Melcer Yaakov, Maymon Ron, Pekar-Zlotin Marina, Pansky Moty, Smorgick Noam
Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, affiliated with Tel-Aviv University, Sackler School of Medicine, Israel.
Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, affiliated with Tel-Aviv University, Sackler School of Medicine, Israel.
J Pediatr Surg. 2018 Jul;53(7):1396-1398. doi: 10.1016/j.jpedsurg.2017.07.011. Epub 2017 Jul 17.
To investigate the accuracy of torsion diagnosis in the pediatric and adolescent population.
This retrospective study included 87 patients <18years who presented with acute pelvic pain and were operated for suspected adnexal torsion from January 2009 to September 2016.
Adnexal torsion was found in 53 of 87 (60.9%) cases operated for suspected torsion. The rate of accurate torsion diagnosis was significantly higher among pre-menarchal (21/21, 100%) compared with post-menarchal girls (32/66, 48.5%) (p<0.001). Patients with torsion were more likely to report nausea or vomiting (73.6% compared with 32.3%, p<0.001) and had higher rates of peritoneal irritation signs on exam (15.1% compared with 0.0%, p=0.02). On the pre-operative ultrasound, patients with torsion were characterized by higher rates of enlarged ovary showing signs of edema (49.1% compared with 8.8%, p<0.001) and free pelvic fluid (45.3% compared with 17.6%, p<0.001). In post-menarchal girls without adnexal torsion, the leading diagnosis was hemorrhagic corpus luteum cyst (found in 18/33, 78.3%) cases.
Various clinical and ultrasound findings may point to the correct diagnosis of torsion in the pediatric and adolescent population. However, none of the clinical and ultrasound characteristics are sufficient to confirm or disprove the pre-operative diagnosis, and young patients with the clinical suspicion of adnexal torsion should undergo laparoscopy.
Level II.
Clinical retrospective study.
探讨儿童及青少年人群中卵巢扭转诊断的准确性。
这项回顾性研究纳入了2009年1月至2016年9月期间87例年龄小于18岁、因急性盆腔疼痛就诊且因疑似附件扭转接受手术的患者。
在87例因疑似扭转接受手术的患者中，53例（60.9%）被发现存在附件扭转。月经初潮前女孩（21/21，100%）的扭转诊断准确率显著高于月经初潮后女孩（32/66，48.5%）（p<0.001）。扭转患者更有可能报告恶心或呕吐（73.6% 对比32.3%，p<0.001），且检查时腹膜刺激征发生率更高（15.1% 对比0.0%，p=0.02）。术前超声检查显示，扭转患者卵巢增大伴水肿征象的发生率更高（49.1% 对比8.8%，p<0.001），盆腔游离液体的发生率也更高（45.3% 对比17.6%，p<0.001）。在月经初潮后无附件扭转的女孩中，主要诊断为黄体出血性囊肿（18/33，78.3%）。
多种临床及超声表现可能有助于儿童及青少年人群中扭转的正确诊断。然而，没有任何临床及超声特征足以证实或排除术前诊断，临床怀疑附件扭转的年轻患者应接受腹腔镜检查。证据级别：二级。研究类型：临床回顾性研究。
