際際滷

際際滷Share a Scribd company logo

4. sacd xoan phan phu.10.2017.vsum.medic.k23

The Nhan Huynh
The Nhan Huynh

Bi gi畉ng si棚u 但m s畉n ph畛 khoa 2017

1 of 66
Download to read offline
SIU M CH畉N ON XO畉N PH畉N PH畛 1 Bs. NGUY畛N QUANG TR畛NG website: www.sieuamvietnam.vn, www.cdhanqk.com (L畛p Si棚u 但m SPK, kh坦a 23, HYPNT-MEDIC, 2017) Ng動畛i ta ch畛 th畉y nh畛ng g狸 ng動畛i ta 動畛c chu畉n b畛 畛 th畉y" Ralph Waldo Emerson
Xo畉n ph畉n ph畛 l c畉p c畛u ph畉u thu畉t ph畛 khoa th動畛ng g畉p 畛ng hng th畛 5. H狸nh 畉nh r畉t thay 畛i, tri畛u ch畛ng l但m sng kh担ng 畉c hi畛u 動a 畉n ch畉m tr畛 trong ch畉n o叩n, ho畉c b畛 s坦t ch畉n o叩n. Si棚u 但m l ph動董ng ti畛n 畉u tay trong ch畉n o叩n Xo畉n ph畉n ph畛. Ch畉n o叩n s畛m = b畉o t畛n 動畛c bu畛ng tr畛ng. Ch畉n o叩n mu畛n ho畉c b畛 s坦t ch畉n o叩n = c畉t b畛 bu畛ng tr畛ng. 2 T畛NG QUAN Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368
Xo畉n ph畉n ph畛 c坦 th畛 x畉y ra 畛 n畛 gi畛i b畉t k畛 l畛a tu畛i no; tuy nhi棚n, t畉n su畉t cao nh畉t 畛 ph畛 n畛 trong 畛 tu畛i sinh s畉n, 17%20% tr動畛ng h畛p x畉y ra trong th畛i k畛 mang thai. L但m sng kinh i畛n: au h畛 ch畉u ph畉i ho畉c tr叩i, th動畛ng kh担ng s畛t, bu畛n n担n ho畉c n担n 坦i t畛ng c董n. Xo畉n ph畉n ph畛 (Adnexal torsion) l thu畉t ng畛 bao g畛m ho畉c xo畉n bu畛ng tr畛ng, ho畉c xo畉n v嘆i tr畛ng, ho畉c xo畉n v嘆i-bu畛ng tr畛ng. Xo畉n v嘆i-bu畛ng tr畛ng chi畉n 畉n 67% tr動畛ng h畛p xo畉n ph畉n ph畛. 3 T畛NG QUAN Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368
4 Aruna R Patil et al. Multimodality imaging in adnexal torsion. Journal of Medical Imaging and Radiation Oncology 59 (2015) 719 Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008 Ovarian-Fallopian tube torsion
Xo畉n v嘆i-bu畛ng tr畛ng, xo畉n bu畛ng tr畛ng 董n thu畉n th動畛ng c坦 i畛u ki畛n thu畉n l畛i l bu畛ng tr畛ng c坦 u nang (50-81% tr動畛ng h畛p), i畛n h狸nh l lnh t鱈nh; th動畛ng g畉p nh畉t l u nang b狸 (mature cystic teratoma). Xo畉n c滴ng hay g畉p 畛 H畛i ch畛ng bu畛ng tr畛ng b畛 k鱈ch th鱈ch qu叩 m畛c (Ovarian hyperstimulation syndrome). Xo畉n v嘆i tr畛ng 董n thu畉n (Isolated Fallopian tube torsion) th動畛ng c坦 i畛u ki畛n thu畉n l畛i l 畛 d畛ch tai v嘆i (hydrosalpinx). 5 T畛NG QUAN Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368
Xo畉n b棚n ph畉i th動畛ng g畉p h董n b棚n tr叩i (v湛ng ch畉u b棚n tr叩i c坦 畉i trng sigma chi畉m ch畛). Xo畉n bu畛ng tr畛ng kh担ng th動畛ng g畉p sau Vi棚m nhi畛m v湛ng ch畉u (pelvic inflammatory disease (PID), L畉c n畛i m畉c t畛 cung (endometriosis), ho畉c B動畛u 叩c t鱈nh (do hi畛n di畛n d畉i d鱈nh lm cho bu畛ng tr畛ng k辿m di 畛ng). 6 T畛NG QUAN Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368
L但m sng v h狸nh 畉nh ch畉n o叩n c畛a xo畉n ph畉n ph畛 r畉t thay 畛i. i畛u ny do sinh l箪 b畛nh ph畛c t畉p, ph畛 thu畛c vo nhi畛u y畉u t畛 kh叩c nhau: Th畛 lo畉i xo畉n: Xo畉n v嘆i-bu畛ng tr畛ng hay Xo畉n bu畛ng tr畛ng 董n thu畉n hay Xo畉n v嘆i tr畛ng 董n thu畉n. C坦 y畉u t畛 thu畉n l畛i (u nang bu畛ng tr畛ng) hay kh担ng?. 畛 n畉ng c畛a ch竪n 辿p m叩ch m叩u r畉t thay 畛i ph畛 thu畛c vo s畛 v嘆ng xo畉n v 畛 ch畉t c畛a xo畉n. 担i khi xo畉n-t畛 th叩o xo畉n (torsion - self-detorsion). 7 SINH L B畛NH Jean Noel Buy. Gynecological Imaging. Springer-Verlag Berlin Heidelberg 2013.
8 Ph畛 n畛 trong 畛 tu畛i sinh s畉n, th畛 t鱈ch bu畛ng tr畛ng b狸nh th動畛ng c坦 th畛 l棚n 畉n 22 mL. Cohen v c畛ng s畛 kh畉o s叩t 866 bu畛ng tr畛ng b狸nh th動畛ng (TAS) ghi nh畉n th畛 t鱈ch trung b狸nh l 9.8 +/- 5.8 ml v畛i gi畛i h畉n tr棚n l 21.9 mL. M畛t nghi棚n c畛u kh叩c tr棚n 406 b畛nh nh但n v畛i bu畛ng tr畛ng b狸nh th動畛ng (TVS) ghi nh畉n th畛 t鱈ch trung b狸nh 6.8 mL, v畛i gi畛i h畉n tr棚n l 18.0 mL. Bu畛ng tr畛ng 動畛c c畉p m叩u t畛 2 ngu畛n (dual vascular supply). Susan Raatz Stephenson. Diagnostic Medical Sonography Obstetrics and Gynecology. 3rd edition. 2012 by Lippincott Williams & Wilkins.
Xo畉n v嘆i-bu畛ng tr畛ng (Ovarian-Fallopian tube torsion): c畉 bu畛ng tr畛ng v voi tr畛ng bi味 xo畉n quanh d但y ch畉ng t畛 cung-bu畛ng tr畛ng (ovarian ligament) v d但y ch畉ng treo bu畛ng tr畛ng (infundibulopelvic ligament). Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008 9
XO畉N VI-BU畛NG TR畛NG (OVARIAN-FALLOPIAN TUBE TORSION) 1. D畉u hi畛u t畉i bu畛ng tr畛ng: - C坦 th畛 c坦 u nang c湛ng t畛n t畉i 畛 bu畛ng tr畛ng xo畉n (y畉u t畛 thu畉n l畛i). - D畉u hi畛u h畉ng 畛nh nh畉t 坦 l bu畛ng tr畛ng to ra g畉p nhi畛u l畉n (th畛 t鱈ch b狸nh th動畛ng : 7-10 ml) so v畛i bu畛ng tr畛ng 畛i b棚n, c坦 nh畛ng nang no達n (8-12 mm) 畛 ngo畉i vi t畉o d畉u hi畛u chu畛i ng畛c (string of pearls sign). Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Th畛 t鱈ch bu畛ng tr畛ng b畛 xo畉n thay 畛i t畛 26 ml t畛i 441 ml, trung b狸nh gia tng 28 l畉n k鱈ch th動畛c b狸nh th動畛ng - The volume of the twisted ovary ranged from 26 ml to 441 ml, an average of 28 times that of the normal ovary.. Graif M et al. Torsion of the ovary: sonographic features. AJR Am J Roentgenol 1984;143 (6):13311334. K鱈ch th動畛c bu畛ng tr畛ng gia tng t畛 38 ml t畛i 4308 ml - The size of the enlarged ovary or adnexa ranged from 38 ml to 4308 ml. Ferah Albayram et al. Ovarian and Adnexal Torsion Spectrum of Sonographic Findings With Pathologic Correlation. J Ultrasound Med 20:10831089, 2001
11 Daniella Navve et al. Medial or Lateral Location of the Whirlpool Sign in Adnexal Torsion - Clinical Importance. J Ultrasound Med 2013; 32:16311634
12 C董 ch畉: Kh畛i 畉u khi s畛 v嘆ng xo畉n ch動a nhi畛u, 畛 ch畉t c畛a xo畉n ch動a cao, 畛ng m畉ch c坦 thnh dy h董n, 叩p l畛c cao h董n ch動a bi味 x畉p, v畉n ti畉p t畛c t動畛i m叩u cho bu畛ng tr畛ng. Trong khi 坦, t挑nh m畉ch c坦 thnh m畛ng h董n, 叩p l畛c th畉p h董n, d畛 dng bi味 x畉p. H畉u qu畉 l bu畛ng tr畛ng b畛 xung huy畉t, ph湛 n畛 d畛 d畛i, tng th畛 t鱈ch.
