risk group of endometrial cancer should be examined by B-ultrasound and MRI, and hysteroscopic biopsy would be performed only when necessary.

目的 通过分析孤立性蝶窦病变的临床特点,进一步提高早期诊断率及治疗疗效。方法 回顾性分析2019年1月—2019年8月在我科手术的孤立性蝶窦病变的9例患者临床资料,总结分析蝶窦病变的临床症状、鼻窦影像学表现及鼻内镜手术疗效。结果 蝶窦病变平均发病年龄约59.1岁,1例为双侧真菌性蝶窦炎,只有1例首诊于耳鼻喉科,8例患者就诊于神经内科,都以头痛为首发症状,1例鼻流清亮液体,鼻腔异味2例,鼻塞、脓涕1例,嗅觉功能减退1例。不同类型的蝶窦病变影像学表现不同,临床症状不同,绝大多数患者以头痛为首发症状。所有患者均在全身麻醉下行鼻内镜手术。术后随访至少3月以上,术后症状完全消失,无复发病例。结论 头痛是孤立性蝶窦病变最常见的临床特点,鼻窦影像学检查是重要的诊断手段,鼻内镜下经嗅裂蝶筛隐窝进路开放蝶窦是最有效的治疗手段。

Objective By analyzing the clinical characteristics of solitary sphenoid sinus disease,the early diagnosis rate and therapeutic effect can be further improved. Methods The clinical data of 9 patients with isolated sphenoid sinus lesions operated on in our department from January 2019 to August 2019 were retrospectively analyzed,and the clinical symptoms,imaging features of the sinuses and the efficacy of nasal endoscopic surgery were summarized and analyzed. Results The average age of onset of sphenoid sinus lesions was 59.1 years old,1 case was bilateral fungal sphenoid sinusitis,only 1 case was first diagnosed in the department of otolaryngology,8 cases were treated in the department of neurology,all with headache as the first symptom,1 case had clear rhinorrhea,2 cases had nasal odor,1 case had nasal obstruction,1 case had purulent nose,and 1 case had anosmia. The imaging manifestations and clinical symptoms of different types of sphenoid sinus lesions were different,and headache was the first symptom of most patients. All patients underwent nasal endoscopic surgery under general anesthesia. The patients were followed up for at least 3 months after the operation,and the symptoms completely disappeared without recurrence. Conclusion Headache is the most common clinical feature of isolated sphenoid sinus lesions. Imaging examination of the sinus is an important diagnostic method,and endoscopic opening of the sphenoid sinus through the sphenoidal cleft via sphenoidal recess is the most effective treatment method.

目的 分析超声引导下经皮肾穿刺活检术对弥漫性肾病进行病理诊断的临床应用价值。方法 回顾性分析我院275例弥漫性肾病患者经超声引导下行经皮肾穿刺活检术进行诊断的情况,针对上述患者的穿刺活检情况、穿刺满意度、取材成功率、并发症发生状况、弥漫性肾病病理分型结果以及术后诊断更正的情况进行分析。结果 275例患者穿刺满意度、取材成功率、并发症总发生率分别为94.91%,100%、10.91%。275例患者术后并发症的发生与年龄、穿刺次数、肾实质厚度、术前血肌酐水平有关。275例患者以膜性肾病、IgA肾病居多,分别占比23.27%、18.55%。275例患者术后诊断更正率为19.79%。结论 超声引导下经皮肾穿刺活检术是一种安全有效的弥漫性肾病诊断方法,其术后并发症发生率较低且较轻。在弥漫性肾病病理分型诊断中以膜性肾病、IgA肾病的发病率较高。超声引导下经皮肾穿刺活检术可早期诊断弥漫性肾病的病理类型,为确定治疗方案提供可靠依据,改善肾脏疾病的预后。

Objective To analyze the clinical value of ultrasound-guided percutaneous renal biopsy for pathological diagnosis of diffuse renal disease. Methods Retrospective analysis of 275 patients with diffuse renal disease in our hospital underwent ultrasound-guided percutaneous renal biopsy for diagnosis. According to the above-mentioned patients' biopsy status,puncture satisfaction,success rate of material extraction,complications,and diffuse results of pathological typing of nephropathy and correction of postoperative diagnosis were analyzed. Results The satisfaction rate of puncture,the success rate of material extraction and the total incidence of complications were 94%,100%,and 10.91%,respectively. The incidence of postoperative complications in 275 patients was related to age,number of punctures,thickness of renal parenchyma,and preoperative serum creatinine levels. Membrane nephropathy and IgA nephropathy were the most common in 275 patients,accounting for 23.27% and 18.55% respectively. The correction rate of postoperative diagnosis in 275 patients was 19.79%. Conclusion Ultrasound-guided percutaneous renal biopsy is a safe and effective method for diagnosing diffuse nephropathy,and the incidence of postoperative complications is low and mild. Membrane nephropathy and IgA nephropathy have a higher incidence in the diagnosis of diffuse nephropathy. Ultrasound-guided percutaneous renal biopsy may early diagnose the pathological type of diffuse renal disease,provide a reliable basis for determining the treatment plan,and improve the prognosis of renal disease.

