探讨卵巢过度刺激（OHSS）患者发生附件扭转的超声诊断要点。

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。

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。

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。

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

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.

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.

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.