13 N畛, 30 tu畛i, au h畛 ch畉u T 2 ngy: bu畛ng tr畛ng T (c叩c 畉u m滴i t棚n) to ra (25.6 ml), c坦 nh畛ng nang no達n to ra 畛 ngo畉i vi. Bu畛ng tr畛ng P b狸nh th動畛ng (8.5 ml). N畛, 27 tu畛i, au d畛 d畛i t畛ng c董n 達 2 ngy: bu畛ng tr畛ng T to ra c坦 nh畛ng nang no達n 畛 ngo畉i vi. 13
XO畉N VI-BU畛NG TR畛NG (OVARIAN-FALLOPIAN TUBE TORSION) 1. D畉u hi畛u t畉i bu畛ng tr畛ng: - C坦 th畛 c坦 u nang c湛ng t畛n t畉i 畛 bu畛ng tr畛ng xo畉n (y畉u t畛 thu畉n l畛i). - D畉u hi畛u h畉ng 畛nh nh畉t 坦 l bu畛ng tr畛ng to ra g畉p nhi畛u l畉n (th畛 t鱈ch b狸nh th動畛ng : 4-7 ml) so v畛i bu畛ng tr畛ng 畛i b棚n, c坦 nh畛ng nang no達n (8-12 mm) 畛 ngo畉i vi t畉o d畉u hi畛u chu畛i ng畛c (string of pearls sign). - D畉u hi畛u vi畛n h畛i 但m dy quanh nang no達n (follicular ring sign): vi畛n h畛i 但m dy (1-2 mm) quanh nh畛ng nang no達n nh畛 (3-7 mm) (畉u d嘆 但m 畉o 動u th畉 h董n 畉u d嘆 qua thnh b畛ng, so s叩nh v畛i bu畛ng tr畛ng 畛i b棚n). Gi畉i th鱈ch: do s畛 ph湛 n畛 v xu畉t huy畉t quanh nh畛ng nang no達n nh畛. D畉u hi畛u ny th動畛ng th畉y 畛 giai o畉n s畛m c畛a b畛nh. Mala Sibal. Follicular Ring Sign - Simple Sonographic Sign for Early Diagnosis of Ovarian Torsion. J Ultrasound Med 2012; 31:1803 1809 | 0278-4297 14 Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
15 Mala Sibal. Follicular Ring Sign - Simple Sonographic Sign for Early Diagnosis of Ovarian Torsion. J Ultrasound Med 2012; 31:1803 1809 | 0278-4297 SA qua ng達 thnh b畛ng: Follicular ring sign 畛 2 tr動畛ng h畛p xo畉n bu畛ng tr畛ng.
16
Mala Sibal. Follicular Ring Sign - Simple Sonographic Sign for Early Diagnosis of Ovarian Torsion. J Ultrasound Med 2012; 31:1803 1809 | 0278-4297 17
18 Mala Sibal. Follicular Ring Sign - Simple Sonographic Sign for Early Diagnosis of Ovarian Torsion. J Ultrasound Med 2012; 31:1803 1809 | 0278-4297
XO畉N VI-BU畛NG TR畛NG (OVARIAN-FALLOPIAN TUBE TORSION) 1. D畉u hi畛u t畉i bu畛ng tr畛ng: - C坦 th畛 c坦 u nang c湛ng t畛n t畉i 畛 bu畛ng tr畛ng xo畉n (y畉u t畛 thu畉n l畛i). - D畉u hi畛u h畉ng 畛nh nh畉t 坦 l bu畛ng tr畛ng to ra g畉p nhi畛u l畉n (th畛 t鱈ch b狸nh th動畛ng : 4-7 ml) so v畛i bu畛ng tr畛ng 畛i b棚n, c坦 nh畛ng nang no達n (8-12 mm) 畛 ngo畉i vi t畉o d畉u hi畛u chu畛i ng畛c (string of pearls sign). - D畉u hi畛u vi畛n h畛i 但m dy quanh nang no達n (Follicular ring sign): vi畛n h畛i 但m dy (1-2 mm) quanh nh畛ng nang no達n nh畛 (3-7 mm) (畉u d嘆 但m 畉o 動u th畉 h董n 畉u d嘆 qua thnh b畛ng, so s叩nh v畛i bu畛ng tr畛ng 畛i b棚n). Gi畉i th鱈ch: do s畛 ph湛 n畛 v xu畉t huy畉t quanh nh畛ng nang no達n nh畛. D畉u hi畛u ny th動畛ng th畉y 畛 giai o畉n s畛m c畛a b畛nh. - Bu畛ng tr畛ng ho畉c u nang bu畛ng tr畛ng n畉m 畛 v畛 tr鱈 b畉t th動畛ng: 畛 動畛ng gi畛a, ph鱈a tr動畛c ho畉c 叩y t畛 cung, t炭i c湛ng. - D畛ch 畛 t炭i c湛ng. Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Bu畛ng tr畛ng ho畉c u nang bu畛ng tr畛ng n畉m 畛 vi味 tr鱈 b畉t th動畛ng ch畛 d畛 nh畉n bi畉t n畉u lm si棚u 但m qua ng達 thnh b畛ng.
Bu畛ng tr畛ng n畉m 畛 m畉t tr動畛c t畛 cung, tr棚n 動畛ng gi畛a, c坦 k鱈ch th動畛c r畉t l畛n so v畛i TC. C坦 nh畛ng nang nh畛 trong bu畛ng tr畛ng. C坦 鱈t di味ch t炭i c湛ng. 20
21 RLQ pain, no fever, vomiting, 10 year old female Sag Trans Sag, midline Annemieke Littooij. Netherlands. Ovarian torsion with twisted pedicle on ultrasound. Radiopaedia.org
22 Ph畛 n畛 tr畉, au b畛ng c畉p, c畉t d畛c v湛ng h畉 vi味 th畉y c畉u tr炭c nang l畛n n畉m tr動畛c TC, ph鱈a tr棚n BQ. Vi味 tr鱈 b畉t th動畛ng ny g畛i 箪 xo畉n bu畛ng tr畛ng. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
Bu畛ng tr畛ng P to ra (so v畛i bu畛ng tr畛ng T- h狸nh C), n畉m 畛 動畛ng gi畛a. 23
Ba th叩ng sau m畛 th叩o xo畉n, bu畛ng tr畛ng tr畛 l畉i k鱈ch th動畛c b狸nh th動畛ng. 24
XO畉N VI-BU畛NG TR畛NG (OVARIAN-FALLOPIAN TUBE TORSION) 1. D畉u hi畛u t畉i bu畛ng tr畛ng: - C坦 th畛 c坦 u nang c湛ng t畛n t畉i 畛 bu畛ng tr畛ng xo畉n (y畉u t畛 thu畉n l畛i). - D畉u hi畛u h畉ng 畛nh nh畉t 坦 l bu畛ng tr畛ng to ra g畉p nhi畛u l畉n (th畛 t鱈ch b狸nh th動畛ng : 4-7 ml) so v畛i bu畛ng tr畛ng 畛i b棚n, c坦 nh畛ng nang no達n (8-12 mm) 畛 ngo畉i vi t畉o d畉u hi畛u chu畛i ng畛c (string of pearls sign). - D畉u hi畛u vi畛n h畛i 但m dy quanh nang no達n (follicular ring sign): vi畛n h畛i 但m dy (1-2 mm) quanh nh畛ng nang no達n nh畛 (3-7 mm) (畉u d嘆 但m 畉o 動u th畉 h董n 畉u d嘆 qua thnh b畛ng, so s叩nh v畛i bu畛ng tr畛ng 畛i b棚n). Gi畉i th鱈ch: do s畛 ph湛 n畛 v xu畉t huy畉t quanh nh畛ng nang no達n nh畛. D畉u hi畛u ny th動畛ng th畉y 畛 giai o畉n s畛m c畛a b畛nh. - Bu畛ng tr畛ng ho畉c u nang bu畛ng tr畛ng n畉m 畛 v畛 tr鱈 b畉t th動畛ng: 畛 動畛ng gi畛a, ph鱈a tr動畛c ho畉c 叩y t畛 cung, t炭i c湛ng. - D畛ch 畛 t炭i c湛ng. - Doppler bu畛ng tr畛ng: + Kh担ng c坦 ph畛 畛ng m畉ch Xo畉n hon ton. + EDV = 0 Xo畉n kh担ng hon ton. + Ph畛 tardus-parvus Xo畉n kh担ng hon ton. * Bu畛ng tr畛ng c坦 kh畉 nng 動畛c b畉o t畛n n畉u ta b畉t 動畛c ph畛 Doppler. 25
26 L働U V畛 K畛 THU畉T SIU M DOPPLER - C畉 Doppler mu v Doppler xung 畛u ph畉i 動畛c s畛 d畛ng. - Doppler xung nh畉y h董n Doppler mu, ph畉i di chuy畛n c畛a s畛 Doppler kh畉p bu畛ng tr畛ng 畛 d嘆 t狸m t鱈n hi畛u Doppler xung. C坦 t鱈n hi畛u Doppler xung kh担ng c坦 ngh挑a l b狸nh th動畛ng, c畉n nh畉n bi畉t ph畛 c坦 EDV = 0 v ph畛 tardus parvus. - Ch畛nh PRF 畛 m畛c 600 Hz (0.6 kHz) khi lm Doppler m畉ch m叩u bu畛ng tr畛ng. N棚n d湛ng Doppler nng l動畛ng ho畉c Doppler nng l動畛ng c坦 畛nh h動畛ng (gi畉m x畉o 畉nh do chuy畛n 畛ng). - C畛 g畉ng ti畉p c畉n v湛ng c畉n kh畉o s叩t sao cho h畛p mu 畉t cng n担ng cng t畛t (cng nh畉y mu). - H畛p mu ch畛nh nh畛, v畛a 畛 bao tr湛m v湛ng c畉n kh畉o s叩t (tng t畛c 畛 khung h狸nh). - C畛 g畉ng gi畛 畉u d嘆 c畛 畛nh, kh担ng di chuy畛n khi lm si棚u 但m Doppler (tr畛 khi lm Doppler mu v畛i d畉u hi畛u xo叩y n動畛c).
