输卵管卵巢脓肿临床与影像数据相关性分析

Correlation Analysis between Clinical and Imaging Data of Tubo-Ovarian Abscess

目的 回顾性分析输卵管卵巢脓肿(TOA)的临床特点、影像学表现和鉴别诊断方法。方法 选取2012年8月至2022年2月142例(年龄21~87岁,平均43.2岁)经腹腔镜或剖腹手术证实的TOA和112例(年龄14~92岁,平均47.16岁)非炎症性疾病(NPID)患者,回顾性分析其感染指标及临床影像学资料并对其诊断效能进行评估。结果 实验室炎症指标白细胞计数(WBC)、中性粒细胞计数(NEUT)、中性粒细胞比例(NEUT%)、单核细胞绝对值(MONO#)和C-反应蛋白(CRP):TOA组分别有93、99、99、71和91例升高,NPID组分别有15、18、20、14和8例升高;肿瘤学指标CA12-5:TOA组66例升高,NPID组9例升高;两者升高比例TOA组均明显高于NPID组(P<0.05)。附件区囊性病变的囊液CT值和囊壁厚度:TOA组分别为(20.316±5.004) HU和(1.97±0.637) mm, NPID组分别为(7.346±5.397)HU和(1.346±0.883)mm,两者均为TOA组大于NPID组(P<0.05)。附件区管状结构、不完整的隔膜、带缺口的较大囊腔和液液分层:TOA组分别有94、85、71和21例,NPID组分别有22、12、7和0例,TOA组均高于NPID组(P<0.05)。结论 回顾性分析表明TOA临床伴或不伴发热,但与发热、实验室炎症指标及女性肿瘤九项中CA12-5明显相关;附件区迂曲增粗管状结构、不完全隔膜、带缺口的较大囊腔及液液分层影像征象对TOA诊断具有相对特异性;脓液CT值及脓壁厚度对影像学诊断TOA具有重要的提示价值。

Objective To retrospectively analyze the clinical characteristics,imaging manifestations and dfferential di-agnostic methods of Tubo-ovarian abscess.Methods 142 patients with Tubo-ovarian abscess(TOA,Age:21-87 years old,mean 43.2 years old)and 112 non-pelvic inflammatory diseases(NPID,Age:14-92 years old,mean 47.16 years old)were enrolled into this study.These patients were diagnosed in the Second Affiliated Hospital of Anhui Medical University from August 2012 to February 2022.Results The numbers of TOA patients with elevated laboratory inflammation parame-ters such as WBC(93 vs.15),NEUT#(99 vs.18),NEUT%(99 vs.20),MONO#(71 vs.14),and CRP(91 vs.8)were remarkably increased compared to those of NPID patients.Elevated CA12-5 was observed in 66.67%(66/99)TOA patients and in only 19.8%(9/83)NPID patients.Furthermore,the increased proportion of CA12-5 in TOA group was sig-nificantly higher than that in NPID group(P<0.05).Cyst fluid CT value(20.316±5.004)HU vs(7.346±5.397)HU and cyst wall thickness(1.97±0.637)mm vs(1.346±0.883)mm in adnexal cystic lesions were significantly increased in TOA patients,compared to those in NPID patients.Tubular structures in the adnexal region(94 vs 22),incomplete sep-tum(85 vs 12),large notched cysts(71 vs 7),and fluid-fluid stratification(21 vs 0)were drastically increased in TOA patients compared to those in NPID patients.Conclusion Retrospective analysis showed that TOA was significantly corre-lated with fever,laboratory inflammatory markers,and CA12-5 in nine female tumors.The tortuous and thickened tubular structure,incomplete septum,large notched cysts,and fluid stratification in the adnexal area are relatively specific for diag-nosing TOA.In addition,the CT value of pus and the thickness of the pus wall has significant prompting values for the diag-nosis of Tubo-ovarian abscess by imaging.