实验性睾丸血运障碍超声表现与再灌注后组织变化相关性研究
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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。
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.
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。
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.
引文
1 Anderson, J.B., Williamson, C.A.N. The fate of the human testis following unilateral torsion of the spermatic cord [J].Br J Urol, 1996,58(3): 698.
2 Visser AJ,Heyns CF. Testicular function after torsion of the spermatic cord [J].BJU Internatinal,2003,92(2):200-203.
3 薛恩生,黄毅斌,林礼务,等.彩色多普勒超声在睾丸不全扭转治疗中的应用价值[J].中国超声医学杂志,2006,22(8):622-624.
4 李颖嘉,文戈,龚渭冰,等.彩色多普勒超声对睾丸扭转的诊断及意义[J].中国超声医学杂志,2004,20(1):55-57.
5 黄毅斌,薛恩生,林礼务,等.实验性睾丸不全扭转的彩色多普勒超声研究[J].中华超声影像学杂志,2005,14(7):546-549.
6 Kehinde EO, Anim JT, Mojiminiyi OA, et al. Significance of determining the point of reperfusion failure in experimental torsion of testis [J]. International Journal of Urology, 2005, 12(1): 81-89.
7 Kwon JW, Kim WS, Cheon JE, et al. Evaluation of testicular viability by power Doppler ultrasonography in experimentally induced acute testicular torsion [J].Investigative Radiology, 2005, 40(10): 682-687.
8 Bentley DF , Ricchiuti DJ , Nasraliah PF , et al. Spermatic cord torsion with preserved testis perfusion: initial anatomical observations [J]. J Urol, 2004, 172(6 Pt 1):2373-6.
9 Arda IS, Ozyaylali I. Testicular tissue bleeding as an indicator of gonadal salvageability in testicular torsion surgery [J]. BJU International 2001,87(1):89-92.
10 陈泽波,刘运初,李贤新,等.睾丸组织出血分级预测睾丸扭转患睾活力[J].罕少疾病杂志,2004,11(3):13-15 .
11 薛恩生,陈舜,林礼务,等。睾丸动脉舒张期反向血流的临床意义[J].中华超声影像学杂志,2007,16(2):52-54.
12 Johnsen SG. Testicular biopsy score count: a method for registration of spermatogenesis in human testes .Normal values and results of 335 hypogonadal males [J].Hormones,1970,1(1):2-25.
13 金惠铭,主编.病理生理学[M].第五版.北京:人民卫生出版社,2002:78-91.
14 姚启盛,叶章群,王晓康,等.大鼠一侧睾丸扭转对侧睾丸改变的实验研究[J].中华男科学,2003,9(8):586-588.
15 Rodriguez MG, Rival C, Theas MS, et al. Immunohistopathology of the contralateral testis of rats undergoing experimental torsion of the spermatic cord [J]. Asian J Androl, 2006,8 (5): 576–583.
16 李 超,袁申如,庞书舰,等.大鼠单侧睾丸扭转复位后对对侧睾丸的影响[J].中国男科学杂志,2006,20(3): 51-55.
17 王浩,王常林,王伟,等.兔睾丸扭转复位后睾丸细胞凋亡的观察[J].中华小儿外科杂志,2002,23(6):543-545.
18.Terry TT, Bang HJ, Lysiak JJ et al. Experiment testicular torsion: reperfusion blood flow and subsequent testicular venous plasma testosterone concentrations [J]. Urology, 2005 ,65(2): 390-394.
19 Somuncu S , Cakmak M , Erdogan S, et al. Protective effects of trapidil in ischemia– reperfusion injury due to testicular torsion and detorsion: an experimental study [J].Int J Urol 2006, 13(5):601–605.
20 马良宏,丁强,王翔,等.精索扭转的超声诊断与早期手术探查[J].临床泌尿科杂志.2005,20(1):57-58.
21 Bartsch G, Frank S, Marberger H, et al. Testicular torsion Late results with special regard to fertility and endocrine function[J] .J Urol 1980,124(3): 375-378.
21 李颖嘉,文戈,崔忠林,等.经静脉声学造影诊断睾丸扭转的价值[J].中国医学影像学杂志.2005,13(6) :422-424.
22 Yamaguchi A, Hayashi Y, Kojima Y, et al. Testicular torsion: usefulness of contrast-enhanced power Doppler sonography [J].Int J Urol, 2005,12(9):849-851.
23 Giard MS , Mattrey RF , Baker KG, et al . Comparison of standard and second harmonic B - mode sonography in the detection of segmental renal infaction with sonographic contrast in a rabbit model [J].J Ultrasound Med, 2000,19(6): 185.
24 周平安,林礼务,薛恩生,等.原发性肝细胞癌超声造影峰值时间与肿瘤动脉密度相关性研究[J].中国医学影像技术,2007,23(6):881-883.
25 赵玉珍,董超,刘红磊,等. 肝脏良恶性肿瘤血流灌注的超声造影定量评价[J]. 中国超声医学杂志,2007,23(5):360-363.
