超声包裹征预测附件囊性包块蒂扭转的价值

目的探讨超声"包裹征"预测附件囊性包块蒂扭转的应用价值。方法回顾性分析193例因急性下腹痛就诊且超声检查存在附件囊性包块女性患者的超声图像,以手术结果为金标准确定附件扭转组131例,非扭转组62例,比较两组间超声包裹征的出现率,计算包裹征预测附件囊性包块蒂扭转的诊断效能。结果 (1)包裹征对应病理表现为扭转后输卵管及囊壁组织的广泛梗死水肿,半包绕扭转蒂部远端的囊肿;(2)扭转组131例中,出现包裹征共36例(27.5%),非扭转组中62例中出现1例(1.6%)包裹征,两组间差异具有统计学意义(P<0.001)。包裹征诊断附件囊性包块蒂扭转灵敏度、特异度和准确度分别为27.5%、98.4%、50.3%。当囊性包块最大长径<75.5mm时,包裹征诊断附件囊肿蒂扭转灵敏度、特异度和准确度分别为51.9%、97.6%、71.6%。结论超声包裹征预测附件囊性包块蒂扭转中具有高特异度。对于因下腹痛来诊女性患者,当合并包裹征时,应敢于提出疑似扭转的诊断。

The Value of Grey-scale Ultrasound encapsulating cyst Sign in Predicting of Adnexal Torsion with Cystic Mass

Objective The sonographic encapsulating cyst sign was described as the echoic or slightly hyperechoic area encapsulting the cystic mass in adnexa.We aimed to investigate the value of grey-scale ultrasound encapsulating cyst sign in predicting of adnexal torsion with cystic mass.Methods The retrospective study included patients with acute lower abdominal pain and adnexal cystic mass simultaneously examed by ultrasound,and those who underwent emergency laparoscopy which was considered as the gold standard.193 patients consisted of the following:Torsion group(n=131)and No torsion group(n=62).The images of each patient were analyzed.The incidence rate of encapsulating cyst sign was compared among two groups.The sensitivity,specificity and accuracy of encapsulating cyst sign were calculated in diagnosing of adnexal torsion with cystic mass.Results (1)The pathological manifestation of encapsulating cyst sign showed widely edema of fallopian tube and cystic wall tissue after torsion.(2)The incidence rate of encapsulating cyst sign was significantly higher among Torsion group(36/131,27.5%)compared with No torsion group(1/62,1.6%)(P<0.001).The encapsulating cyst sign in diagnosing of adnexal torsion with cystic mass showed a sensitivity of 27.5%,a specificity of 98.4% and an accuracy of 50.3%,respectively.When the maximum diameter of the cystic mass was<75.5 mm,the encapsulating cyst sign in diagnosing of adnexal torsion with cystic mass showed a sensitivity of 51.9%,a specificity of 97.6% and an accuracy of 71.6%,respectively.Conclusions Ultrasound grey-scale encapsulating cyst sign has high specificity in predicting of adnexal torsion with cystic mass.When encapsulating cyst sign was observed in female patient with lower abdominal pain,adnexal torsion should be suspected.