27 (a) Doppler US cho th畉y tr畛 kh叩ng th畉p 畛 bu畛ng tr畛ng tr叩i, bu畛ng tr畛ng 動u th畉 (dominant). (b) Doppler US cho th畉y tr畛 kh叩ng cao 畛 bu畛ng tr畛ng ph畉i, bu畛ng tr畛ng ng畛 (dormant). Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368 Left Right
N畛, 24 tu畛i, au c畉p t鱈nh HCP: BT (P) to ra, c坦 nh畛ng nang nh畛 畛 ngo畉i vi, c坦 鱈t di味ch bao quanh (*). Doppler: kh担ng c坦 ph畛 畛ng m畉ch l畉n ph畛 t挑nh m畉ch. Xo畉n hon ton 28
EDV =0 Xo畉n kh担ng hon ton 29
10/31/2017 PH畛 TARDUS-PARVUS V畛i d嘆ng ch畉y b畛 h畉p n畉ng 畛 th動畛ng l動u, ta c坦 ph畛 tardus parvus (ph畛 m畉ch ch畉m) 畛 h畉 l動u d嘆ng ch畉y. Ph畛 ny c滴ng th畉y khi d嘆ng ch畉y b畛 h畉p n畉ng tr棚n m畛t o畉n di, d嘆ng ch畉y do tu畉n hon bng h畛 h狸nh thnh v c坦 th畛 th畉y 畛 cu畛ng xo畉n c畛a c叩c c董 quan (bu畛ng tr畛ng, tinh hon...). 畉c tr動ng c畛a ph畛 ny l th畛i gian gia t畛c (AT acceleration time) k辿o di, PSV th畉p v tr嘆n. Ta c畉n nh畉n bi畉t 動畛c d畉ng s坦ng ny 畛 tr叩nh b畛 s坦t ch畉n o叩n. 30
10/31/2017 H畉p > 75% v畛i tng PSV > 150cm/s, AT (acceleration time th畛i gian gia t畛c) > 0,07s 畛 o畉n g畉n M th畉n (P) v ph畛 tardus-parvus trong nhu m担 th畉n (P) v畛i AT k辿o di, PSV th畉p v tron. C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition.2005 31
10/31/2017 So s叩nh ph畛 畛 M c畉nh chung, c畉nh trong b狸nh th動畛ng v ph畛 tardus-parvus 畛 h畉 l動u ch畛 h畉p. 32
10/31/2017 Ph畛 b狸nh th動畛ng 畛 M gian thuy th畉n Ph畛 tardus-parvus 畛 M gian thuy th畉n 33
10/31/2017 34
10/31/2017 35
BN c坦 thai v畛i bu畛ng tr畛ng bi味 k鱈ch th鱈ch qu叩 m畛c (hyperstimulated), vo vi畛n v狸 au b畛ng c畉p: SA th畉y bu畛ng tr畛ng T r畉t to, Doppler c坦 ph畛 tardus-parvus. M畛: xo畉n 3 vong. 10/31/2017 36
37 Left ovary: 5x5x4 cm = 50 ml. Normal right ovary Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368
38 BN n畛, 29 tu畛i, au h畛 ch畉u tr叩i, l畉p i l畉p l畉i, SA ch畉n o叩n u nang b狸 bu畛ng tr畛ng tr叩i. See-Ying Chiou et al. Adnexal Torsion- New Clinical and Imaging Observations by Sonography, Computed Tomography, and Magnetic Resonance Imaging. J Ultrasound Med 2007; 26:12891301 BN 動畛c m畛 mu畛n trong ngy v狸 l但m sng nghi ng畛. K畉t qu畉: Xo畉n v嘆i-bu畛ng tr畛ng tr叩i ho畉i t畛.
39 Hx: PCOS M畛t tu畉n sau: right necrotic ovarian torsion! 8x7x5 cm = 140 ml. Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368
XO畉N VI-BU畛NG TR畛NG (OVARIAN-FALLOPIAN TUBE TORSION) 2. D畉u hi畛u t畉i cu畛ng xo畉n: D畉u hi畛u xo叩y n動畛c (whirlpool sign) 動畛c xem l d畉u hi畛u 畉c hi畛u: + D畉u hi畛u ny ch畛 th畉y 動畛c khi c畉t ngang cu畛ng xo畉n v di chuy畛n 畉u d嘆 t畛i-lui (to and fro) d畛c theo tr畛c c畛a cu畛ng xo畉n. 坦 l h狸nh 畉nh xo叩y n動畛c c湛ng ho畉c ng動畛c chi畛u kim 畛ng h畛. + N畉u si棚u 但m Doppler th畉y 動畛c t鱈n hi畛u mu ho畉c b畉t 動畛c ph畛 c畛a m畉ch m叩u trong xo叩y n動畛c Bu畛ng tr畛ng c嘆n kh畉 nng b畉o t畛n. Vijayaraghavan SB. Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med 2004;23(12):16431649. 40
41 - D畉u hi畛u xo叩y n動畛c c坦 th畛 th畉y 畛 vi味 tr鱈 gi畛a bu畛ng tr畛ng v thnh b棚n v湛ng ch畉u (lateral whirlpool sign) ho畉c gi畛a bu畛ng tr畛ng v t畛 cung (medial whirlpool sign). N坦i c叩ch kh叩c, n坦 n畉m 畛 c畉nh ngoi ho畉c c畉nh trong bu畛ng tr畛ng, i畛u ny r畉t quan tr畛ng khi i t狸m d畉u hi畛u ny. - Bu畛ng tr畛ng cng to th狸 cng nhi畛u kh畉 nng t狸m th畉y lateral whirlpool sign. Daniella Navve et al. Medial or Lateral Location of the Whirlpool Sign in Adnexal Torsion - Clinical Importance. J Ultrasound Med 2013; 32:16311634 Medial whirlpool sign Lateral whirlpool sign LM TH畉 NO 畛 TM 働畛C CU畛NG XO畉N?
42 D. V. VALSKY et al. Whirlpool sign in the diagnosis of adnexal torsion with atypical clinical presentation. Ultrasound Obstet Gynecol 2009; 34: 239242
43 D. V. VALSKY et al. Whirlpool sign in the diagnosis of adnexal torsion with atypical clinical presentation. Ultrasound Obstet Gynecol 2009; 34: 239242
Xo畉n bu畛ng tr畛ng T - D畉u hi畛u xo叩y n動畛c Arthur C. Fleischer et al. Sonography in Obstetrics & Gynecology: principles and practice, 6th Edition. 2001 44
45 D. V. VALSKY et al. Whirlpool sign in the diagnosis of adnexal torsion with atypical clinical presentation. Ultrasound Obstet Gynecol 2009; 34: 239242
46 D. V. VALSKY et al. Whirlpool sign in the diagnosis of adnexal torsion with atypical clinical presentation. Ultrasound Obstet Gynecol 2009; 34: 239242
47 XO畉N VI TR畛NG N THU畉N (ISOLATED FALLOPIAN TUBE TORSION) - H狸nh 畉nh bu畛ng tr畛ng hai b棚n b狸nh th動畛ng, bu畛ng tr畛ng kh担ng tng th畛 t鱈ch. - Hi畛n di畛n c畉u tr炭c nang di味ch c畉nh bu畛ng tr畛ng, h狸nh thoi, v畛i m畛t b棚n c坦 h狸nh 畉nh m畛 chim (beakbird pattern) h動畛ng v畛 bu畛ng tr畛ng b棚n t畛n th動董ng. Thnh 畛ng dy. Th但m nhi畛m m畛 quanh 畛ng. - D畉u hi畛u xo叩y n動畛c (whirlpool sign) t畉i cu畛ng xo畉n. - D畛ch t動味 do 畛 tui cung.
