婴幼儿陈旧性卵巢囊肿蒂扭转的超声表现及诊断价值

doi:10.3877/cma.j.issn.1672-6448.2025.08.009

目的

探讨婴幼儿陈旧性卵巢囊肿蒂扭转的超声表现及诊断价值。

方法

回顾性选取浙江大学医学院附属儿童医院2021年1月至2024年7月收治的1岁以内确诊为婴幼儿卵巢囊肿的病例60例。分析其超声图像特征及病理表现，计算超声特征诊断陈旧性卵巢囊肿蒂扭转的敏感度、特异度、阳性预测值、阴性预测值、准确性，以评估超声特征的诊断效能。

结果

60例婴幼儿卵巢囊肿中34例为陈旧性卵巢囊肿蒂扭转。其主要超声图像特征为钙化（诊断敏感度、特异度、阳性预测值、阴性预测值分别为67.6%、80.8%、82.1%、65.6%），囊内分层（诊断敏感度、特异度、阳性预测值、阴性预测值分别为67.6%、73.1%、76.7%、63.3%），漩涡征样蒂结构（诊断敏感度、特异度、阳性预测值、阴性预测值分别为47.1%、100%、100%、59.1%）。3种特征同时具备的诊断敏感度为26.5%，特异度为100%，阳性预测值为100%，阴性预测值为51.0%。超声诊断陈旧性卵巢囊肿蒂扭转的准确性为88.2%（30/34）。

结论

婴幼儿陈旧性卵巢囊肿蒂扭转具有特征性的超声表现，钙化、囊内分层以及漩涡征样蒂结构的特征具有良好的诊断价值。

关键词: 卵巢囊肿蒂扭转, 超声检查, 婴幼儿

Objective

To explore the ultrasound imaging features of torsion of the pedicle of old ovarian cysts in infants and young children.

Methods

A retrospective study was conducted on 60 infants or young children under the age of 1 year who were diagnosed with ovarian cysts and admitted to the Children's Hospital Affiliated to Zhejiang University School of Medicine from January 2021 to July 2024. The ultrasound features and pathological manifestations were analyzed, and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ultrasound features for diagnosing torsion of the pedicle of old ovarian cysts were calculated to evaluate their diagnostic efficacy.

Results

Out of 60 cases of ovarian cysts in infants and young children, 34 cases were old ovarian cyst torsion. The main ultrasound features and their diagnostic efficacy were: calcification (sensitivity: 67.6%; specificity: 80.8%; positive predictive value: 82.1%; negative predictive value: 65.6%); intracystic layering (sensitivity: 67.6%; specificity: 73.1%; positive predictive value: 76.7%; negative predictive value: 63.3%); and vortex sign-like pedicle structure (sensitivity: 47.1%; specificity: 100%; positive predictive value: 100%; negative predictive value: 59.1%). The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were 26.5%, 100%, 100%, and 51.0%, respectively, when the three characteristics were present simultaneously. The accuracy of ultrasound diagnosis of torsion of old ovarian cyst pedicle was 88.2% (30/34).

Conclusion

The torsion of the pedicle of old ovarian cysts in infants and young children has characteristic ultrasound manifestations, including calcification, intracystic layering, and vortex sign-like pedicle structures, which have good diagnostic value.

Key words: Torsion of ovarian cyst pedicle, Ultrasonography, Infants

图1 婴幼儿陈旧性卵巢囊肿蒂扭转超声图像表现为钙化。图a为女性婴幼儿出生1个月，超声可见右侧腹囊性包块，内见液体分层征，囊壁可见散在环状钙化点（箭头所示），超声诊断右侧卵巢及囊肿陈旧性扭转坏死；图b为女性新生儿出生5 d，超声可见左侧腹囊实性包块，内见液体分层征，囊壁可见多发钙化斑（箭头所示），超声诊断左侧卵巢及囊肿陈旧性扭转坏死

