超声“漩涡征”诊断卵巢囊肿蒂扭转

目的 探讨超声“漩涡征”诊断卵巢囊肿蒂扭转的可行性及临床意义.资料与方法 2006-07～2010-08共468例临床有急性和间歇性低位腹痛症状且超声发现有卵巢肿块的患者,其中24例怀疑卵巢囊肿蒂扭转且存在超声“漩涡征”,分析其二维超声特点,采用彩色多普勒超声观察蒂内血流并初步预测卵巢功能.结果 23例经手术证实为蒂扭转,1例为卵巢囊肿合并输卵管积液,超声“漩涡征”诊断卵巢囊肿蒂扭转的敏感性为100％,特异性为99.7％.23例患者扭转的蒂有3种超声表现:①13例呈“靶环样”表现;②6例呈“蜗牛壳样”表现;③4例表现为低回声圆形肿块.彩色多普勒超声发现10例患者扭转的血管蒂中无血流信号,4例患者血管蒂近端可见动脉血流频谱,术中发现此14例卵巢广泛坏死,行卵巢切除术.4例患者血管蒂远端可见动脉血流频谱,其中2例卵巢坏死,行卵巢切除术;2例卵巢复位后存活.5例患者蒂内既可见动脉频谱又可见静脉频谱,卵巢复位后都存活.结论 超声“漩涡征”诊断卵巢囊肿蒂扭转特异性高,结合多普勒超声检查可初步预测卵巢存活情况.

Sonographic Whirlpool Sign in Ovarian Torsion

Purpose To investigate the value of sonographic whirlpool sign in diagnosis of ovarian torsion.Materials and Methods From July 2006 to August 2010,468 patients with acute or intermittent lower abdominal pain undertook ultrasound and ovarian masses were detected.Whirlpool sign was revealed in 24 cases who were diagnosed as ovarian torsion by ultrasound before surgery.The twodimensional sonographic features were analysed retrospectively.Color Doppler ultrasound was used to evaluate blood flow inside the predict and to predict the ovarian function.Results 23 cases were confirmed with ovarian torsion by surgery,and 1 was ovarian cyst with sactosalpinx.The sensitivity was 100% and specificity was 99.7%.There were three kinds of sonographic appearance of twisted vascular pedicle:① target appearance in 13 patients;② snail shell appearance in 6 patients;③ hypoechoic mass in 4 patients.Color Doppler did not reveal blood flow in the twisted pedicle in 10 patients and in other 4 patients,blood flow was detected in the proximal part of the pedicle.During the surgery,necrosis of the ovary was removed and ovariectomy was done in all 14 patients.Another 4 patients had blood flow in the distal part of the artery,and the ovary,and the ovary was removed in 2 of the patients.The ovaries of other 5 patients were survival after resetting the ovary due to both artery and vein flow were seen in them.Conclusion Sonographic whirlpool sign in the twisted vascular pedicle of the ovary is a definitive sign of ovarian torsion.Blood flow in the twisted pedicle can predict pathophysiological status of the ovary.