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输卵管卵巢脓肿及输卵管积水的多层螺旋CT表现及诊断价值

作者:王越凤

所属单位:四川省彭州市人民医院妇产科(四川 彭州 611930)

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摘要

目的 研究多层螺旋CT诊断输卵 管卵巢脓肿及输卵管积水的临床价值。方 法 选取我院67例输尿管卵巢脓肿及输尿 管积水患者为研究对象,均经手术病理证 实,其中输卵管卵巢脓肿39例,输卵管积 水28例,采取西门子 Sensation 64层螺 旋CT机对上述患者进行检查,分析输卵 管卵巢脓肿及输尿管积水的CT影像学特 点。结果 67例患者共检出87侧输卵管病 变,所有患者均可见单、双侧子宫囊状及 混杂密度肿块,管状型56例,多囊型15 例,单囊型16例。输卵管卵巢脓肿管状型 35例,多囊型7例,单囊型2例;输卵管 积水管状型22例,多囊型8例,单囊型13 例;卵巢脓肿主要表现为厚壁肿块,边界 模糊,内壁清晰,增强扫描后可见均匀或 分层状强化,液性部分未见强化,肿块周 围条索影和脂肪密度上升。输卵管积水CT 表现主要为囊状肿块、多囊状、管状,其 中多囊状发生率明显高于输卵管卵巢肿 块,壁光清晰,强化扫描后强化轻微。结 论 多层螺旋CT可准确鉴别输卵管卵巢脓 肿及输卵管积水,通过分析两种疾病类型 的CT影像学差异,可对治疗方案的制定提 供可靠依据。

Objective To study the clinical value of multi-slice spiral CT in the diagnosis of tubal ovarian abscess and hydrosalpinx. Methods 67 cases of patients with tubal ovarian abscess and hydrosalpinx in the hospital were selected as the research objects. All patients were confirmed by surgery and pathology. There was tubal ovarian abscess in 39 cases and hydrosalpinx in 28 cases. The Siemens Sensation 64 slice spiral CT machine was used to examine the patients. The CT imaging features of tubal ovarian abscess and hydrosalpinx were analyzed. Results There were 87 fallopian tube lesions detected in 67 cases of patients. All patients were with visible, bilateral uterine cystic and mixed density masses, including tubular type in 56 cases, polycystic type in 15 cases and single cystic type in 16 cases. There were tubal ovarian abscesses of tubular type in 35 cases, polycystic type in 7 cases and single cystic type in 2 cases; hydrosalpinx of tubular type in 22 cases, polycystic type in 8 cases and single cystic type in 13 cases. The main features of ovarian abscesses were thick wall masses, blurred boundaries and clear inner wall. After enhancement scan, there were homogeneous or layering enhancement while there was no enhancement in the liquid part. Stripes around masses and fat density increased. The CT findings of hydrosalpinx mainly were cystic masses, polycystic and tubular, in which the incidence rate of polycystic shape was significantly higher than that of tubal ovarian masses, with clear wall light. After enhancement scan, the enhancement was slight. Conclusion Multislice spiral CT can accurately identify tubal ovarian abscess and hydrosalpinx. Through analyzing the differences in CT imaging of the two kinds of diseases, reliable basis can be provided for making treatment plan.

【关键词】输卵管;卵巢脓肿;输卵管 积水;多层螺旋CT

【中图分类号】R737

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2017.02.027

前言

输卵管炎为妇科常见疾病,输卵管炎治疗未愈时可演变为伞端粘 连闭锁,液体在管腔内凝聚形成输卵管积水[1],而化脓性输卵管炎则 因输卵管积浓形成输尿管卵巢脓肿,以上两种情况均是导致女性不孕 的主要因素,早期准确诊断具有重要的临床价值[2]。目前临床进行卵 巢脓肿和输尿管积水诊断的主要方式为超声,但超声对卵巢脓肿的诊 断准确率较低,因此临床应用受限[3]。CT在患者超声检测不典型时具 有较高价值。本次研究采取多层螺旋CT对67例输卵管卵巢脓肿及输卵 管积水患者进行诊断,现将结果报告如下。