Department of Obstetrics and Gynecology, affiliated to the Rappaport Faculty of Medicine, Technion-IIT, The Lady Davis Carmel Medical Center, Haifa, Israel.
Ultrasound Obstet Gynecol. 2009 Aug;34(2):208-11. doi: 10.1002/uog.6369.
To propose, in cases with coiling of the ovarian vessels, a classification of severity of torsion based on Doppler and gray-scale ultrasound findings and to suggest a treatment strategy for each situation.
Seventeen patients were examined in a gynecological emergency room between December 1995 and February 2003 due to suspected adnexal torsion. Doppler and gray-scale ultrasound were used to visualize coiling of the ovarian blood vessels. Intraovarian flow was assessed by spectral Doppler and on this basis, along with the patient's clinical condition, the decision was made as to whether surgery was necessary. Findings on surgery were recorded.
All 17 patients showed coiling of the ovarian vessels. Nine had arterial and venous blood flow within the ovary and ultrasound and surgical findings usually demonstrated normal sized or mildly enlarged ovaries. Five had only arterial blood flow within the ovary and surgery usually revealed enlarged ovaries with normal color or mild discoloration. Three had neither arterial nor venous blood flow within the ovary, with vessel coiling evident only on gray-scale and not on Doppler examination, and surgical findings included signs of ovarian ischemia or necrosis.
In cases of coiling of the ovarian vessels, Doppler flow analysis of the ovary can help differentiate between ischemic adnexal torsion and coiling of the ovarian blood vessels without strangulation, aiding in the choice of treatment. According to type of blood flow seen on Doppler examination, we suggest the following classification of severity of adnexal torsion and treatment strategy: Class 1, coiling with arterial and venous ovarian blood flow; a conservative approach may be considered if the clinical condition permits; Class 2, coiling with arterial ovarian flow but no venous flow; surgical intervention is required; and Class 3, true strangulation, with no ovarian blood flow; urgent surgical intervention is required.
提出一种基于多普勒和灰阶超声表现的卵巢血管扭转严重程度分类方法，并针对不同情况提出治疗策略。
1995 年 12 月至 2003 年 2 月，17 例因怀疑附件扭转而在妇科急诊室就诊的患者接受了检查。多普勒和灰阶超声用于显示卵巢血管的卷曲。通过频谱多普勒评估卵巢内的血流，并根据患者的临床情况决定是否需要手术。记录手术结果。
17 例患者均显示卵巢血管卷曲。9 例患者卵巢内有动脉和静脉血流，超声和手术结果通常显示卵巢大小正常或轻度增大。5 例患者卵巢内仅有动脉血流，手术结果通常显示卵巢增大，颜色正常或轻度变色。3 例患者卵巢内既无动脉也无静脉血流，仅在灰阶上显示血管卷曲，而在多普勒检查上无显示，手术结果包括卵巢缺血或坏死的迹象。
在卵巢血管卷曲的情况下，卵巢的多普勒血流分析有助于区分缺血性附件扭转和无绞窄的卵巢血管卷曲，有助于选择治疗方法。根据多普勒检查所见的血流类型，我们建议采用以下附件扭转严重程度分类和治疗策略：1 类，卵巢动脉和静脉血流卷曲；如果临床情况允许，可以考虑保守治疗；2 类，卵巢动脉血流卷曲但无静脉血流；需要手术干预；3 类，真正的绞窄，无卵巢血流；需要紧急手术干预。
