超音波很少检测到不可触知的睾丸


  2002年10月14日─根据10月份《Pediatrics》发表的一份病例回顾结果指出,没有必要对无法触知睾丸的患者进行超音波成像检测。难以发现睾丸在阴囊与腹股沟的情况,经由泌尿科专家触诊检查的效果较超音波检测好,这是因为超音波很少能检出无法触知的睾丸,故通常对手术干预没什么差异。
  
  美国俄亥俄州克里夫兰市Case Western Reserve大学医学院的Jack S. Elder医师及其同事指出,对于无法触知的男孩,通常进行腹股沟超音波扫描,以「定位」睾丸,也就是判断睾丸是否存在。
  
  Dr. Elder的研究小组对62位男孩的病历与超音波检查结果进行分析,这些男孩皆因无法触知睾丸,而到儿科泌尿中心就诊,并进行腹股沟超音波扫描。其中,51位男孩是由初级保健医师安排超音波检查(82%),另外11位男孩则是由一位普通泌尿科专家所安排的(18%)。
  
  这66位进行超音波检查的患者,确定有12位患者(18%)的睾丸全都位于腹股沟管。经一位小儿泌尿科专家进行体检,发现其中6位的睾丸位于阴囊中,另外6位则于腹股沟管或会阴中。此外,超音波检查遗漏的54例中,有33人(61%)的睾丸是可触知,另外21人(39%)则否。这21位患者经腹腔镜检查与腹部/腹股沟探测确认,有10位患者确实无法触知睾丸是否位于腹部,而另外11位患者则因为精索扭转而导致萎缩。
  
  对于无法触知睾丸的孩子而言,是没有必要进行超音波检查,因为这种检查很少能够真正定位不可触知的睾丸,而且不能改变对其进行的外科检查法。
  
  
  
  

Ultrasound Rarely Detects Nonp

By Laurie Barclay, MD
Medscape Medical News

Oct. 14, 2002 — Ultrasound imaging is not necessary to evaluate a nonpalpable testis, according to a record review published in the October issue of Pediatrics. Urologists are better at palpating hard-to-find testes in the scrotum and in the inguinal canal, and the operative intervention is usually no different since ultrasound rarely detects a nonpalpable testis.

"An inguinal sonogram often is obtained in boys with a nonpalpable testis to 'localize' the testis, i.e., determine whether the testis is present," writes Jack S. Elder, MD, and colleagues from Case Western Reserve University School of Medicine in Cleveland, Ohio.

Elder's group analyzed records and results of ultrasonography in 62 boys who were referred to a pediatric urology center with a diagnosis of a nonpalpable testis, and who had undergone an inguinal sonogram. The primary care physician ordered the sonogram in 51 boys (82%), and a general urologist ordered it in 11 boys (18%).

The sonogram localized the testis in 12 (18%) of 66 cases, all in the inguinal canal. Physical examination by a pediatric urologist detected six of these in the scrotum and six in the inguinal canal or perineum. Of the 54 testes missed by the sonogram, 33 (61%) were palpable and 21 (39%) were not. Laparoscopy and abdominal/inguinal exploration identified the truly nonpalpable testes as abdominal in 10 cases and as atrophic secondary to spermatic cord torsion in 11 cases.

"Sonography is unnecessary in boys with a nonpalpable testis, because it rarely if ever localizes a true nonpalpable testis, and it does not alter the surgical approach in these patients," the authors write.

Pediatrics. 2002;110(4):748-751

Reviewed by Gary D. Vogin, MD

    
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