27.张家庭,李泉水,曹秋平,等.乳腺肿瘤超声造影时间一强度曲线的初步分析[J].中华医学超声杂志(电子版),2005,2(1):22-24.
28.Jie Li, Baowei Dong, Xiaoling Yu et al . Grey-scale contrast enhancement in rabbit liver with SonoVue at different doses[J]. Ultrasound in Med. & Biol.,2005, 31 (2):185-190.
29.郭文彬,张楠,张蕾,等.经静脉超声造影量化评价肾动脉狭窄的实验研究[J]. 中华超声影像学杂志,2005,14(8):621-624.
30 Cosgrove D. Microbubble enhancement of tumor neovascularity [J] . Eur Radiol, 1999, 9 (Suppl. 3):413-414.
1 Anderson, J.B., Williamson, C.A.N. The fate of the human testis following unilateral torsion of the spermatic cord [J].Br J Urol, 1996,58(3): 698.
2 Visser AJ,Heyns CF. Testicular function after torsion of the spermatic cord[J].BJU Internatinal,2003,92(2):200-203.
3 薛恩生,黄毅斌,林礼务,等.彩色多普勒超声在睾丸不全扭转治疗中的应用价值[J].中国超声医学杂志,2006,22(8):622-624.
4 李颖嘉,文戈,龚渭冰,等.彩色多普勒超声对睾丸扭转的诊断及意义[J].中国超声医学杂志,2004,20(1):55-57.
5 金惠铭,主编.病理生理学[M].第五版.北京:人民卫生出版社,2002:78-91.
6 黄毅斌,薛恩生,林礼务,等.实验性睾丸不全扭转的彩色多普勒超声研究[J].中华超声影像学杂志,2005,14(7):546-549.
7 薛恩生,陈舜,林礼务,等。睾丸动脉舒张期反向血流的临床意义[J].中华超声影像学杂志,2007,16(2):52-54.
8 Kehinde EO, Anim JT, Mojiminiyi OA, et al. Significance of determining the point of reperfusion failure in experimental torsion of testis[J]. International Journal of Urology, 2005, 12(1): 81-89.
9 Kwon JW, Kim WS, Cheon JE, et al. Evaluation of testicular viability by power Doppler ultrasonography in experimentally induced acute testicular torsion [J]. Investigative Radiology, 2005, 40(10): 682-687.
10 姚启盛,叶章群,王晓康,等.大鼠一侧睾丸扭转对侧睾丸改变的实验研究[J].中华男科学,2003,9(8):586-588.
11 Rodriguez MG, Rival C, Theas MS, et al. Immunohistopathology of the contralateral testis of rats undergoing experimental torsion of the spermatic cord[J]. Asian J Androl, 2006,8 (5): 576–583.
12 李 超,袁申如,庞书舰,等.大鼠单侧睾丸扭转复位后对对侧睾丸的影响[J].中国男科学杂志,2006,20(3): 51-55.
13 王浩,王常林,王伟,等.兔睾丸扭转复位后睾丸细胞凋亡的观察[J].中华小儿外科杂志,2002,23(6):543-545.
14.Terry TT, Bang HJ, Lysiak JJ. Experiment testicular torsion: reperfusion blood flow andsubsequent testicular venous plasma testosterone concentrations [J]. Urology, 2005 ,65(2): 390-394.
15 Somuncu S , Cakmak M , Erdogan S, et al. Protective effects of trapidil in ischemia– reperfusion injury due to testicular torsion and detorsion: an experimental study[J] .Int J Urol 2006, 13(5):601–605.
16 马良宏,丁强,王翔,等.精索扭转的超声诊断与早期手术探查[J].临床泌尿科杂志,2005,20(1):57-58.
17 Bartsch G, Frank S, Marberger H, et al. Testicular torsion late results with special regard to fertility and endocrine function [J].J Urol 1980,124: 375-378.
18 Bentley DF , Ricchiuti DJ , Nasraliah PF , et al. Spermatic cord torsion with preserved testis perfusion: initial anatomical observations[J]. J Urol, 2004, 172(6 Pt 1):2373-6.
19 Arda IS, Ozyaylali I. Testicular tissue bleeding as an indicator of gonadal salvageability in testicular torsion surgery [J]. BJU International 2001,87(1):89-92.
20 陈泽波,刘运初,李贤新,等.睾丸组织出血分级预测睾丸扭转患睾活力[J].罕少疾病杂志,2004,11(3):13-15.
21 李颖嘉,文戈,崔忠林,等.经静脉声学造影诊断睾丸扭转的价值[J].中国医学影像学杂志,2005,13(6) :422-424.
22 Yamaguchi A, Hayashi Y, Kojima Y, et al. Testicular torsion: usefulness of contrast-enhanced power Doppler sonography [J]. Int J Urol, 2005,12(9):849-851.
23 Giard MS , Mattrey RF , Baker KG, et al . Comparison of standard and second harmonic B - mode sonography in the detection of segmental renal infaction with sonographic contrast in a rabbit model [J].J Ultrasound Med, 2000,19(6): 185.
