Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan.
Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan.
J Pediatr Adolesc Gynecol. 2023 Aug;36(4):349-352. doi: 10.1016/j.jpag.2023.03.005. Epub 2023 Mar 21.
To identify preoperative transabdominal sonographic predictors of surgically confirmed ovarian torsion (OT) in premenarchal girls METHODS: We conducted a retrospective case-control study of 32 premenarchal girls aged 0-12 undergoing surgery for OT (cases) or a non-torsed ovarian mass (controls) from 2006 to 2017 at a single academic center. Cases had ICD-9/10 codes for torsion of the ovary, adnexa, ovarian pedicle, or fallopian tube and surgically confirmed OT; controls had codes for ovarian mass or cyst and surgically confirmed absence of OT. Preoperative transabdominal ultrasounds were analyzed by 3 radiologists blinded to final diagnosis. We used χ, Fisher[s exact, and Student's t tests for statistical comparisons.
From 2016 to 2017, 32 patients presented with acute abdominal pain or symptoms concerning for ovarian mass requiring ultrasound imaging and subsequent diagnostic laparoscopy; 24 (75.0%) had confirmed OT by laparoscopy, and 8 (25.0%) did not. The mean age in both groups was similar (7.3 ± 2.9 years). Preoperative sonographic variables significantly associated with OT included presence of a simple cyst (20.8% vs 12.5%), ovarian heterogeneity (100% vs 12.5%), presence of peripheralized follicles (70.8% vs 0%), and asymmetry of color Doppler (75.0% vs 37.5%; all P < .05). Presence of free fluid, arterial color Doppler, and a whirlpool sign were not predictive of OT.
In premenarchal patients, although certain variables on transabdominal sonography predicted surgically confirmed OT, only the presence of peripheralized follicles was unique to girls with OT. The decision to proceed with diagnostic laparoscopy for suspected OT can be aided by these specific sonographic findings but should ultimately be based on high clinical suspicion.
确定经腹超声术前预测青春期前女孩卵巢扭转（OT）的指标。
我们对 2006 年至 2017 年在一家学术中心因 OT 而行手术（病例组）或因非扭转卵巢肿块而行手术（对照组）的 32 名青春期前女孩进行回顾性病例对照研究。病例组的 ICD-9/10 编码为卵巢、附件、卵巢蒂或输卵管扭转，且手术证实 OT；对照组的编码为卵巢肿块或囊肿，且手术证实 OT 不存在。术前经腹超声由 3 位对最终诊断不知情的放射科医生进行分析。我们使用 χ2、Fisher's 确切检验和学生 t 检验进行统计学比较。
从 2016 年至 2017 年，32 名患者因急性腹痛或怀疑卵巢肿块而出现症状，需要进行超声成像检查和随后的诊断性腹腔镜检查；24 名（75.0%）经腹腔镜证实存在 OT，8 名（25.0%）不存在 OT。两组的平均年龄相似（7.3 ± 2.9 岁）。与 OT 相关的术前超声变量包括存在单纯囊肿（20.8%比 12.5%）、卵巢异质性（100%比 12.5%）、周围化卵泡（70.8%比 0%）和彩色多普勒不对称（75.0%比 37.5%；均 P <.05）。存在游离液体、动脉彩色多普勒和漩涡征不能预测 OT。
在青春期前患者中，尽管经腹超声的某些变量预测了手术证实的 OT，但只有外周化卵泡的存在是 OT 女孩特有的。对于疑似 OT 的患者，是否进行诊断性腹腔镜检查可以根据这些特定的超声发现来辅助决策，但最终应基于高度的临床怀疑。
