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| 卵巢扭转的超声诊断质量分析及改进模式探究 |
| 桂阳,张晓燕,马莉,李平,吕珂,李建初,朱庆莉 |
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| (作者单位：100730 北京市,中国医学科学院北京协和医学院,北京协和医院超声医学科) |
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| 摘要: |
| 目的 分析卵巢扭转术前超声报告质量，探究诊断模式改进措施，提高诊断敏感性。
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、病理和超声影像学检查资料，分析术前超声病变检出率、报告描述质量、诊断准确率等，并比较住院医师组和主治及以上医师组的诊断准确率。探讨诊断卵巢扭转的改进模式，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90°~1440°卵巢扭转，，其中单纯性卵巢扭转2例（1.32%），继发性卵巢扭转149例（98.68%）；术后病理主要为成熟性畸胎瘤（31.13%）和囊腺瘤（24.50%）。超声病变检出率为99.34%，超声报告描述完整率为100%，超声诊断准确率9.93%。其中住院医师组诊断准确率仅6.02%，主治及以上医师组诊断准确率为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例检出漩涡征阳性组。以腹痛、局部压痛及超声发现附件区包块三联征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三联征为诊断基础，结合恶心、呕吐等临床症状和特征性超声表现综合评估，有助于卵巢扭转的及时诊断和积极治疗，最大限度保留卵巢功能。 |
| 关键词: 超声 卵巢扭转 质量控制 质量改进 |
| DOI： |
| 投稿时间：2022-04-19修订日期：2022-06-10 |
| 基金项目:中国医学科学院医学与健康科技创新工程项目（CIFMS）2020-I2M-C&T-B-033 |
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| Analysis of the ultrasound diagnosis quality for ovarian torsion and exploring the improvement of the diagnosis mode |
| GUI Yang,ZHANG Xiaoyan,MA Li,LI Ping,LV Ke,LI Jianchu,ZHU Qingli |
| (Pecking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College) |
| Abstract: |
| Objective Analyze the quality of preoperative ultrasound report for ovarian torsion. Explore the improvement of diagnostic mode to increase the diagnostic sensitivity.
Methods One hundred and fifty-one patients operatively diagnosed with ovarian torsion were collected in our hospital.The clinical data，pathological results，and conventional ultrasound findings of all the patients were retrospectively analyzed. The lesion detection rate of the ultrasound，the description quality of the reports，and the diagnostic accuracy of preoperative ultrasound were assessed. The diagnostic accuracy was compared between the resident group and the attending and above physicians group. The diagnostic sensitivity of the triad of abdominal pain，local tenderness and adnexal mass in 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%） cases had nausea with or without vomiting. All patients had 90 °~1440 °unilateral ovarian torsion. There were 2(1.32%) cases of simple ovarian torsion and 149(98.68%) cases of secondary ovarian torsion. The postoperative pathology was mainly mature teratoma （31.13%） and cystadenoma （24.50%）. The lesion detection rate of ultrasound was 99.34% （150/151）.The description integrity rate of the reports was 100% （150/150）.The diagnostic accuracy of preoperative ultrasound was 9.93% （15/151）.Separately，the diagnostic accuracy of the resident group was 6.02% （8/133），and the diagnostic accuracy of attending and above physicians group was 38.89% （7/18）. The difference between groups was statistically significant （P ＜ 0.001）. Local tenderness point could be touched in three cases by transvaginal ultrasound. Whirlpool sign was detected in seven cases.The diagnostic sensitivity of the triad of abdominal pain，local tenderness，and adnexal mass were 98.0% （148/151）.
Conclusions Based on the triad of abdominal pain，local tenderness and a pelvic mass，accompanied by characteristic ultrasonic manifestations and other clinical symptoms，such as nausea and vomiting，it is expected to achieve timely diagnosis and treatment of ovarian torsion，maximize the preservation of ovarian function |
| Key words: Ultrasonography Ovarian torsion Quality control Quality improvement |
