多模态超声在男性尿道狭窄诊断中的应用
Application of Multimodal Ultrasound in the Diagnosis of Male Urethral Stricture
摘要: 男性尿道狭窄精准术前评估对术式选择至关重要，传统X线造影无法显示海绵体纤维化等软组织信息。多模态超声无辐射、实时动态且软组织分辨率较高，可作为补充甚至替代手段。本文系统阐述超声尿道造影(SUG)、经尿道对比增强超声(CEUS)、超声弹性成像及三维超声的应用进展。现有证据提示：SUG可较准确评估前尿道狭窄长度及纤维化范围，决策价值可能优于X线造影；CEUS通过微泡造影剂提升管腔边界显示，狭窄长度与术中实测高度相关；剪切波弹性成像可定量海绵体硬度；初步证据表明AI辅助三维超声可将重建时间缩短至分钟级，提供立体解剖信息。多模态超声在后尿道显示、检查流程标准化及高级别证据方面仍面临瓶颈。本文提出分层递进临床决策路径及未来研究方向。
Abstract: Precise preoperative assessment of male urethral strictures is essential for surgical decision-making, yet conventional X-ray urethrography fails to reveal soft-tissue details such as spongiofibrosis. Multimodal ultrasound, being radiation-free, real-time, and offering high soft-tissue resolution, may serve as a complementary or alternative tool. This review summarizes advances in sonourethrography (SUG), transurethral contrast-enhanced ultrasound (CEUS), ultrasound elastography, and three-dimensional (3D) ultrasound. Evidence indicates that SUG can reliably measure anterior stricture length and fibrosis extent, potentially outperforming X-ray urethrography in guiding treatment. CEUS improves luminal border visualization via microbubble contrast agents, with stricture length correlating closely with intraoperative findings. Shear-wave elastography quantifies spongiosal stiffness, and preliminary data suggest that AI-assisted 3D ultrasound can reduce reconstruction time to minutes while providing stereotactic anatomical detail. Nevertheless, multimodal ultrasound still faces limitations in posterior urethral visualization, procedural standardization, and high-level evidence. The article proposes a stepwise clinical decision-making pathway and outlines future research directions.
文章引用：张容萍, 薛宇红, 刘莉. 多模态超声在男性尿道狭窄诊断中的应用[J]. 临床医学进展, 2026, 16(7): 308-318. https://doi.org/10.12677/acm.2026.1672528

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