小儿患者单纯性输卵管扭转的相关因素
Factors Associated With Isolated Fallopian Tube Torsion in Pediatric Patients.
作者信息
Schwartz Beth, Weerasooriya Nimali, Mercier Rebecca, Gould Sharon, Saul David, Berman Loren
机构信息
Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA; Division of Adolescent Medicine and Pediatric Gynecology, Nemours Children's Health, Wilmington, DE, USA.
Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA.
出版信息
J Pediatr Surg. 2024 Aug;59(8):1538-1544. doi: 10.1016/j.jpedsurg.2024.03.054. Epub 2024 Mar 29.
BACKGROUND
Isolated fallopian tube torsion (IFTT) is a rare form of adnexal torsion that is more difficult to diagnose, which may lead to delays in treatment. Our objectives were to identify clinical and radiologic factors associated with surgically-confirmed IFTT and compare them with those of patients without torsion and with adnexal torsion (AT) in a large pediatric population.
METHODS
We conducted a retrospective chart review of all patients who underwent surgery for suspected adnexal torsion from 2016 to 2019. Torsion was determined intraoperatively, with IFFT defined as those with only tubal but no ovarian torsion and AT defined as those with ovarian torsion, with or without involvement of the ipsilateral fallopian tube. Clinical and radiologic variables were compared between patients with IFTT and those without torsion and with AT using descriptive statistics. A previously-described composite score to predict torsion based on the presence of vomiting and adnexal volume (VVCS) was calculated for each patient.
RESULTS
Of 291 patients who underwent surgery for suspected torsion, 168 had confirmed torsion: 33 (19.6%) IFTT and 135 (80.4%) AT. Patients with IFTT were more likely to be younger (12.8 vs. 14.2 years, P = 0.02), premenarchal (29.0% vs. 10.7%, P = 0.009), experience nausea (90.6% vs. 70.9%, P = 0.02) and vomiting (81.3% vs. 32.8%, P < 0.001), have a paratubal cyst on imaging (18.8% vs. 2.5%, P = 0.003), and have larger adnexal volume (143.3 vs. 64.9 ml, P < 0.001) than those without torsion. Higher BMI (26.6 vs. 22.9 kg/m2, P = 0.03), a paratubal cyst on imaging (18.8% vs. 1.5%, P < 0.001), presence of arterial (65.5% vs. 44.1%, P = 0.04) and venous Doppler flow (79.3% vs. 55.9%, P = 0.02), and radiologic impression indicating lack of torsion (37.9% vs. 16.8%, P = 0.04) were more common in IFTT than AT. The accuracy of the VVCS in predicting torsion for the IFFT group was 83.9%.
CONCLUSIONS
IFTT has a similar clinical presentation to AT but with a higher likelihood of a paratubal cyst and preserved Doppler flow on imaging. IFTT should be strongly considered in patients who present with pain, nausea, and vomiting and have an adnexal mass separate from the ovary on imaging, regardless of Doppler flow.
LEVEL OF EVIDENCE
Level II.
TYPE OF STUDY
Prognosis study.
背景
孤立性输卵管扭转（IFTT）是附件扭转的一种罕见形式，更难诊断，可能导致治疗延误。我们的目的是确定与手术确诊的IFTT相关的临床和影像学因素，并将其与大量儿科患者中无扭转及附件扭转（AT）患者的因素进行比较。
方法
我们对2016年至2019年因疑似附件扭转接受手术的所有患者进行了回顾性病历审查。术中确定扭转情况，IFTT定义为仅输卵管扭转而无卵巢扭转的患者，AT定义为有卵巢扭转的患者，无论同侧输卵管是否受累。使用描述性统计方法比较IFTT患者与无扭转及AT患者的临床和影像学变量。为每位患者计算先前描述的基于呕吐和附件体积的预测扭转的综合评分（VVCS）。
结果
在291例因疑似扭转接受手术的患者中，168例确诊为扭转：33例（19.6%）为IFTT，135例（80.4%）为AT。IFTT患者更可能年龄较小（12.8岁对14.2岁，P = 0.02）、月经初潮前（29.0%对10.7%，P = 0.009）、经历恶心（90.6%对70.9%，P = 0.02）和呕吐（81.3%对32.8%，P < 0.001），影像学检查发现输卵管旁囊肿（18.8%对2.5%，P = 0.003），且附件体积较大（143.3对64.9 ml，P < 0.001）。与无扭转患者相比，IFTT患者的BMI更高（26.6对22.9 kg/m²，P = 0.03），影像学检查发现输卵管旁囊肿（18.8%对1.5%，P < 0.001），存在动脉（65.5%对44.1%，P = 0.04）和静脉多普勒血流（79.3%对55.9%，P = 0.02），且影像学印象显示无扭转（37.9%对16.8%，P = 0.04）更为常见。VVCS对IFTT组扭转预测的准确率为83.9%。
结论
IFTT的临床表现与AT相似，但影像学检查发现输卵管旁囊肿的可能性更高，且保留多普勒血流信号。对于出现疼痛、恶心和呕吐且影像学检查发现附件肿块与卵巢分离的患者，无论多普勒血流情况如何，均应高度考虑IFTT。
证据级别
二级。
研究类型
预后研究。
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