图2 婴幼儿陈旧性卵巢囊肿蒂扭转病理图片中钙化表现。图a为女性婴幼儿出生1个月，超声诊断左侧卵巢囊肿陈旧性蒂扭转，病理提示广泛坏死组织伴钙化改变，箭头所示可见蓝色团块状沉积（HE ×40）；图b为女性新生儿出生14 d，超声诊断盆腔囊性肿块，卵巢来源首先考虑，病理提示卵巢囊肿蒂扭转伴坏死钙化，箭头所示可见深蓝色团块状沉积（HE ×40）

图3 婴幼儿陈旧性卵巢囊肿囊内分层超声图像。图a为女性婴幼儿，出生1个月，超声可见左下腹囊性包块，内见液体分层征，超声诊断左侧卵巢囊肿伴扭转；图b为女性婴幼儿，出生2个月，超声可见盆腔左侧囊实性包块，内见回缩样团块回声，囊壁可见斑片状钙化，超声诊断左侧卵巢来源囊肿及左侧卵巢陈旧性扭转坏死

图4 婴幼儿陈旧性卵巢囊肿病理图片中出血表现。图a为女性新生儿，出生1 d，超声诊断右侧卵巢来源占位伴出血可能，病理提示右侧卵巢黄素化囊肿伴广泛出血坏死，箭头所示可见红细胞聚集（HE ×100）；图b为女性婴幼儿，出生2个月，超声诊断左侧卵巢囊肿伴扭转，病理提示左侧卵巢囊肿伴广泛出血水肿坏死及钙化，箭头所示可见红细胞聚集（HE ×40）

图5 婴幼儿陈旧性卵巢囊肿漩涡征样蒂结构超声图像。图a为女性新生儿，出生1 d，超声可见左中腹囊性包块，包块左下缘见螺旋样同心圆结构（箭头所示），扭转约360°，超声诊断左中腹囊性包块，左侧卵巢来源可能性大合并扭转考虑；图b为女性新生儿，出生8 d，超声可见右下腹囊性包块，内见液体分层征，包块后下缘低回声团，呈蒂样结构（箭头所示），超声诊断右侧卵巢来源囊肿及右侧卵巢陈旧性扭转坏死可能性大

图6 婴幼儿陈旧性卵巢囊肿缺血性坏死病理图像。图a为女性婴幼儿，出生4个月，超声诊断右侧卵巢囊肿陈旧性扭转坏死，病理提示卵巢囊肿蒂扭转伴坏死，红色星号处可见细胞核碎裂消失（HE ×40）；图b为女性婴幼儿，出生1个月，超声诊断右侧卵巢来源囊肿及卵巢陈旧性扭转坏死，病理提示卵巢囊肿蒂扭转伴坏死，红色星号处可见细胞核碎裂消失（HE ×40）

图7 陈旧性卵巢囊肿蒂扭转超声误诊病例超声及病理表现。图a为女性婴幼儿，出生12个月，超声可见盆腔内不均质团块回声，内见斑片状强回声伴声影，超声诊断左侧卵巢来源畸胎瘤；图b为女性婴幼儿，出生1个月，超声可见右侧附件区囊性包块，内见液体分层征，超声诊断右附件畸胎瘤；图c为女性新生儿，出生4 d，超声可见盆腔内囊实性包块，内见液体分层征，超声诊断盆腔囊实性包块，畸胎瘤待排；图d为女性新生儿，出生3 d，超声可见右侧腹囊性包块，内透声差，见分隔，超声诊断右侧腹囊性包块，肠重复畸形可能；图e（与图a为同一病例）病理提示左侧卵巢组织广泛坏死伴钙化改变，可见少许深蓝色团块状沉积和细胞核的碎裂消失（HE ×40）；图f（与图b为同一病例）病理提示卵巢单纯性囊肿伴坏死钙化，可见散在细胞核的碎裂消失（HE ×100）；图g（与图c为同一病例）病理提示卵巢囊肿蒂扭转伴坏死，可见深蓝色团块状沉积和红细胞在血管外聚集（HE ×200）；图h（与图d为同一病例）病理提示卵巢囊肿蒂扭转伴出血坏死钙化，可见红细胞散在分布（HE ×200）

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Ultrasonic manifestations and diagnostic value of torsion of the pedicle of old ovarian cysts in infants and young children

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Ultrasonic manifestations and diagnostic value of torsion of the pedicle of old ovarian cysts in infants and young children