48 BN n畛, 60 tu畛i, au h畛 ch畉u P 達 4 ngy
49 M畛: xo畉n voi tr畛ng (P) 3 v嘆ng S. Boopathy Vijayaraghavan et al. Isolated Torsion of the Fallopian Tube The Sonographic Whirlpool sign. J Ultrasound Med 2009; 28:657-662
50 S. Boopathy Vijayaraghavan et al. Isolated Torsion of the Fallopian Tube The Sonographic Whirlpool sign. J Ultrasound Med 2009; 28:657-662 Hydrosalpinx hai b棚n, b棚n P nhi畛u h董i b棚n T BN n畛, 29 tu畛i, au c畉nh d動畛i r畛n b棚n P 達 3 ngy
51 Bu畛ng tr畛ng P b狸nh th動畛ng, d畉u hi畛u xo叩y n動畛c c畉nh bu畛ng tr畛ng P. V嘆i tr畛ng P bi味 xo畉n 3 v嘆ng (HS: hydrosalpinx) S. Boopathy Vijayaraghavan et al. Isolated Torsion of the Fallopian Tube The Sonographic Whirlpool sign. J Ultrasound Med 2009; 28:657-662
52 BN n畛, 46 tu畛i, au h担ng (T) k竪m n担n 坦i 2 ngy. S. Boopathy Vijayaraghavan et al. Isolated Torsion of the Fallopian Tube The Sonographic Whirlpool sign. J Ultrasound Med 2009; 28:657-662
53 BN n畛, 52 tu畛i, au h畛 ch畉u (T) 15 gi畛. 畛 di味ch voi tr畛ng (T). S. Boopathy Vijayaraghavan et al. Isolated Torsion of the Fallopian Tube The Sonographic Whirlpool sign. J Ultrasound Med 2009; 28:657-662
54
55Radoica Jokic et al. Isolated Fallopian Tube Torsion - A Challenge for the Timely Diagnosis and Treatment. Paratubal cyst
SIU M CH畉N ON XO畉N PH畉N PH畛 (ADNEXAL TORSION) 1. D畉u hi畛u t畉i bu畛ng tr畛ng: - Y畉u t畛 thu畉n l畛i: U nang bu畛ng tr畛ng (th動畛ng lnh t鱈nh) y畉u t畛 thu畉n l畛i. - D畉u hi畛u h畉ng 畛nh nh畉t 坦 l bu畛ng tr畛ng to ra g畉p nhi畛u l畉n (> 4 cm chi畛u di, > 20 ml th畛 t鱈ch). - D畉u hi畛u vi畛n h畛i 但m dy quanh nang no達n (follicular ring sign). - Bu畛ng tr畛ng ho畉c u nang bu畛ng tr畛ng n畉m 畛 v畛 tr鱈 b畉t th動畛ng. - D畛ch 畛 t炭i c湛ng. - Doppler bu畛ng tr畛ng: + Kh担ng c坦 ph畛 畛ng m畉ch Xo畉n hon ton. + EDV = 0 Xo畉n kh担ng hon ton. + Ph畛 tardus-parvus Xo畉n kh担ng hon ton. Bu畛ng tr畛ng c坦 kh畉 nng 動畛c b畉o t畛n n畉u ta b畉t 動畛c ph畛 Doppler. 2. D畉u hi畛u t畉i cu畛ng xo畉n: - D畉u hi畛u xo叩y n動畛c (whirlpool sign). - Doppler mu (+): Bu畛ng tr畛ng c嘆n kh畉 nng b畉o t畛n. * Ngh挑 畉n Xo畉n v嘆i tr畛ng 董n thu畉n khi th畉y 畛 d畛ch tai v嘆i + D畉u hi畛u xo叩y n動畛c + Bu畛ng tr畛ng b狸nh th動畛ng. 56
Ch畉n o叩n xo畉n ph畉n ph畛 bao gi畛 c滴ng l m畛t th叩ch th畛c c畉 v畛i Bs l但m sng l畉n Bs si棚u 但m. U nang bu畛ng tr畛ng ho畉c 畛 d畛ch tai v嘆i l y畉u t畛 thu畉n l畛i. C畉n c畉nh gi叩c v畛i nh畛ng thai ph畛 c坦 d湛ng thu畛c k鱈ch th鱈ch r畛ng tr畛ng. Tng th畛 t鱈ch bu畛ng tr畛ng l d畉u hi畛u c畉nh b叩o. Bu畛ng tr畛ng c坦 th畛 hon ton b狸nh th動畛ng n畉u ch畛 xo畉n v嘆i tr畛ng. 57 I畛M NH畉N TH畛C HNH
Bu畛ng tr畛ng n畉m 畛 v畛 tr鱈 b畉t th動畛ng l d畉u hi畛u g畛i 箪. Bu畛ng tr畛ng c嘆n t動畛i m叩u kh担ng c坦 ngh挑a l kh担ng bi味 xo畉n (dual supply arteries). Kh担ng t動畛i m叩u bu畛ng tr畛ng ch畛 th畉y 畛 giai o畉n mu畛n (c畉t b畛 bu畛ng tr畛ng). au h畉 v畛 畛 ph畛 n畛, n畉u nghi ng畛 xo畉n ph畉n ph畛, c畉n ph畉i i t狸m d畉u hi畛u vi畛n h畛i 但m dy quanh nang no達n (follicular ring sign) v d畉u hi畛u xo叩y n動畛c (whirlpool sign). 58 I畛M NH畉N TH畛C HNH
Kh畛i 畉u kh畉o s叩t n棚n d湛ng 畉u d嘆 qua ng達 thnh b畛ng: 畉u d嘆 qua ng達 thnh b畛ng tuy 畛 ph但n gi畉i kh担ng cao so v畛i 畉u d嘆 qua ng達 但m 畉o nh動ng s畉 cho c叩i nh狸n ton c畉nh h董n, nh畉t l khi i t狸m v畛 tr鱈 b畉t th動畛ng c畛a ph畉n ph畛. 畉u d嘆 qua ng達 thng b畛ng c坦 t畉n s畛 th畉p h董n, 畛 nh畉y Doppler mu v Doppler xung s畉 cao h董n 畉u d嘆 qua ng達 但m 畉o. Si棚u 但m ch畉n o叩n v畛i 畛 nh畉y 84%, 畛 畉c hi畛u 77%, 畛 ch鱈nh x叩c 81%. 59 I畛M NH畉N TH畛C HNH Jie-Ling Feng et al. Spectrums and Outcomes of Adnexal Torsion at Different Ages. J Ultrasound Med Volume 36, Issue 9 September 2017 Pages 18591866.
60 Mala Sibal. Follicular Ring Sign - Simple Sonographic Sign for Early Diagnosis of Ovarian Torsion. J Ultrasound Med 2012; 31:1803 1809 | 0278-4297
61 Follicular ring sign th畉y 畛 12/15 tr動畛ng h畛p. Whirlpool sign th畉y 畛 7/15 tr動畛ng h畛p. Kh担ng c坦 t鱈n hi畛u Doppler th畉y 畛 7/15 tr動畛ng h畛p. C坦 c畉 3 d畉u hi畛u th畉y 畛 2/15 tr動畛ng h畛p. Follicular ring sign v Whirlpool sign th畉y 畛 3/15 tr動畛ng h畛p. Follicular ring sign v Kh担ng c坦 t鱈n hi畛u Doppler th畉y 畛 3/15 tr動畛ng h畛p. Whirlpool sign v Kh担ng c坦 t鱈n hi畛u Doppler th畉y 畛 1/15 tr動畛ng h畛p. Ch畛 c坦 Follicular ring sign th畉y 畛 4/15 tr動畛ng h畛p. Ch畛 c坦 Whirlpool sign th畉y 畛 1/15 tr動畛ng h畛p. Ch畛 c坦 Kh担ng c坦 t鱈n hi畛u Doppler th畉y 畛 1/15 tr動畛ng h畛p. Whirlpool sign v Kh担ng c坦 t鱈n hi畛u Doppler 動畛c xem l 2 d畉u hi畛u 畉c hi畛u nh畉t. Whirlpool sign l d畉u hi畛u th畉y s畛m nh動ng c坦 khi kh担ng th畉y ho畉c do kinh nghi畛m c畛a ng動畛i lm si棚u 但m, ho畉c do h畉n ch畉 tr動畛ng nh狸n v狸 kh担ng th畛 lm si棚u 但m qua ng達 但m 畉o, do nh但n x董 che l畉p ho畉c cu畛ng xo畉n 畛 vi味 tr鱈 kh担ng thu畉n l畛i. Th棚m n畛a, whirlpool sign c坦 t畉n su畉t d動董ng t鱈nh gi畉 (false- positive) l 10%. Kh担ng c坦 t鱈n hi畛u Doppler 畛 bu畛ng tr畛ng l d畉u hi畛u mu畛n v v狸 th畉 kh担ng th畛 th畉y 畛 giai o畉n s畛m c畛a xo畉n. Mala Sibal. Follicular Ring Sign - Simple Sonographic Sign for Early Diagnosis of Ovarian Torsion. J Ultrasound Med 2012; 31:1803 1809 | 0278-4297
BN n畛, 32 tu畛i, v畛a sanh th動畛ng 13 ngy tr動畛c. S叩ng nay th畉y au HCP, kh担ng s畛t. 62
63
64
Surgical Procedure and Findings: The patient was placed in supine position. Introduced 3 trocars. There was right ovarian cyst torsion about 360 degrees with swelling and congestion of right ovarian tube. Detorsion of right ovary. Cystectomy of 2 dermoid ovarian cysts. Controlled bleeding. Placed a drain in Douglas' sac. Extraction of specimen through umbilical incision. Closure of all incision. Estimated blood loss: 100ml. 65
