2026 年第 8 期 第 21 卷

孕期附件扭转临床处理策略的决策因素分析

Analysis of decision-making factors for clinical management strategies of adnexal torsion during pregnancy

作者：郑帅1张然2王静怡3陈斌4李东梅1李晓君1

英文作者：Zheng Shuai1 Zhang Ran2 Wang Jingyi3 Chen Bin4 Li Dongmei1 Li Xiaojun1

单位：1北京市海淀区妇幼保健院超声科，北京100094；2北京市海淀区妇幼保健院产科，北京100094；3首都医科大学附属北京安贞医院胎儿心脏母胎医学中心，北京100029；4北京市海淀区妇幼保健院妇科，北京100094

英文单位：1Department of Ultrasound Haidian District Maternal and Child Health Care Hospital of Beijing Beijing 100094 China; 2Department of Obstetrics Haidian District Maternal and Child Health Care Hospital of Beijing Beijing 100094 China; 3Fetal Heart and Maternal-Fetal Medicine Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 4Department of Gynecology Haidian District Maternal and Child Health Care Hospital of Beijing Beijing 100094 China

关键词：附件扭转；孕期；超声检查；扭转度数；漩涡征；附件占位性病变

英文关键词：Adnexaltorsion;Pregnancy;Ultrasonography;Torsiondegree;Whirlpoolsign;Adnexalspace-occupyinglesion

• 摘要：

• 目的 探讨超声征象在孕期附件扭转临床处理策略中的决策价值，并分析附件占位性病变大小与扭转度数的相关性。方法 回顾性分析2010年1月至2025年8月北京市海淀区妇幼保健院收治的48例临床诊断孕期附件扭转患者的病历资料。根据治疗方案分为手术组（27例）与保守治疗组（21例）。比较2组患者的一般资料、孕期分布及卵巢血供变化、盆腹腔积液等5种超声征象的差异，并分析手术组中附件占位性病变大小与扭转度数的相关性。结果 48例附件扭转病例中27例行手术治疗，21例保守治疗。其中早期合并其他因素行人工流产2例，余46例均足月分娩，无不良妊娠结局。超声诊断附件扭转中早、中及晚孕期之间检出率差异有统计学意义（P＜0.05）。手术组与保守治疗组5种典型超声征象比较结果表明，卵巢血供变化及盆腹腔积液方面比较差异均有统计学意义（均P＜0.05），而蒂部“漩涡征”、卵巢二维图像变化及附件占位性病变比较差异均无统计学意义（均P＞0.05）。手术组分析结果表明，附件占位性病变大小［二维径线（a×b）］与扭转度数呈正相关（r=0.462，P=0.020）。结论 卵巢血供变化与盆腹腔积液是提示需手术干预的关键超声征象；附件占位性病变大小与扭转严重程度密切相关。综合超声征象与病变大小进行评估，可为孕期附件扭转的个体化治疗决策及风险分层提供重要依据。

• Objective To investigate the decision-making value of ultrasound features in the clinical management of adnexal torsion during pregnancy, and to analyze the correlation between the size of adnexal space-occupying lesion and torsion degree. Methods Clinical data of 48 pregnant patients diagnosed with adnexal torsion at Haidian District Maternal and Child Health Care Hospital of Beijing from January 2010 to August 2025 were retrospectively analyzed. Patients were divided into surgery group (27 cases) and conservative treatment group (21 cases) according to treatment regimens. General data, gestational distribution, and five ultrasound features including ovarian blood flow changes and pelvic ascites were compared between the two groups. The correlation between the size of adnexal space-occupying lesion and torsion degree was analyzed in the surgery group. Results Of the 48 cases, 27 underwent surgery and 21 received conservative treatment. Two cases in early pregnancy with other complications underwent artificial abortion, and the remaining 46 cases had full-term delivery without adverse pregnancy outcomes. The detection rate of adnexal torsion by ultrasound differed significantly among early, middle and late pregnancy (P<0.05). Comparison of five typical ultrasound features between the surgery and conservative groups showed significant differences in ovarian blood flow changes and pelvic ascites (both P<0.05), but no significant differences in pedicle whirlpool sign, two-dimensional ovarian morphological changes or adnexal space-occupying lesion (all P>0.05). In the surgery group, the size of adnexal space-occupying lesion ［two-dimensional diameter (a×b)］ was positively correlated with torsion degree (r=0.462, P=0.020). Conclusions Ovarian blood flow changes and pelvic ascites are key ultrasound features indicating the need for surgical intervention. The size of adnexal space-occupying lesion is closely related to the severity of torsion. Comprehensive evaluation based on ultrasound features and lesion size can provide important evidence for individualized treatment decision-making and risk stratification of adnexal torsion during pregnancy.