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中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (05) : 416 -421. doi: 10.3877/cma.j.issn.1672-6448.2022.05.005

妇产科超声影像学

卵巢过度刺激伴附件扭转的超声表现及结局分析
涂鹏1, 董虹美1, 唐静1, 钟春燕1, 冉素真1,()   
  1. 1. 401147 重庆市妇幼保健院超声科
  • 收稿日期:2020-06-19 出版日期:2022-05-01
  • 通信作者: 冉素真
  • 基金资助:
    重庆市技术创新与应用发展专项(cstc2019jscx-msxmX0235)

Ultrasonographic findings and outcomes of ovarian hyperstimulation syndrome with adnexal torsion

Peng Tu1, Hongmei Dong1, Jing Tang1, Chunyan Zhong1, Suzhen. Ran1,()   

  1. 1. Department of Ultrasound, Chongqing Maternal and Child Health Hospital, Chongqing 401147, China
  • Received:2020-06-19 Published:2022-05-01
  • Corresponding author: Suzhen. Ran
引用本文:

涂鹏, 董虹美, 唐静, 钟春燕, 冉素真. 卵巢过度刺激伴附件扭转的超声表现及结局分析[J/OL]. 中华医学超声杂志(电子版), 2022, 19(05): 416-421.

Peng Tu, Hongmei Dong, Jing Tang, Chunyan Zhong, Suzhen. Ran. Ultrasonographic findings and outcomes of ovarian hyperstimulation syndrome with adnexal torsion[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(05): 416-421.

目的

探讨卵巢过度刺激(OHSS)患者发生附件扭转的超声诊断要点。

方法

回顾性分析2016年1月至2020年4月重庆市妇幼保健院15例超声诊断为OHSS伴附件扭转患者的临床资料及超声图像特征,并随访患者后期结局,分析病例误诊原因。采用两样本配对Wilcoxon检验比较卵巢患侧和对侧的差异。

结果

15例患者中,12例手术治疗(1例误诊),3例保守观察。手术治疗者中11例确诊为附件扭转,扭转角度为180°~1080°,均为单侧发病,右侧7例(63.6%),左侧4例(36.4%);2例(18.2%)为单纯卵巢扭转,9例(81.8%)为输卵管、韧带合并卵巢扭转。3例保守观察者后期症状好转至消失。1例误诊病例为宫内合并宫外复合妊娠。附件扭转手术确诊患者超声表现主要为患侧卵巢较对侧卵巢明显增大[8.5(7.5,10.3)cm vs 5.8(4.3,7.3)cm],差异具有统计学意义(Z=-2.58,P=0.010)。扭转蒂部结构呈“漩涡征”,血流信号较对侧减少或者消失,存在盆腔积液;扭转蒂部结构的“漩涡征”可作为OHSS患者发生附件扭转的直接且特异性征象。

结论

超声特征性图像可帮助OHSS伴附件扭转的诊断,同时对卵巢活性进行初步判定;扫查过程中应结合临床病史及超声特征,避免误诊,为患者争取临床处理时间。

Objective

To explore the key points of ultrasound diagnosis of adnexal torsion (AT) in patients with ovarian hyperstimulation (OHSS).

Methods

A retrospective analysis was carried out on the clinical medical records and ultrasonic features of 15 patients diagnosed with OHSS with AT at Chongqing Maternal and Child Health Hospital from January 2016 to April 2020. Their outcomes were followed, and the causes of misdiagnosis were analyzed. The difference between the affected ovary and contralateral ovary was compared by two-sample paired Wilcoxon test.

Results

Among the 15 patients included, 12 were treated by surgery (1 case was misdiagnosed), and 3 underwent follow-up observation. Eleven of the patients treated by surgery were diagnosed with AT, with torsion angle ranging from 180° to 1080°. All of them had unilateral onset, including 7 cases (63.6%) on the right side and 4 (36.4%) on the left side. There were 2 cases (18.2%) with ovarian torsion alone, and 9 cases (81.8%) with fallopian tube, ligament, and ovarian torsion. The symptoms of 3 patients improved or disappeared after clinical follow-up observation. One case was misdiagnosed as intrauterine complicated with extrauterine pregnancy. In the patients diagnosed with AT, ultrasonography showed significant enlargement of the ovary on the affected side [8.5 (7.5, 10.3) cm vs 5.8 (4.3, 7.3) cm], the difference was statistically significant (Z=-2.58, P=0.010 ). The torsion pedicle structure showed the "vortex sign", decreased or disappeared blood flow signals, and pelvic effusion compared with the opposite side. The "vortex sign" of the torsion pedicle structure can be a direct and specific sign of AT in OHSS patients.

Conclusion

Ultrasound can be used to diagnose OHSS with AT and preliminarily judge the ovarian activity. During scanning, clinical history and ultrasonic characteristics should be combined to avoid misdiagnosis, so as to give timely clinical treatment for patients.

图1 患者取卵术后19 h、腹痛3 h,双侧卵巢及蒂扭转超声图像特征。图a为患者双侧卵巢彩色多普勒图像:双侧卵巢均增大,卵巢实质内呈取卵术后多个囊泡样结构改变;彩色多普勒可见患侧(右侧图像)卵巢血流信号较对侧减少。图b为三维超声(OmniView模式)蒂扭转长轴图像(白色箭头所示);图c为二维超声显示蒂扭转横切面“漩涡征”图像(测量键所示)
表1 患侧卵巢及对侧卵巢大小对比[cm,MQR)]
图2 不同附件扭转角度患者蒂扭转二维超声图像(测量键及箭头所示)。图a患者蒂扭转180°,显示附件区增粗的管状结构,内可见多个“小囊泡样回声”;图b患者蒂扭转360°,显示附件区包块样结构,内呈“同心圆”状;图c患者蒂扭转720°,呈“漩涡征”图像;图d患者蒂扭转900°,显示附件区包块样结构内呈“同心圆”状及部分内可见小囊泡样结构
图3 卵巢过度刺激综合征蒂扭转患者术中及病理图像。图a术中见患侧卵巢增大,患侧输卵管、卵巢外观均呈蓝紫色,扭转720°(箭头所示);图b为卵巢间质水肿、出血病理图(HE×100);图c为输卵管间质水肿、出血病理切片图(HE×100)
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