小儿卵巢扭转的超声诊断价值

摘要

Objective To evaluate the value of ultrasonography in the diagnosis of pediatric ovarian torsion (OT).Methods Ultrasonography was performed in 38 OT,and 52 non-OT children.Bilateral ovarian area was measured.The larger area was defined as S1,whereas,the smaller area was defined as S2.S1/S2 ratio was calculated.Follicles around ovaries,ovarian blood flow,and pelvic effusion were also observed during the ultrasonographic scanning.ROC curve was employed to evaluate the clinical value of ultrasonography in pediatric OT diagnosis.Results ①S1/S2 ratio,incidence of follicles around ovaries and of no ovarian blood flow were all higher in OT compared to non-OT children (P =0.000).While pelvic effusion showed no significant difference between the two groups (P =0.004).②Using S1/S2 ratio to diagnose OT,the area under the ROC curve was 0.925 (0.865-0.986),the best cutoff point was 1.6,sensitivity was 97％ and specificity was 88％.Patients were divided into two groups based on the cutoff point of 1.6,the area under the ROC curve of S1/S2 was 0.924(0.847-0.969),of follicles around ovarian was 0.896(0.781-0.931),and of no ovarian blood flow was 0.911 (0.831-0.961),indicating S1/S2 held the highest diagnostic value.Conclusions Ultrasonography is an accurate method in the early diagnosis of pediatric ovarian torsion,with S1/S2 ratio holding the highest diagnostic value in this application.%目的 探讨超声对小儿卵巢扭转的诊断价值.方法 选取卵巢扭转患儿38例为扭转组,无卵巢扭转患儿52例为对照组,对受试患儿双侧卵巢面积进行测量,较大侧卵巢面积为S1,另一侧为S2,计算S1/S2.观察超声特征:S1/S2,滤泡是否在卵巢周围,卵巢有无血流信号,盆腔有无积液,比较两组间差异,并用ROC曲线评价其临床价值.结果 ①扭转组较对照组S1/S2增大,卵巢周围出现滤泡及卵巢内无血流信号发生率增高(P=0.000),盆腔积液差异无统计学意义(P=0.444).②S1/S2诊断卵巢扭转的ROC曲线下面积为0.925(0.865～0.986),最佳界值点为1.6,敏感性97％,特异性88％,据此将其分为两组,并与卵巢周围出现滤泡及卵巢内无血流信号进行ROC曲线诊断效力评价,ROC曲线下面积分别为0.924(0.847～0.969)、0.896(0.781～0.931)、0.911(0.831～0.961),显示S1/S2的诊断价值最高.结论 超声检查作为一种无创便捷的检查方法对卵巢扭转诊断的准确性较高,其中卵巢面积比值有助于卵巢扭转的早期诊断.