目的:由于非特异性症状,附件扭转仍然是一个诊断挑战,超声特征,和实验室发现。结合临床的价值,超声检查,实验室功能还没有很好地建立起来,关于其诊断价值的争议仍在继续。这项研究旨在回顾超声检查,临床,和实验室特征,并分别和组合分析它们的价值,管理和诊断附件扭转。
方法:这项研究包括278名女性,她们因怀疑附件扭转而接受了紧急腹腔镜手术,根据临床怀疑,有或没有超声检查的一致性。腹腔镜检查结果证实了扭转的明确诊断。比较了有和没有附件扭转的患者的临床实验室和超声特征。
结果:附件扭转在110/278(39.6%)女性中得到证实。在扭转与非扭转组相比,在前24小时患有急性腹痛的女性比例较高([50]45.5%vs.[35]20.8%,p<0.001),呕吐([45]40.9%vs.[24]14.3%,p<0.001),经阴道超声检查怀疑扭转([49]44.5%vs.[23]13.7%,p<0.001)。在研究组的65(59.1%)和对照组的60(35.7%)中发现了高中性粒细胞与淋巴细胞比率(>3)(p<0.001)。结合后三个发现,扭转的预测概率为58%-85%,取决于组合。
结论:基于临床,实验室,超声检查结果有助于附件扭转的术前诊断,预测概率为85%。我们的模型可以帮助临床医生评估疑似附件扭转的女性,提高术前诊断的准确性。
OBJECTIVE: Adnexal torsion remains a diagnostic challenge due to the nonspecific symptoms, sonographic features, and laboratory findings. The value of combining clinical, sonographic, and laboratory features is not well established, and controversy continues regarding their value in diagnosis. This
study aimed to review sonographic, clinical, and laboratory features and to analyze their value separately and in combination, in managing and diagnosing adnexal torsions.
METHODS: The
study included 278 women who underwent urgent laparoscopic surgery due to suspected adnexal torsion, according to clinical suspicion, with or without sonographic concordance. Laparoscopy findings confirmed the definitive diagnosis of torsion. Clinical laboratory and sonographic features were compared between those with and without adnexal torsion.
RESULTS: Adnexal torsion was confirmed in 110/278 (39.6%) women. In the torsion compared to nontorsion group, proportions were higher of women with acute abdominal pain in the preceding 24 h ([50] 45.5% vs. [35] 20.8%, p < 0.001), with vomiting ([45] 40.9% vs. [24] 14.3%, p < 0.001) and with suspected torsion by transvaginal sonography ([49] 44.5% vs. [23] 13.7%, p < 0.001). A high neutrophil-to-lymphocyte ratio (>3) was identified in 65 (59.1%) of the
study group and 60 (35.7%) of the control group (p < 0.001). Combining the latter three findings, the predicted probability of torsion was 58%-85%, depending on the combinations.
CONCLUSIONS: A simple predictive model based on combinations of clinical, laboratory, and sonographic findings can contribute to preoperative diagnosis of adnexal torsion, with predicted probability of 85%. Our model may assist clinicians in evaluating women with suspected adnexal torsion, and improve preoperative diagnostic accuracy.