Dane Banu, Dane Cem, Kiray Murat, Cetin Ahmet
Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, Istanbul, Turkey.
Arch Gynecol Obstet. 2009 Jun;279(6):841-4. doi: 10.1007/s00404-008-0835-9. Epub 2008 Nov 19.
The aim of this study was to correlate the preoperative sonographic findings and operation type in cases with surgically proven adnexal torsion in our clinic.
This retrospective study included 34 postmenarchal patients with adnexal torsion who were examined with ultrasound and then operated between November 2003 and October 2007. Surgical procedures performed were divided into two groups: (1) detorsion followed by aspiration or detorsion combined with resection of the adnexal cyst, (2) resection of the whole adnexa. Patients with additional adnexal pathologies as a cause of adnexal torsion were excluded from the study.
Twenty-four out of 34 patients (71%) were treated with ovarian conservation and 10 (29%) with resection of the adnexa. Echogenic features of lesions identified in both patient subgroups were similar in appearance. The lowest resection rate was in the group with multicystic appearance (14%), and the highest in solid-cystic group (44.4%). The average mass size was not significantly different between resection (69.3 vs 86.1 mm) and conservation groups. The risk of adnexal resection was higher in cases with an adnexal mass larger than 60 mm (sensitivity 90%, specificity 54.1%) (P = 0.031). The blood flow was present in six of the 21 cases (28.5%). The number of cases who were treated with adnexal resection were significantly more in the group with absent blood flow (P = 0.045).
Determination of preoperative sonographic appearance of the mass may be valuable, but it is not specific in the prediction of the operation type of the cases with adnexal torsion. The measurement of the diameter and assessment of blood flow in the adnexal mass might be helpful in detection of the cases who have high risk of adnexal resection.
本研究旨在关联我院经手术证实为附件扭转病例的术前超声检查结果与手术类型。
这项回顾性研究纳入了34例初潮后附件扭转患者，这些患者于2003年11月至2007年10月期间接受了超声检查并随后接受手术。所实施的手术程序分为两组：（1）扭转复位后抽吸或扭转复位联合附件囊肿切除术，（2）整个附件切除术。因其他附件病变导致附件扭转的患者被排除在本研究之外。
34例患者中有24例（71%）接受了卵巢保留治疗，10例（29%）接受了附件切除术。两个患者亚组中所识别病变的回声特征在外观上相似。多囊外观组的切除率最低（14%），实性 - 囊性组最高（44.4%）。切除组（69.3对86.1毫米）与保留组之间的平均肿块大小无显著差异。附件肿块大于60毫米的病例行附件切除术的风险更高（敏感性90%，特异性54.1%）（P = 0.031）。21例病例中有6例（28.5%）存在血流信号。血流信号缺失组中行附件切除术的病例数显著更多（P = 0.045）。
确定肿块术前超声表现可能有价值，但在预测附件扭转病例的手术类型方面并不具有特异性。附件肿块直径的测量和血流评估可能有助于检测有附件切除高风险的病例。
