MSCTA辅助儿童卵巢肿瘤蒂扭转定位诊断及精准手术

Assisted diagnostic value and precise surgery significance of MSCT angiography in torsion of ovarian tumors in children

目的探讨多层螺旋CT血管成像(MSCTA)在辅助儿童卵巢肿瘤蒂扭转中的定位诊断价值及精准手术意义。方法回顾性分析2008年1月至2015年9月重庆医科大学附属儿童医院15例进行了MSCT双期增强的经手术证实为儿童卵巢肿瘤蒂扭转的CT影像数据,采用多平面重建(MPR)、最大密度投影(MIP)、容积再现(VR)等多种血管成像后处理方法显示卵巢血管变化,定位肿瘤起源及扭转侧别,并与手术结果对照。结果 15例2个月至11岁的卵巢肿瘤蒂扭转患儿中良性肿瘤11例(畸胎瘤9例,浆液性囊腺瘤2例),恶性肿瘤4例(卵黄囊瘤3例,混合性生殖细胞肿瘤1例)。MSCTA显示的卵巢血管变化主要表现为患侧卵巢供血动脉远端反常增粗、扭曲以及肿瘤血管网形成,引流静脉表现为卵巢周围静脉丛增粗、迂曲、密度增高,个别可见"漩涡征"。术前MSCTA显示卵巢肿瘤供血动脉为下行的卵巢动脉供血来源5例,为上行的子宫动脉卵巢支供血来源10例,定位肿瘤起源于左侧卵巢并扭转4例,起源于右侧卵巢并扭转11例,均与术中发现一致。术中依据MSCTA提供信息准确选择了手术切口位置、精准离断了肿瘤血管并切除了肿瘤及病变侧卵巢,节约了手术时间,减少了出血量。结论 MSCTA能在术前准确显示卵巢肿瘤血管、定位肿瘤起源及扭转侧别,对儿童卵巢肿瘤蒂扭转精准手术具有重要辅助指导意义。

Objective To study the assisted diagnostic value and significance in precise surgery of MSCT angiography in torsion of ovar- ian tumors in children. Methods The dual-phase enhanced MSCT images data of 15 children patients with ovarian tumor torsion which were confirmed by surgery were retrospectively analyzed. Showed the vascular changes around the ovaries and judged the ovarian tumors arise and torsion side with the vascular reconstruction methods of multi-planar reconstruction （ MPR ）, maximum intensity projection （ MIP）, volume rendering （ VR）, then compared with the operation situation. Results Among the 15 cases aged from 2 months to 11 years old who were detected with MSCT scanning and angiography, there were 11 cases of benign tumor （9 cases of ovarian teratoma and 2 cases of serous cystadenoma） and 4 cases of malignant tumor （3 cases of yolk sac tumor and 1 case of malignant mixed germ cell tumor）. MSCTA displayed that o- varian vessels changes were abnormal thickening and twisting of distal feeding artery and tumor vascular network formation;and there were thickening, tortuosity, increased density and a few visible ＇ whirl sign＇ in draining veins. Preoperative MSCTA displayed ovarian tumor blood supply arteries were found 5 cases of downlink of ovarian artery and 10 cases of asscending branches of uterine artery. There were 4 cases of ovarian tumor originated from the left ovary combined with reverse and 11 cases originated from the right ovary combined with reverse, which were consistent with intraoperative findings. Intraoperative MSCTA provide information which helped accurate chose of the surgical incision, precise abruption of tumor blood vessels and resection of the tumor and ovarian lesions, thus saved the operation time and reduced the blood loss. Conclusion MSCT angiography can not only provide diagnosis information of torsion of ovarian tumors in children, but also more importantly, it has an important assisted significance in precision surgery.