4. sacd xoan phan phu.10.2017.vsum.medic.k23

More Related Content

4. sacd xoan phan phu.10.2017.vsum.medic.k23

  • 1. SIU M CH畉N ON XO畉N PH畉N PH畛 1 Bs. NGUY畛N QUANG TR畛NG website: www.sieuamvietnam.vn, www.cdhanqk.com (L畛p Si棚u 但m SPK, kh坦a 23, HYPNT-MEDIC, 2017) Ng動畛i ta ch畛 th畉y nh畛ng g狸 ng動畛i ta 動畛c chu畉n b畛 畛 th畉y" Ralph Waldo Emerson
  • 2. Xo畉n ph畉n ph畛 l c畉p c畛u ph畉u thu畉t ph畛 khoa th動畛ng g畉p 畛ng hng th畛 5. H狸nh 畉nh r畉t thay 畛i, tri畛u ch畛ng l但m sng kh担ng 畉c hi畛u 動a 畉n ch畉m tr畛 trong ch畉n o叩n, ho畉c b畛 s坦t ch畉n o叩n. Si棚u 但m l ph動董ng ti畛n 畉u tay trong ch畉n o叩n Xo畉n ph畉n ph畛. Ch畉n o叩n s畛m = b畉o t畛n 動畛c bu畛ng tr畛ng. Ch畉n o叩n mu畛n ho畉c b畛 s坦t ch畉n o叩n = c畉t b畛 bu畛ng tr畛ng. 2 T畛NG QUAN Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368
  • 3. Xo畉n ph畉n ph畛 c坦 th畛 x畉y ra 畛 n畛 gi畛i b畉t k畛 l畛a tu畛i no; tuy nhi棚n, t畉n su畉t cao nh畉t 畛 ph畛 n畛 trong 畛 tu畛i sinh s畉n, 17%20% tr動畛ng h畛p x畉y ra trong th畛i k畛 mang thai. L但m sng kinh i畛n: au h畛 ch畉u ph畉i ho畉c tr叩i, th動畛ng kh担ng s畛t, bu畛n n担n ho畉c n担n 坦i t畛ng c董n. Xo畉n ph畉n ph畛 (Adnexal torsion) l thu畉t ng畛 bao g畛m ho畉c xo畉n bu畛ng tr畛ng, ho畉c xo畉n v嘆i tr畛ng, ho畉c xo畉n v嘆i-bu畛ng tr畛ng. Xo畉n v嘆i-bu畛ng tr畛ng chi畉n 畉n 67% tr動畛ng h畛p xo畉n ph畉n ph畛. 3 T畛NG QUAN Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368
  • 4. 4 Aruna R Patil et al. Multimodality imaging in adnexal torsion. Journal of Medical Imaging and Radiation Oncology 59 (2015) 719 Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008 Ovarian-Fallopian tube torsion
  • 5. Xo畉n v嘆i-bu畛ng tr畛ng, xo畉n bu畛ng tr畛ng 董n thu畉n th動畛ng c坦 i畛u ki畛n thu畉n l畛i l bu畛ng tr畛ng c坦 u nang (50-81% tr動畛ng h畛p), i畛n h狸nh l lnh t鱈nh; th動畛ng g畉p nh畉t l u nang b狸 (mature cystic teratoma). Xo畉n c滴ng hay g畉p 畛 H畛i ch畛ng bu畛ng tr畛ng b畛 k鱈ch th鱈ch qu叩 m畛c (Ovarian hyperstimulation syndrome). Xo畉n v嘆i tr畛ng 董n thu畉n (Isolated Fallopian tube torsion) th動畛ng c坦 i畛u ki畛n thu畉n l畛i l 畛 d畛ch tai v嘆i (hydrosalpinx). 5 T畛NG QUAN Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368
  • 6. Xo畉n b棚n ph畉i th動畛ng g畉p h董n b棚n tr叩i (v湛ng ch畉u b棚n tr叩i c坦 畉i trng sigma chi畉m ch畛). Xo畉n bu畛ng tr畛ng kh担ng th動畛ng g畉p sau Vi棚m nhi畛m v湛ng ch畉u (pelvic inflammatory disease (PID), L畉c n畛i m畉c t畛 cung (endometriosis), ho畉c B動畛u 叩c t鱈nh (do hi畛n di畛n d畉i d鱈nh lm cho bu畛ng tr畛ng k辿m di 畛ng). 6 T畛NG QUAN Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368
  • 7. L但m sng v h狸nh 畉nh ch畉n o叩n c畛a xo畉n ph畉n ph畛 r畉t thay 畛i. i畛u ny do sinh l箪 b畛nh ph畛c t畉p, ph畛 thu畛c vo nhi畛u y畉u t畛 kh叩c nhau: Th畛 lo畉i xo畉n: Xo畉n v嘆i-bu畛ng tr畛ng hay Xo畉n bu畛ng tr畛ng 董n thu畉n hay Xo畉n v嘆i tr畛ng 董n thu畉n. C坦 y畉u t畛 thu畉n l畛i (u nang bu畛ng tr畛ng) hay kh担ng?. 畛 n畉ng c畛a ch竪n 辿p m叩ch m叩u r畉t thay 畛i ph畛 thu畛c vo s畛 v嘆ng xo畉n v 畛 ch畉t c畛a xo畉n. 担i khi xo畉n-t畛 th叩o xo畉n (torsion - self-detorsion). 7 SINH L B畛NH Jean Noel Buy. Gynecological Imaging. Springer-Verlag Berlin Heidelberg 2013.
  • 8. 8 Ph畛 n畛 trong 畛 tu畛i sinh s畉n, th畛 t鱈ch bu畛ng tr畛ng b狸nh th動畛ng c坦 th畛 l棚n 畉n 22 mL. Cohen v c畛ng s畛 kh畉o s叩t 866 bu畛ng tr畛ng b狸nh th動畛ng (TAS) ghi nh畉n th畛 t鱈ch trung b狸nh l 9.8 +/- 5.8 ml v畛i gi畛i h畉n tr棚n l 21.9 mL. M畛t nghi棚n c畛u kh叩c tr棚n 406 b畛nh nh但n v畛i bu畛ng tr畛ng b狸nh th動畛ng (TVS) ghi nh畉n th畛 t鱈ch trung b狸nh 6.8 mL, v畛i gi畛i h畉n tr棚n l 18.0 mL. Bu畛ng tr畛ng 動畛c c畉p m叩u t畛 2 ngu畛n (dual vascular supply). Susan Raatz Stephenson. Diagnostic Medical Sonography Obstetrics and Gynecology. 3rd edition. 2012 by Lippincott Williams & Wilkins.
  • 9. Xo畉n v嘆i-bu畛ng tr畛ng (Ovarian-Fallopian tube torsion): c畉 bu畛ng tr畛ng v voi tr畛ng bi味 xo畉n quanh d但y ch畉ng t畛 cung-bu畛ng tr畛ng (ovarian ligament) v d但y ch畉ng treo bu畛ng tr畛ng (infundibulopelvic ligament). Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008 9
  • 10. XO畉N VI-BU畛NG TR畛NG (OVARIAN-FALLOPIAN TUBE TORSION) 1. D畉u hi畛u t畉i bu畛ng tr畛ng: - C坦 th畛 c坦 u nang c湛ng t畛n t畉i 畛 bu畛ng tr畛ng xo畉n (y畉u t畛 thu畉n l畛i). - D畉u hi畛u h畉ng 畛nh nh畉t 坦 l bu畛ng tr畛ng to ra g畉p nhi畛u l畉n (th畛 t鱈ch b狸nh th動畛ng : 7-10 ml) so v畛i bu畛ng tr畛ng 畛i b棚n, c坦 nh畛ng nang no達n (8-12 mm) 畛 ngo畉i vi t畉o d畉u hi畛u chu畛i ng畛c (string of pearls sign). Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Th畛 t鱈ch bu畛ng tr畛ng b畛 xo畉n thay 畛i t畛 26 ml t畛i 441 ml, trung b狸nh gia tng 28 l畉n k鱈ch th動畛c b狸nh th動畛ng - The volume of the twisted ovary ranged from 26 ml to 441 ml, an average of 28 times that of the normal ovary.. Graif M et al. Torsion of the ovary: sonographic features. AJR Am J Roentgenol 1984;143 (6):13311334. K鱈ch th動畛c bu畛ng tr畛ng gia tng t畛 38 ml t畛i 4308 ml - The size of the enlarged ovary or adnexa ranged from 38 ml to 4308 ml. Ferah Albayram et al. Ovarian and Adnexal Torsion Spectrum of Sonographic Findings With Pathologic Correlation. J Ultrasound Med 20:10831089, 2001
  • 11. 11 Daniella Navve et al. Medial or Lateral Location of the Whirlpool Sign in Adnexal Torsion - Clinical Importance. J Ultrasound Med 2013; 32:16311634
  • 12. 12 C董 ch畉: Kh畛i 畉u khi s畛 v嘆ng xo畉n ch動a nhi畛u, 畛 ch畉t c畛a xo畉n ch動a cao, 畛ng m畉ch c坦 thnh dy h董n, 叩p l畛c cao h董n ch動a bi味 x畉p, v畉n ti畉p t畛c t動畛i m叩u cho bu畛ng tr畛ng. Trong khi 坦, t挑nh m畉ch c坦 thnh m畛ng h董n, 叩p l畛c th畉p h董n, d畛 dng bi味 x畉p. H畉u qu畉 l bu畛ng tr畛ng b畛 xung huy畉t, ph湛 n畛 d畛 d畛i, tng th畛 t鱈ch.
