超声在预测子宫附件扭转坏死中的应用价值

The application value of ultrasound in predicting necrosis in uterine adnexal torsion

目的:探讨超声诊断子宫附件扭转的应用价值,并建立与子宫附件扭转坏死相关的预测模型。资料与方法:回顾性纳入2017年6月—2022年6月在郑州大学第三附属医院经手术证实的62例子宫附件扭转坏死患者,根据手术方式分为保守手术组(n=45)及附件切除手术组(n=17)。比较保守手术组与附件切除手术组患者临床特征、病理结果、超声表现、术中及术后一般情况的差异;采用多因素Logistic回归分析评估保守手术和附件切除手术患者之间的差异;分析联合持续性腹痛及血管蒂血流信号消失对预测子宫附件扭转坏死的效能。结果:患者持续性腹痛及血管蒂血流信号消失与附件切除手术相关,差异具有统计学意义(P<0.05)。单独血管蒂血流信号消失预测子宫附件扭转坏死的敏感度和特异度分别为88.23%、84.44%,血管蒂血流信号消失+持续性腹痛预测子宫附件扭转坏死的敏感度和特异度分别为94.11%、93.33%。结论:超声检查对子宫附件扭转坏死具有一定的诊断价值,患者持续性腹痛及血管蒂血流信号消失可预测子宫附件扭转坏死,二者联合应用可提高预测子宫附件扭转坏死的效能。

Objective:To investigate the application value of ultrasonography in the diagnosis of uterine adnexal torsion,and to establish a predictive model related to uterine adnexal torsion and necrosis.Materials and Methods:A total of 62 patients with adnexal torsion confirmed by surgery in the Third Affiliated Hospital of Zhengzhou University from June 2017 to June 2022 were retrospectively included and divided into conservative surgery group(n=45)and adnexectomy group(n=17).The differences in clinical characteristics,pathological findings,ultrasonographic findings,intraoperative and postoperative general conditions of patients in the conservative surgery group and the adnexectomy group were compared.Multivariate Logistic regression analysis was used to evaluate the differences between patients with conservative surgery and adnexectomy.The evaluation efficacy of predicting adnexal torsion necrosis was studied by combining persistent abdominal pain and loss of vascular pedicle blood flow signal.Results:Persistent abdominal pain and disappearance of vascular pedicle blood flow signals were associated with adnexectomy,and the difference was statistically significant(P<0.05).The disappearance of vascular pedicle blood flow signal alone predicted adnexal torsion necrosis with the sensitivity and specificity of 88.23%and 84.44%,respectively,and the disappearance of vascular pedicle blood flow signal plus persistent abdominal pain predicted adnexal torsion necrosis with the sensitivity and specificity of 94.11%and 93.33%,respectively.Conclusion:Ultrasound has certain diagnostic value for uterine adnexal torsion.Persistent abdominal pain and disappearance of vascular pedicle blood flow signal can predict adnexal torsion necrosis,and combined application of the two can improve the performance of predicting adnexal torsion necrosis.