目的 分析彩色多普勒超声在小儿阴囊急症诊断中的应用价值。方法 于2019年1月—2019年12月选取院内收治的100例以阴囊急症就诊的患儿作为研究对象,使用彩色多普勒超声对所有患儿进行诊断,分析患儿的超声影像学特点,并对彩色多普勒超声的诊断结果与手术和病理结果进行对比。结果 急性睾丸扭转患儿的影像学形态以睾丸肿胀(90.63%)、阴囊壁水肿(75.00%)、鞘膜积液(68.75%)、睾丸实质回声异常(59.38%)和附睾增大(53.13%)为主,其中睾丸肿胀和睾丸实质回声异常的患儿例数明显高于其他疾病类型(P＜0.05);急性睾丸附件扭转患儿的影像学形态以睾丸外结节(96.30%)、附睾增大(74.07%%)、阴囊壁水肿(70.37%)和鞘膜积液(51.85%)为主,其中睾丸外结节的患儿例数高于其他疾病类型(P＜0.05);急性附睾炎患儿的影像学形态以阴囊壁水肿(82.61%)、附睾增大(73.91%)和鞘膜积液(52.17%)为主;急性睾丸炎患儿的影像学形态也以阴囊壁水肿(83.33%)、附睾增大(83.33%)、和鞘膜积液(55.56%)为主,急性附睾炎和急性睾丸炎患儿的影像学形态相比差异无统计学意义(P＞0.05);急性睾丸扭转患儿的睾丸内血流分布主要为减少或消失和精索扭转,与其他疾病类型患儿相比差异有统计学意义(P＜0.05);急性睾丸附件扭转患儿的睾丸内血流分布主要为正常,与其他疾病类型患儿相比差异有统计学意义(P＜0.05);急性附睾炎和睾丸炎患儿的睾丸内血流分布主要为增加,与其他疾病类型患儿相比差异有统计学意义(P＜0.05),急性附睾炎和急性睾丸炎患儿的睾丸内血流分布情况相比差异无统计学意义(P＞0.05);彩色多普勒超声在阴囊急症中的总诊断率为97%,与手术病理结果相比无差异(P＞0.05),在急性睾丸扭转中的诊断符合率为96.88%,在急性睾丸附件扭转中的诊断率为96.30%,在急性附睾炎中的诊断符合率为95.65%,在急性睾丸炎中的诊断率为100.00%,不同疾病类型阴囊急症患儿中的诊断率与手术病理结果相比均无差异(P＞0.05)。结论 彩色多普勒超声在小儿阴囊急症的诊断中发挥出了较好的临床诊断效果,在不同疾病类型阴囊急症中的诊断符合率均相对较高,应当作为小儿阴囊急症早期筛查的主要影像学方法,值得广泛应用及推广。

Objective To analyze the value of color Doppler ultrasound in the diagnosis of scrotal emergency in children. Methods From January 2019 to December 2019,100 children admitted to the hospital with scrotal emergency were selected as the research objects. All patients were diagnosed by color Doppler ultrasound and the characteristics of ultrasound imaging were analyzed. The diagnostic results of color Doppler ultrasound were compared with surgical and pathological results. Results The imaging morphology of children with acute testicular torsion was testicular swelling (90.63%),scrotal wall edema (75.00%),hydrocele (68.75%),abnormal testicular parenchymal echo (59.38%),and enlarged epididymis (53.13%) mainly. The numbers of children with testicular swelling and abnormal testicular parenchymal echo were higher than other disease types (P<0.05); the imaging morphology of children with acute testicular attachment reversal was extratesticular nodules (96.30%) and enlarged epididymis (74.07 %%),scrotal wall edema (70.37%),and hydrocele (51.85%) were predominant,and the numbers of children with extra testicular nodules were higher than other disease types (P<0.05); acute epididymis morphology of scrotal wall edema (82.61%),enlarged epididymis (73.91%),and hydrocele (52.17%) in children with inflammation are mainly; the morphology of scrotal wall edema in children with acute orchitis (83.33%) also,epididymis enlargement (83.33%),and hydrocele (55.56%) were the main factors. There was no significant difference in imaging morphology between children with acute epididymitis and acute orchitis (P> 0.05); Testicular blood flow distribution in children with acute testicular torsion was mainly reduced or disappeared and spermatic cord twisted,the difference was statistically significant compared with children with other disease types (P<0.05); blood distribution in the testis of children with acute testicular accessory torsion was mainly normal,compared with children with other disease types. The difference was statistically significant (P<0.05); the distribution of blood flow in the testis of children with acute epididymitis and orchitis was mainly increased,and the difference was statistically significant compared with children with other disease types (P<0.05). There was no significant difference in testicular blood flow distribution between children with inflammation and acute orchitis (P> 0.05);The overall diagnosis rate of color Doppler ultrasound in scrotal emergency was 97%,and there was no significant difference compared with the surgical pathological results (P> 0.05). The diagnostic coincidence rate in acute testicular torsion was 96.88%,and in acute testis, the diagnostic rate of attachment reversal was 96.30%,the diagnostic coincidence rate in acute epididymitis was 95.65%,the diagnostic rate in acute orchitis was 100.00%. Compared with the diagnosis rates and surgical pathology results in children with scrotal emergency of different disease types,there were no significant differences (P> 0.05). Conclusion Color Doppler ultrasound has a good clinical diagnosis effect in the diagnosis of scrotal emergencies in children,and the diagnostic coincidence rate in different types of scrotal emergencies is relatively high. It should be used as the main early screening for scrotal emergencies. The imaging method is worthy of wide application and promotion.