  • 13. 13 N畛, 30 tu畛i, au h畛 ch畉u T 2 ngy: bu畛ng tr畛ng T (c叩c 畉u m滴i t棚n) to ra (25.6 ml), c坦 nh畛ng nang no達n to ra 畛 ngo畉i vi. Bu畛ng tr畛ng P b狸nh th動畛ng (8.5 ml). N畛, 27 tu畛i, au d畛 d畛i t畛ng c董n 達 2 ngy: bu畛ng tr畛ng T to ra c坦 nh畛ng nang no達n 畛 ngo畉i vi. 13
  • 14. XO畉N VI-BU畛NG TR畛NG (OVARIAN-FALLOPIAN TUBE TORSION) 1. D畉u hi畛u t畉i bu畛ng tr畛ng: - C坦 th畛 c坦 u nang c湛ng t畛n t畉i 畛 bu畛ng tr畛ng xo畉n (y畉u t畛 thu畉n l畛i). - D畉u hi畛u h畉ng 畛nh nh畉t 坦 l bu畛ng tr畛ng to ra g畉p nhi畛u l畉n (th畛 t鱈ch b狸nh th動畛ng : 4-7 ml) so v畛i bu畛ng tr畛ng 畛i b棚n, c坦 nh畛ng nang no達n (8-12 mm) 畛 ngo畉i vi t畉o d畉u hi畛u chu畛i ng畛c (string of pearls sign). - D畉u hi畛u vi畛n h畛i 但m dy quanh nang no達n (follicular ring sign): vi畛n h畛i 但m dy (1-2 mm) quanh nh畛ng nang no達n nh畛 (3-7 mm) (畉u d嘆 但m 畉o 動u th畉 h董n 畉u d嘆 qua thnh b畛ng, so s叩nh v畛i bu畛ng tr畛ng 畛i b棚n). Gi畉i th鱈ch: do s畛 ph湛 n畛 v xu畉t huy畉t quanh nh畛ng nang no達n nh畛. D畉u hi畛u ny th動畛ng th畉y 畛 giai o畉n s畛m c畛a b畛nh. Mala Sibal. Follicular Ring Sign - Simple Sonographic Sign for Early Diagnosis of Ovarian Torsion. J Ultrasound Med 2012; 31:1803 1809 | 0278-4297 14 Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 15. 15 Mala Sibal. Follicular Ring Sign - Simple Sonographic Sign for Early Diagnosis of Ovarian Torsion. J Ultrasound Med 2012; 31:1803 1809 | 0278-4297 SA qua ng達 thnh b畛ng: Follicular ring sign 畛 2 tr動畛ng h畛p xo畉n bu畛ng tr畛ng.
  • 16. 16
  • 17. Mala Sibal. Follicular Ring Sign - Simple Sonographic Sign for Early Diagnosis of Ovarian Torsion. J Ultrasound Med 2012; 31:1803 1809 | 0278-4297 17
  • 18. 18 Mala Sibal. Follicular Ring Sign - Simple Sonographic Sign for Early Diagnosis of Ovarian Torsion. J Ultrasound Med 2012; 31:1803 1809 | 0278-4297
  • 19. XO畉N VI-BU畛NG TR畛NG (OVARIAN-FALLOPIAN TUBE TORSION) 1. D畉u hi畛u t畉i bu畛ng tr畛ng: - C坦 th畛 c坦 u nang c湛ng t畛n t畉i 畛 bu畛ng tr畛ng xo畉n (y畉u t畛 thu畉n l畛i). - D畉u hi畛u h畉ng 畛nh nh畉t 坦 l bu畛ng tr畛ng to ra g畉p nhi畛u l畉n (th畛 t鱈ch b狸nh th動畛ng : 4-7 ml) so v畛i bu畛ng tr畛ng 畛i b棚n, c坦 nh畛ng nang no達n (8-12 mm) 畛 ngo畉i vi t畉o d畉u hi畛u chu畛i ng畛c (string of pearls sign). - D畉u hi畛u vi畛n h畛i 但m dy quanh nang no達n (Follicular ring sign): vi畛n h畛i 但m dy (1-2 mm) quanh nh畛ng nang no達n nh畛 (3-7 mm) (畉u d嘆 但m 畉o 動u th畉 h董n 畉u d嘆 qua thnh b畛ng, so s叩nh v畛i bu畛ng tr畛ng 畛i b棚n). Gi畉i th鱈ch: do s畛 ph湛 n畛 v xu畉t huy畉t quanh nh畛ng nang no達n nh畛. D畉u hi畛u ny th動畛ng th畉y 畛 giai o畉n s畛m c畛a b畛nh. - Bu畛ng tr畛ng ho畉c u nang bu畛ng tr畛ng n畉m 畛 v畛 tr鱈 b畉t th動畛ng: 畛 動畛ng gi畛a, ph鱈a tr動畛c ho畉c 叩y t畛 cung, t炭i c湛ng. - D畛ch 畛 t炭i c湛ng. Peter W. Callen et al. Ultrasonography in Obstetrics and Gynecology. 5th edition. 2008. Saunders. Elsevier. Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2nd edition. 2012. Wolters Kluwer. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Bu畛ng tr畛ng ho畉c u nang bu畛ng tr畛ng n畉m 畛 vi味 tr鱈 b畉t th動畛ng ch畛 d畛 nh畉n bi畉t n畉u lm si棚u 但m qua ng達 thnh b畛ng.
  • 20. Bu畛ng tr畛ng n畉m 畛 m畉t tr動畛c t畛 cung, tr棚n 動畛ng gi畛a, c坦 k鱈ch th動畛c r畉t l畛n so v畛i TC. C坦 nh畛ng nang nh畛 trong bu畛ng tr畛ng. C坦 鱈t di味ch t炭i c湛ng. 20
  • 21. 21 RLQ pain, no fever, vomiting, 10 year old female Sag Trans Sag, midline Annemieke Littooij. Netherlands. Ovarian torsion with twisted pedicle on ultrasound. Radiopaedia.org
  • 22. 22 Ph畛 n畛 tr畉, au b畛ng c畉p, c畉t d畛c v湛ng h畉 vi味 th畉y c畉u tr炭c nang l畛n n畉m tr動畛c TC, ph鱈a tr棚n BQ. Vi味 tr鱈 b畉t th動畛ng ny g畛i 箪 xo畉n bu畛ng tr畛ng. Carol M. Rumack et al. Diagnostic Ultrasound. 4th edition. 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 23. Bu畛ng tr畛ng P to ra (so v畛i bu畛ng tr畛ng T- h狸nh C), n畉m 畛 動畛ng gi畛a. 23
  • 24. Ba th叩ng sau m畛 th叩o xo畉n, bu畛ng tr畛ng tr畛 l畉i k鱈ch th動畛c b狸nh th動畛ng. 24
  • 25. XO畉N VI-BU畛NG TR畛NG (OVARIAN-FALLOPIAN TUBE TORSION) 1. D畉u hi畛u t畉i bu畛ng tr畛ng: - C坦 th畛 c坦 u nang c湛ng t畛n t畉i 畛 bu畛ng tr畛ng xo畉n (y畉u t畛 thu畉n l畛i). - D畉u hi畛u h畉ng 畛nh nh畉t 坦 l bu畛ng tr畛ng to ra g畉p nhi畛u l畉n (th畛 t鱈ch b狸nh th動畛ng : 4-7 ml) so v畛i bu畛ng tr畛ng 畛i b棚n, c坦 nh畛ng nang no達n (8-12 mm) 畛 ngo畉i vi t畉o d畉u hi畛u chu畛i ng畛c (string of pearls sign). - D畉u hi畛u vi畛n h畛i 但m dy quanh nang no達n (follicular ring sign): vi畛n h畛i 但m dy (1-2 mm) quanh nh畛ng nang no達n nh畛 (3-7 mm) (畉u d嘆 但m 畉o 動u th畉 h董n 畉u d嘆 qua thnh b畛ng, so s叩nh v畛i bu畛ng tr畛ng 畛i b棚n). Gi畉i th鱈ch: do s畛 ph湛 n畛 v xu畉t huy畉t quanh nh畛ng nang no達n nh畛. D畉u hi畛u ny th動畛ng th畉y 畛 giai o畉n s畛m c畛a b畛nh. - Bu畛ng tr畛ng ho畉c u nang bu畛ng tr畛ng n畉m 畛 v畛 tr鱈 b畉t th動畛ng: 畛 動畛ng gi畛a, ph鱈a tr動畛c ho畉c 叩y t畛 cung, t炭i c湛ng. - D畛ch 畛 t炭i c湛ng. - Doppler bu畛ng tr畛ng: + Kh担ng c坦 ph畛 畛ng m畉ch Xo畉n hon ton. + EDV = 0 Xo畉n kh担ng hon ton. + Ph畛 tardus-parvus Xo畉n kh担ng hon ton. * Bu畛ng tr畛ng c坦 kh畉 nng 動畛c b畉o t畛n n畉u ta b畉t 動畛c ph畛 Doppler. 25
  • 26. 26 L働U V畛 K畛 THU畉T SIU M DOPPLER - C畉 Doppler mu v Doppler xung 畛u ph畉i 動畛c s畛 d畛ng. - Doppler xung nh畉y h董n Doppler mu, ph畉i di chuy畛n c畛a s畛 Doppler kh畉p bu畛ng tr畛ng 畛 d嘆 t狸m t鱈n hi畛u Doppler xung. C坦 t鱈n hi畛u Doppler xung kh担ng c坦 ngh挑a l b狸nh th動畛ng, c畉n nh畉n bi畉t ph畛 c坦 EDV = 0 v ph畛 tardus parvus. - Ch畛nh PRF 畛 m畛c 600 Hz (0.6 kHz) khi lm Doppler m畉ch m叩u bu畛ng tr畛ng. N棚n d湛ng Doppler nng l動畛ng ho畉c Doppler nng l動畛ng c坦 畛nh h動畛ng (gi畉m x畉o 畉nh do chuy畛n 畛ng). - C畛 g畉ng ti畉p c畉n v湛ng c畉n kh畉o s叩t sao cho h畛p mu 畉t cng n担ng cng t畛t (cng nh畉y mu). - H畛p mu ch畛nh nh畛, v畛a 畛 bao tr湛m v湛ng c畉n kh畉o s叩t (tng t畛c 畛 khung h狸nh). - C畛 g畉ng gi畛 畉u d嘆 c畛 畛nh, kh担ng di chuy畛n khi lm si棚u 但m Doppler (tr畛 khi lm Doppler mu v畛i d畉u hi畛u xo叩y n動畛c).