24.张家庭,李泉水,曹秋平,等.乳腺肿瘤超声造影时间~强度曲线的初步分析[J].中华医学超声杂志(电子版),2005,2(1):22-24.
25.Jie Li, Baowei Dong, Xiaoling Yu, et al. Grey-scale contrast enhancement in rabbit liver with SonoVue at different doses[J]. Ultrasound in Med. & Biol.,2005, 31 (2):185-190.
26.郭文彬,张楠,张蕾,等.经静脉超声造影量化评价肾动脉狭窄的实验研究[J]. 中华超声影像学杂志,2005,14(8):621-624.
2 Visser AJ,Heyns CF. Testicular function after torsion of the spermatic cord [J].BJU Internatinal,2003,92(2):200-203.
3 薛恩生,黄毅斌,林礼务,等.彩色多普勒超声在睾丸不全扭转治疗中的应用价值[J].中国超声医学杂志,2006,22(8):622-624.
4 李颖嘉,文戈,龚渭冰,等.彩色多普勒超声对睾丸扭转的诊断及意义[J].中国超声医学杂志,2004,20(1):55-57.
5 黄毅斌,薛恩生,林礼务,等.实验性睾丸不全扭转的彩色多普勒超声研究[J].中华超声影像学杂志,2005,14(7):546-549.
6 Kehinde EO, Anim JT, Mojiminiyi OA, et al. Significance of determining the point of reperfusion failure in experimental torsion of testis [J]. International Journal of Urology, 2005, 12(1): 81-89.
7 Kwon JW, Kim WS, Cheon JE, et al. Evaluation of testicular viability by power Doppler ultrasonography in experimentally induced acute testicular torsion [J].Investigative Radiology, 2005, 40(10): 682-687.
8 Bentley DF , Ricchiuti DJ , Nasraliah PF , et al. Spermatic cord torsion with preserved testis perfusion: initial anatomical observations [J]. J Urol, 2004, 172(6 Pt 1):2373-6.
9 Arda IS, Ozyaylali I. Testicular tissue bleeding as an indicator of gonadal salvageability in testicular torsion surgery [J]. BJU International 2001,87(1):89-92.
10 陈泽波,刘运初,李贤新,等.睾丸组织出血分级预测睾丸扭转患睾活力[J].罕少疾病杂志,2004,11(3):13-15 .
11 薛恩生,陈舜,林礼务,等。睾丸动脉舒张期反向血流的临床意义[J].中华超声影像学杂志,2007,16(2):52-54.
12 Johnsen SG. Testicular biopsy score count: a method for registration of spermatogenesis in human testes .Normal values and results of 335 hypogonadal males [J].Hormones,1970,1(1):2-25.
13 金惠铭,主编.病理生理学[M].第五版.北京:人民卫生出版社,2002:78-91.
14 姚启盛,叶章群,王晓康,等.大鼠一侧睾丸扭转对侧睾丸改变的实验研究[J].中华男科学,2003,9(8):586-588.
15 Rodriguez MG, Rival C, Theas MS, et al. Immunohistopathology of the contralateral testis of rats undergoing experimental torsion of the spermatic cord [J]. Asian J Androl, 2006,8 (5): 576–583.
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11 Rodriguez MG, Rival C, Theas MS, et al. Immunohistopathology of the contralateral testis of rats undergoing experimental torsion of the spermatic cord[J]. Asian J Androl, 2006,8 (5): 576–583.
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14.Terry TT, Bang HJ, Lysiak JJ. Experiment testicular torsion: reperfusion blood flow andsubsequent testicular venous plasma testosterone concentrations [J]. Urology, 2005 ,65(2): 390-394.
15 Somuncu S , Cakmak M , Erdogan S, et al. Protective effects of trapidil in ischemia– reperfusion injury due to testicular torsion and detorsion: an experimental study[J] .Int J Urol 2006, 13(5):601–605.
16 马良宏,丁强,王翔,等.精索扭转的超声诊断与早期手术探查[J].临床泌尿科杂志,2005,20(1):57-58.
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22 Yamaguchi A, Hayashi Y, Kojima Y, et al. Testicular torsion: usefulness of contrast-enhanced power Doppler sonography [J]. Int J Urol, 2005,12(9):849-851.
23 Giard MS , Mattrey RF , Baker KG, et al . Comparison of standard and second harmonic B - mode sonography in the detection of segmental renal infaction with sonographic contrast in a rabbit model [J].J Ultrasound Med, 2000,19(6): 185.
24.张家庭,李泉水,曹秋平,等.乳腺肿瘤超声造影时间~强度曲线的初步分析[J].中华医学超声杂志(电子版),2005,2(1):22-24.
25.Jie Li, Baowei Dong, Xiaoling Yu, et al. Grey-scale contrast enhancement in rabbit liver with SonoVue at different doses[J]. Ultrasound in Med. & Biol.,2005, 31 (2):185-190.
26.郭文彬,张楠,张蕾,等.经静脉超声造影量化评价肾动脉狭窄的实验研究[J]. 中华超声影像学杂志,2005,14(8):621-624.