谢忱忱,董虹美,唐静,罗田田.妊娠合并附件扭转:临床及超声表现[J].中国医学影像技术,2024,40(4):566~569
妊娠合并附件扭转:临床及超声表现
Pregnancy complicated with adnexal torsion: Clinical and ultrasonic manifestations
投稿时间:2023-08-04  修订日期:2023-10-24
DOI:10.13929/j.issn.1003-3289.2024.04.018
中文关键词:  妊娠  附件扭转  超声检查
英文关键词:pregnancy  accessory torsion  ultrasonography
基金项目:重庆市科卫联合医学科研项目(2021MSXM280)。
作者单位E-mail
谢忱忱 重庆市妇幼保健院 重庆医科大学附属妇女儿童医院超声科, 重庆 401147  
董虹美 重庆市妇幼保健院 重庆医科大学附属妇女儿童医院超声科, 重庆 401147  
唐静 重庆市妇幼保健院 重庆医科大学附属妇女儿童医院超声科, 重庆 401147  
罗田田 重庆市妇幼保健院 重庆医科大学附属妇女儿童医院超声科, 重庆 401147 ltt383508209@sina.com 
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中文摘要:
      目的 观察妊娠合并附件扭转(AT)的临床及超声表现。方法 回顾性分析20例经超声诊断并经手术证实AT孕妇的临床资料及声像图特征,并记录其随访结局。结果 20例中,8例左侧AT、12例右侧AT,均表现为腹痛伴患侧下腹部压痛,5例伴恶心呕吐、2例伴恶心无呕吐。超声于18例见卵巢肿物、2例卵巢均匀性增大,15例患侧卵巢内见点条状血流信号;15例附件区探及扭转的蒂样结构,即"漩涡征";1例卵巢周围皮质内见放射状排列的窦卵泡,即"滤泡环征";3例见卵巢间质水肿;16例伴腹盆腔积液。11例接受经腹腔镜手术,9例接受开腹探查术(5例联合剖宫产术);术中见AT扭转90°~1 800°。对18例卵巢肿物中的9例行附件切除术、7例行囊肿剥离术,2例仅予复位卵巢及输卵管。15例接受随访,9例妊娠至足月后7例顺产、2例接受剖宫产,6例继续妊娠未见明显异常。结论 妊娠合并AT以腹痛为主要临床表现,可伴恶心呕吐;超声常见卵巢肿物较大或卵巢增大和特征性的卵巢旁扭转蒂样结构。
英文摘要:
      Objective To observe the clinical and ultrasonic characteristics of pregnancy complicated with adnexal torsion (AT). Methods Clinical and ultrasonic data of 20 pregnant women with AT diagnosed by ultrasound and confirmed by surgery were retrospectively reviewed, and the outcomes were followed. Results Among 20 patients, left side and right side AT occurred in 8 and 12 cases, respectively, all with abdominal pain accompanied by lower abdominal tenderness on the affected side, 5 cases with nausea and vomiting, 2 cases with nausea without vomiting. Ultrasound detected ovarian mass in 18 cases and uniform ovarian enlargement in 2 cases. Punctate blood flow signals in the affected ovary were observed in 15 cases, and pedicle like structures with detectable torsion in the accessory area present as "vortex sign" were noticed in 15 cases. Radial arrangement of sinus follicles in the cortex around the ovary, known as "follicular ring sign" was found in 1 case, ovarian stromal edema was observed in 3 cases, while abdominal and pelvic fluid accumulation were detected in 16 cases. Laparoscopic and open exploratory surgeries were performed in 11 and 9 cases (combined cesarean section in 5 cases), respectively, and 90° to 1 800° torsions were found during operations. Among 18 cases with ovarian masses appendectomy or cyst dissection was performed in 9 and 7 cases, respectively, while ovarian and fallopian tube derotation was performed in 2 cases. Fifteen cases underwent follow-up, pregnancy continued to term in 9 cases, and then 7 cases underwent spontaneous delivery and 2 cases underwent cesarean sections, while 6 cases continuing pregnancy without significant abnormalities. Conclusion Pregnancy complicated with AT mainly characterized by abdominal pain accompanied by nausea and vomiting. Ultrasound often displayed large ovarian mass or ovarian enlargement and the characterized twisted pedicle like structures adjacent to the ovaries.
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