单纯性输卵管扭转的超声诊断

The clinical value of ultrasound in diagnosing the isolated fallopian tube torsion

目的结合临床总结单纯性输卵管扭转的超声声像图特征。方法采用经腔内超声或经腹部超声对12例单纯性输卵管扭转患者进行检查,并按照输卵管扭转后的形态改变进行超声分型。结果 12例单纯性输卵管扭转患者均以腹痛就诊,4例伴恶心呕吐。其临床及超声声像图表现:(1)输卵管扭转部位:12例患者患侧输卵管扭转部位均为输卵管峡部,右侧输卵管扭转4例,左侧输卵管扭转8例,输卵管扭转处管径增粗,最大直径为3～7cm。(2)输卵管扭转圈数:12例中3例患侧输卵管扭转1圈,4例输卵管扭转2圈,3例输卵管扭转3圈,1例输卵管扭转4圈,1例输卵管扭转6圈。(3)超声直接征象:二维动态超声声像图示5例输卵管扭转处呈漩涡征。(4)超声间接征象:二维超声声像图示囊肿型10例(10/12,轻型4例,输卵管迂曲扩张,壁厚不光滑,输卵管黏膜皱襞较长,且清晰易辨认;重型6例,表现为圆形或椭圆形无回声区,壁较厚,多不光滑,输卵管黏膜皱襞呈小突起样不易辨认或黏膜皱襞消失);混合回声型2例(2/12),表现为附件区高回声、低回声和无回声混杂的团块,输卵管的结构不清晰。(5)内部血流显示情况:彩色多普勒血流成像示10例(囊肿型9例,混合回声型1例)患侧输卵管内部血流信号减少或消失,2例血流信号正常。(6)6例(6/12)伴少量盆腔积液(囊肿型5例,混合回声型1例)。12例患者卵巢均正常。与手术病理诊断结果对照显示术前超声正确诊断单纯性输卵管扭转6例(6/12),误诊6例(6/12,2例误诊为卵巢扭转,2例误诊为卵巢囊肿蒂扭转,2例误诊为炎性包块)。结论漩涡征是诊断单纯性输卵管扭转的直接征象;患侧卵巢正常而附件区输卵管扩张形成的囊肿或混合回声团块是诊断单纯性输卵管扭转重要的间接征象,认识并观察到这些超声征象有助于提高术前超声诊断准确性。

Objective To summarize the characteristics of ultrasound images of the isolated fallopian tube torsion(IFTT).Methods Transabdominal ultrasongraphy or endosonography was carried out in 12 cases of IFTT,and the ultrasound images are classified according to the morphological changes.Results All of the 12 cases complained abdominal pain,four of which with nausea and vomiting.Clinical data and ultrasound findings:(1)The part of tubal torsion:all of the torsions happened on the isthmus of fallopian tubes.Four of the 12 torsions occurred on the right side and eight on the left.The maximum diameter was 3-7 cm.(2)The loops of the tubal torsion:three cases twisted one loop,three cases twisted one loop,four cases twisted two loops,three cases twisted three loops,one cases twisted four loops,one cases twisted six loops.(3)The direct sign:the direct sign of the isolated fallopian tube torsion was whirlpool sign and the dynamic images of the two-dimensional ultrasound in five patients showed it.(4)Indirect signs:indirect signs of the isolated fallopian tube torsion were as following:two-dimensional ultrasound images of isolated fallopian tube torsion were classified into two types,including:cystic type,ten cases,which could be further divided into mild and severe ones.Four cases of mild cystic type showed prolonged and extended tube with rough folds inside.The mucosal folds could be identified easily by ultrasound doctors.Six cases of severe cystic type exhibited round or oval cysts with thicken wall.The mucosal folds were stretched into small protrusions and were not easily to be identified.Echogenic adnexal masses:two cases were classified into this group and both of the structures of fallopian tubes were unclear.Some of the folds were even disappeared.(5)Blood flow situation:color Doppler ultrasound imagining revealed blood flow signals decreased or disappeared in ten cases(nine cases of cystic type and one case of echogenic adnexal masses).(6)Concurrent pelvic fluid situation:six cases presented with pelvic cavity fluid(five cases of cystic type and one case of echogenic adnexal masses).Ipsilateral ovary was normal in all cases.In comparison with surgical pathology diagnosis,six cases out of 12 were correctly diagnosed preoperatively(two cases were misdiagnosed as ovarian torsion,two cases were misdiagnosed as ovarian cyst pedicle torsion and two cases were misdiagnosed as inflammatory mass).Conclusions Whirl sign is the direct sign of IFTT.Cystic mass formed by dilated tube or mixed echogenic mass in annex area and normal ipsilateral ovary are the most important indirect signs.Knowledge about the ultrasonic characteristics of IFTT was important for the correct preoperative diagnosis.