  • 27. 27 (a) Doppler US cho th畉y tr畛 kh叩ng th畉p 畛 bu畛ng tr畛ng tr叩i, bu畛ng tr畛ng 動u th畉 (dominant). (b) Doppler US cho th畉y tr畛 kh叩ng cao 畛 bu畛ng tr畛ng ph畉i, bu畛ng tr畛ng ng畛 (dormant). Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368 Left Right
  • 28. N畛, 24 tu畛i, au c畉p t鱈nh HCP: BT (P) to ra, c坦 nh畛ng nang nh畛 畛 ngo畉i vi, c坦 鱈t di味ch bao quanh (*). Doppler: kh担ng c坦 ph畛 畛ng m畉ch l畉n ph畛 t挑nh m畉ch. Xo畉n hon ton 28
  • 29. EDV =0 Xo畉n kh担ng hon ton 29
  • 30. 10/31/2017 PH畛 TARDUS-PARVUS V畛i d嘆ng ch畉y b畛 h畉p n畉ng 畛 th動畛ng l動u, ta c坦 ph畛 tardus parvus (ph畛 m畉ch ch畉m) 畛 h畉 l動u d嘆ng ch畉y. Ph畛 ny c滴ng th畉y khi d嘆ng ch畉y b畛 h畉p n畉ng tr棚n m畛t o畉n di, d嘆ng ch畉y do tu畉n hon bng h畛 h狸nh thnh v c坦 th畛 th畉y 畛 cu畛ng xo畉n c畛a c叩c c董 quan (bu畛ng tr畛ng, tinh hon...). 畉c tr動ng c畛a ph畛 ny l th畛i gian gia t畛c (AT acceleration time) k辿o di, PSV th畉p v tr嘆n. Ta c畉n nh畉n bi畉t 動畛c d畉ng s坦ng ny 畛 tr叩nh b畛 s坦t ch畉n o叩n. 30
  • 31. 10/31/2017 H畉p > 75% v畛i tng PSV > 150cm/s, AT (acceleration time th畛i gian gia t畛c) > 0,07s 畛 o畉n g畉n M th畉n (P) v ph畛 tardus-parvus trong nhu m担 th畉n (P) v畛i AT k辿o di, PSV th畉p v tron. C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition.2005 31
  • 32. 10/31/2017 So s叩nh ph畛 畛 M c畉nh chung, c畉nh trong b狸nh th動畛ng v ph畛 tardus-parvus 畛 h畉 l動u ch畛 h畉p. 32
  • 33. 10/31/2017 Ph畛 b狸nh th動畛ng 畛 M gian thuy th畉n Ph畛 tardus-parvus 畛 M gian thuy th畉n 33
  • 36. BN c坦 thai v畛i bu畛ng tr畛ng bi味 k鱈ch th鱈ch qu叩 m畛c (hyperstimulated), vo vi畛n v狸 au b畛ng c畉p: SA th畉y bu畛ng tr畛ng T r畉t to, Doppler c坦 ph畛 tardus-parvus. M畛: xo畉n 3 vong. 10/31/2017 36
  • 37. 37 Left ovary: 5x5x4 cm = 50 ml. Normal right ovary Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368
  • 38. 38 BN n畛, 29 tu畛i, au h畛 ch畉u tr叩i, l畉p i l畉p l畉i, SA ch畉n o叩n u nang b狸 bu畛ng tr畛ng tr叩i. See-Ying Chiou et al. Adnexal Torsion- New Clinical and Imaging Observations by Sonography, Computed Tomography, and Magnetic Resonance Imaging. J Ultrasound Med 2007; 26:12891301 BN 動畛c m畛 mu畛n trong ngy v狸 l但m sng nghi ng畛. K畉t qu畉: Xo畉n v嘆i-bu畛ng tr畛ng tr叩i ho畉i t畛.
  • 39. 39 Hx: PCOS M畛t tu畉n sau: right necrotic ovarian torsion! 8x7x5 cm = 140 ml. Hannah C. Chang et al. Pearls and Pitfalls in Diagnosis of Ovarian Torsion. RadioGraphics 2008; 28:13551368
  • 40. XO畉N VI-BU畛NG TR畛NG (OVARIAN-FALLOPIAN TUBE TORSION) 2. D畉u hi畛u t畉i cu畛ng xo畉n: D畉u hi畛u xo叩y n動畛c (whirlpool sign) 動畛c xem l d畉u hi畛u 畉c hi畛u: + D畉u hi畛u ny ch畛 th畉y 動畛c khi c畉t ngang cu畛ng xo畉n v di chuy畛n 畉u d嘆 t畛i-lui (to and fro) d畛c theo tr畛c c畛a cu畛ng xo畉n. 坦 l h狸nh 畉nh xo叩y n動畛c c湛ng ho畉c ng動畛c chi畛u kim 畛ng h畛. + N畉u si棚u 但m Doppler th畉y 動畛c t鱈n hi畛u mu ho畉c b畉t 動畛c ph畛 c畛a m畉ch m叩u trong xo叩y n動畛c Bu畛ng tr畛ng c嘆n kh畉 nng b畉o t畛n. Vijayaraghavan SB. Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med 2004;23(12):16431649. 40
  • 41. 41 - D畉u hi畛u xo叩y n動畛c c坦 th畛 th畉y 畛 vi味 tr鱈 gi畛a bu畛ng tr畛ng v thnh b棚n v湛ng ch畉u (lateral whirlpool sign) ho畉c gi畛a bu畛ng tr畛ng v t畛 cung (medial whirlpool sign). N坦i c叩ch kh叩c, n坦 n畉m 畛 c畉nh ngoi ho畉c c畉nh trong bu畛ng tr畛ng, i畛u ny r畉t quan tr畛ng khi i t狸m d畉u hi畛u ny. - Bu畛ng tr畛ng cng to th狸 cng nhi畛u kh畉 nng t狸m th畉y lateral whirlpool sign. Daniella Navve et al. Medial or Lateral Location of the Whirlpool Sign in Adnexal Torsion - Clinical Importance. J Ultrasound Med 2013; 32:16311634 Medial whirlpool sign Lateral whirlpool sign LM TH畉 NO 畛 TM 働畛C CU畛NG XO畉N?
  • 42. 42 D. V. VALSKY et al. Whirlpool sign in the diagnosis of adnexal torsion with atypical clinical presentation. Ultrasound Obstet Gynecol 2009; 34: 239242
  • 43. 43 D. V. VALSKY et al. Whirlpool sign in the diagnosis of adnexal torsion with atypical clinical presentation. Ultrasound Obstet Gynecol 2009; 34: 239242
  • 44. Xo畉n bu畛ng tr畛ng T - D畉u hi畛u xo叩y n動畛c Arthur C. Fleischer et al. Sonography in Obstetrics & Gynecology: principles and practice, 6th Edition. 2001 44
  • 45. 45 D. V. VALSKY et al. Whirlpool sign in the diagnosis of adnexal torsion with atypical clinical presentation. Ultrasound Obstet Gynecol 2009; 34: 239242
  • 46. 46 D. V. VALSKY et al. Whirlpool sign in the diagnosis of adnexal torsion with atypical clinical presentation. Ultrasound Obstet Gynecol 2009; 34: 239242
  • 47. 47 XO畉N VI TR畛NG N THU畉N (ISOLATED FALLOPIAN TUBE TORSION) - H狸nh 畉nh bu畛ng tr畛ng hai b棚n b狸nh th動畛ng, bu畛ng tr畛ng kh担ng tng th畛 t鱈ch. - Hi畛n di畛n c畉u tr炭c nang di味ch c畉nh bu畛ng tr畛ng, h狸nh thoi, v畛i m畛t b棚n c坦 h狸nh 畉nh m畛 chim (beakbird pattern) h動畛ng v畛 bu畛ng tr畛ng b棚n t畛n th動董ng. Thnh 畛ng dy. Th但m nhi畛m m畛 quanh 畛ng. - D畉u hi畛u xo叩y n動畛c (whirlpool sign) t畉i cu畛ng xo畉n. - D畛ch t動味 do 畛 tui cung.
