卵巢扭转的超声诊断质量分析及改进模式探究

Analysis of ultrasound diagnosis quality for ovarian torsion and exploring the improvement mode

目的分析卵巢扭转患者术前超声报告的质量,探究诊断模式的改进措施,提高术前超声诊断敏感性。方法回顾性分析我院经手术确诊的151例卵巢扭转患者的临床、病理和超声检查资料,分析术前超声报告描述质量、病变检出率和诊断准确率等,比较不同年资超声医师对卵巢扭转的诊断准确率。改进卵巢扭转的诊断模式,评价腹痛、局部压痛、超声发现附件区包块联合应用对卵巢扭转的诊断敏感性。结果151例患者中,134例(88.74%)表现为急性腹痛,15例(9.94%)表现为间歇性隐痛,2例(1.32%)无腹痛症状;92例(60.93%)有恶心症状,伴或不伴呕吐。所有患者均为单侧卵巢扭转90°~1440°,其中继发性卵巢扭转149例(98.68%),术后病理提示主要为成熟性畸胎瘤(47例)和囊腺瘤(37例);单纯性卵巢扭转2例(1.32%)。超声报告描述完整率为100%,超声病变检出率为99.34%,超声诊断准确率为9.93%。其中住院医师的诊断准确率仅6.02%,主治及以上医师的诊断准确率为38.89%,差异有统计学意义(P<0.001)。其中,3例经阴道超声检查可触及局部压痛点,7例检出漩涡征。腹痛、局部压痛及超声发现附件区包块联合应用对卵巢扭转的诊断敏感性为98.0%。结论以腹痛、局部压痛和超声发现附件区包块为诊断基础,结合恶心、呕吐等临床症状和特征性超声表现综合评估,有助于提高术前超声诊断敏感性。

Objective To analyze the quality of preoperative ultrasound report for ovarian torsion,and to explore the improvement of diagnostic mode to increase the diagnostic sensitivity.Methods One hundred and fifty-one patients with ovarian torsion confirmed by surgery were collected in our hospital,and the clinical data,pathological results and ultrasonic findings of all the patients were retrospectively analyzed.The lesion detection rate,the description quality of the reports,and the diagnostic accuracy of preoperative ultrasound were assessed.The diagnostic accuracy was compared between the sonographers with different seniority.The diagnostic mode of ouarian torsion was improved,then the diagnostic sensitivity of acute abdominal pain,local tenderness and adnexal mass in combined for diagnosing ovarian torsion was evaluated.Results Of the 151 patients,134(88.74%)patients had acute abdominal pain,15(9.94%)patients had intermittent dull pain,and 2(1.32%)patients had no abdominal ache.92(60.93%)patients had nausea with or without vomiting.All patients had 90°~1440°unilateral ovarian torsion,including 149(98.68%)patients of secondary ovarian torsion and 2(1.32%)patients of simple ovarian torsion.The postoperative pathology was mainly mature teratoma(47 cases)and cystadenoma(37 cases).The description integrity rate of the ultrasound reports was 100%.The lesion detection rate of ultrasound was 99.34%.The diagnostic accuracy of ultrasound was 9.93%.Separately,the diagnostic accuracy of the resident was 6.02%,and the diagnostic accuracy of attending and above sonographers was 38.89%.The difference was statistically significant(P<0.001).Local tenderness point could be touched in 3 cases by transvaginal ultrasound.Whirlpool sign was detected in 7 cases.The diagnostic sensitivity of the combination of abdominal pain,local tenderness,and adnexal mass was 98.0%.Conclusion Based on the abdominal pain,local tenderness and adnexal mass,accompanied by characteristic ultrasonic manifestations and other clinical symptoms,such as nausea and vomiting,it is expected to improve the diagnostic sensitivity by preoperative ultrasound.