  • 48. 48 BN n畛, 60 tu畛i, au h畛 ch畉u P 達 4 ngy
  • 49. 49 M畛: xo畉n voi tr畛ng (P) 3 v嘆ng S. Boopathy Vijayaraghavan et al. Isolated Torsion of the Fallopian Tube The Sonographic Whirlpool sign. J Ultrasound Med 2009; 28:657-662
  • 50. 50 S. Boopathy Vijayaraghavan et al. Isolated Torsion of the Fallopian Tube The Sonographic Whirlpool sign. J Ultrasound Med 2009; 28:657-662 Hydrosalpinx hai b棚n, b棚n P nhi畛u h董i b棚n T BN n畛, 29 tu畛i, au c畉nh d動畛i r畛n b棚n P 達 3 ngy
  • 51. 51 Bu畛ng tr畛ng P b狸nh th動畛ng, d畉u hi畛u xo叩y n動畛c c畉nh bu畛ng tr畛ng P. V嘆i tr畛ng P bi味 xo畉n 3 v嘆ng (HS: hydrosalpinx) S. Boopathy Vijayaraghavan et al. Isolated Torsion of the Fallopian Tube The Sonographic Whirlpool sign. J Ultrasound Med 2009; 28:657-662
  • 52. 52 BN n畛, 46 tu畛i, au h担ng (T) k竪m n担n 坦i 2 ngy. S. Boopathy Vijayaraghavan et al. Isolated Torsion of the Fallopian Tube The Sonographic Whirlpool sign. J Ultrasound Med 2009; 28:657-662
  • 53. 53 BN n畛, 52 tu畛i, au h畛 ch畉u (T) 15 gi畛. 畛 di味ch voi tr畛ng (T). S. Boopathy Vijayaraghavan et al. Isolated Torsion of the Fallopian Tube The Sonographic Whirlpool sign. J Ultrasound Med 2009; 28:657-662
  • 54. 54
  • 55. 55Radoica Jokic et al. Isolated Fallopian Tube Torsion - A Challenge for the Timely Diagnosis and Treatment. Paratubal cyst
  • 56. SIU M CH畉N ON XO畉N PH畉N PH畛 (ADNEXAL TORSION) 1. D畉u hi畛u t畉i bu畛ng tr畛ng: - Y畉u t畛 thu畉n l畛i: U nang bu畛ng tr畛ng (th動畛ng lnh t鱈nh) y畉u t畛 thu畉n l畛i. - D畉u hi畛u h畉ng 畛nh nh畉t 坦 l bu畛ng tr畛ng to ra g畉p nhi畛u l畉n (> 4 cm chi畛u di, > 20 ml th畛 t鱈ch). - D畉u hi畛u vi畛n h畛i 但m dy quanh nang no達n (follicular ring sign). - Bu畛ng tr畛ng ho畉c u nang bu畛ng tr畛ng n畉m 畛 v畛 tr鱈 b畉t th動畛ng. - D畛ch 畛 t炭i c湛ng. - Doppler bu畛ng tr畛ng: + Kh担ng c坦 ph畛 畛ng m畉ch Xo畉n hon ton. + EDV = 0 Xo畉n kh担ng hon ton. + Ph畛 tardus-parvus Xo畉n kh担ng hon ton. Bu畛ng tr畛ng c坦 kh畉 nng 動畛c b畉o t畛n n畉u ta b畉t 動畛c ph畛 Doppler. 2. D畉u hi畛u t畉i cu畛ng xo畉n: - D畉u hi畛u xo叩y n動畛c (whirlpool sign). - Doppler mu (+): Bu畛ng tr畛ng c嘆n kh畉 nng b畉o t畛n. * Ngh挑 畉n Xo畉n v嘆i tr畛ng 董n thu畉n khi th畉y 畛 d畛ch tai v嘆i + D畉u hi畛u xo叩y n動畛c + Bu畛ng tr畛ng b狸nh th動畛ng. 56
  • 57. Ch畉n o叩n xo畉n ph畉n ph畛 bao gi畛 c滴ng l m畛t th叩ch th畛c c畉 v畛i Bs l但m sng l畉n Bs si棚u 但m. U nang bu畛ng tr畛ng ho畉c 畛 d畛ch tai v嘆i l y畉u t畛 thu畉n l畛i. C畉n c畉nh gi叩c v畛i nh畛ng thai ph畛 c坦 d湛ng thu畛c k鱈ch th鱈ch r畛ng tr畛ng. Tng th畛 t鱈ch bu畛ng tr畛ng l d畉u hi畛u c畉nh b叩o. Bu畛ng tr畛ng c坦 th畛 hon ton b狸nh th動畛ng n畉u ch畛 xo畉n v嘆i tr畛ng. 57 I畛M NH畉N TH畛C HNH
  • 58. Bu畛ng tr畛ng n畉m 畛 v畛 tr鱈 b畉t th動畛ng l d畉u hi畛u g畛i 箪. Bu畛ng tr畛ng c嘆n t動畛i m叩u kh担ng c坦 ngh挑a l kh担ng bi味 xo畉n (dual supply arteries). Kh担ng t動畛i m叩u bu畛ng tr畛ng ch畛 th畉y 畛 giai o畉n mu畛n (c畉t b畛 bu畛ng tr畛ng). au h畉 v畛 畛 ph畛 n畛, n畉u nghi ng畛 xo畉n ph畉n ph畛, c畉n ph畉i i t狸m d畉u hi畛u vi畛n h畛i 但m dy quanh nang no達n (follicular ring sign) v d畉u hi畛u xo叩y n動畛c (whirlpool sign). 58 I畛M NH畉N TH畛C HNH
  • 59. Kh畛i 畉u kh畉o s叩t n棚n d湛ng 畉u d嘆 qua ng達 thnh b畛ng: 畉u d嘆 qua ng達 thnh b畛ng tuy 畛 ph但n gi畉i kh担ng cao so v畛i 畉u d嘆 qua ng達 但m 畉o nh動ng s畉 cho c叩i nh狸n ton c畉nh h董n, nh畉t l khi i t狸m v畛 tr鱈 b畉t th動畛ng c畛a ph畉n ph畛. 畉u d嘆 qua ng達 thng b畛ng c坦 t畉n s畛 th畉p h董n, 畛 nh畉y Doppler mu v Doppler xung s畉 cao h董n 畉u d嘆 qua ng達 但m 畉o. Si棚u 但m ch畉n o叩n v畛i 畛 nh畉y 84%, 畛 畉c hi畛u 77%, 畛 ch鱈nh x叩c 81%. 59 I畛M NH畉N TH畛C HNH Jie-Ling Feng et al. Spectrums and Outcomes of Adnexal Torsion at Different Ages. J Ultrasound Med Volume 36, Issue 9 September 2017 Pages 18591866.
  • 60. 60 Mala Sibal. Follicular Ring Sign - Simple Sonographic Sign for Early Diagnosis of Ovarian Torsion. J Ultrasound Med 2012; 31:1803 1809 | 0278-4297
  • 61. 61 Follicular ring sign th畉y 畛 12/15 tr動畛ng h畛p. Whirlpool sign th畉y 畛 7/15 tr動畛ng h畛p. Kh担ng c坦 t鱈n hi畛u Doppler th畉y 畛 7/15 tr動畛ng h畛p. C坦 c畉 3 d畉u hi畛u th畉y 畛 2/15 tr動畛ng h畛p. Follicular ring sign v Whirlpool sign th畉y 畛 3/15 tr動畛ng h畛p. Follicular ring sign v Kh担ng c坦 t鱈n hi畛u Doppler th畉y 畛 3/15 tr動畛ng h畛p. Whirlpool sign v Kh担ng c坦 t鱈n hi畛u Doppler th畉y 畛 1/15 tr動畛ng h畛p. Ch畛 c坦 Follicular ring sign th畉y 畛 4/15 tr動畛ng h畛p. Ch畛 c坦 Whirlpool sign th畉y 畛 1/15 tr動畛ng h畛p. Ch畛 c坦 Kh担ng c坦 t鱈n hi畛u Doppler th畉y 畛 1/15 tr動畛ng h畛p. Whirlpool sign v Kh担ng c坦 t鱈n hi畛u Doppler 動畛c xem l 2 d畉u hi畛u 畉c hi畛u nh畉t. Whirlpool sign l d畉u hi畛u th畉y s畛m nh動ng c坦 khi kh担ng th畉y ho畉c do kinh nghi畛m c畛a ng動畛i lm si棚u 但m, ho畉c do h畉n ch畉 tr動畛ng nh狸n v狸 kh担ng th畛 lm si棚u 但m qua ng達 但m 畉o, do nh但n x董 che l畉p ho畉c cu畛ng xo畉n 畛 vi味 tr鱈 kh担ng thu畉n l畛i. Th棚m n畛a, whirlpool sign c坦 t畉n su畉t d動董ng t鱈nh gi畉 (false- positive) l 10%. Kh担ng c坦 t鱈n hi畛u Doppler 畛 bu畛ng tr畛ng l d畉u hi畛u mu畛n v v狸 th畉 kh担ng th畛 th畉y 畛 giai o畉n s畛m c畛a xo畉n. Mala Sibal. Follicular Ring Sign - Simple Sonographic Sign for Early Diagnosis of Ovarian Torsion. J Ultrasound Med 2012; 31:1803 1809 | 0278-4297
  • 62. BN n畛, 32 tu畛i, v畛a sanh th動畛ng 13 ngy tr動畛c. S叩ng nay th畉y au HCP, kh担ng s畛t. 62
  • 63. 63
  • 64. 64
  • 65. Surgical Procedure and Findings: The patient was placed in supine position. Introduced 3 trocars. There was right ovarian cyst torsion about 360 degrees with swelling and congestion of right ovarian tube. Detorsion of right ovary. Cystectomy of 2 dermoid ovarian cysts. Controlled bleeding. Placed a drain in Douglas' sac. Extraction of specimen through umbilical incision. Closure of all incision. Estimated blood loss: 100ml. 65