White Melissa, Stella Julian
Emergency Department, The Geelong Hospital, Geelong, Victoria, Australia.
Emerg Med Australas. 2005 Jun;17(3):231-7. doi: 10.1111/j.1742-6723.2005.00728.x.
To define the presenting symptoms and clinical progress of surgically proven cases of ovarian torsion presenting to a tertiary women's hospital.
A retrospective case review of surgically proven ovarian torsion at The Royal Women's Hospital, Melbourne between 8 May 1990 and 8 May 2000.
Fifty-two cases were identified. Median age at presentation was 33.5 years (interquartile range [IQR]: 28.7-39.3). Known risk factors at presentation were found in 16 (30.8%, 95% CI: 26.9-34.6%) cases including 6/49 (12.2%, 95% CI 11.1-12.4%) with ovarian hyperstimulation syndrome. The main clinical features included: sudden pain (20/23, 87%, 95% CI 75-98.9%), nausea/vomiting (23/39, 59%, 95% CI 49.9-68.1%) and palpable abdominal mass (23/37, 62.2%, 95% CI 52.4-71.9%). Median symptom duration was 3 days (IQR: 1-7.25). Median time to diagnosis was 22 h (IQR: 7.8-55.0). The diagnosis was mostly made at surgery (36, 69.2%, 95% CI 60.5-77.9%) with clinically suspicion in 10 (19.2%, 95% CI 17.2-21.3%) and sonographic suspicion/confirmation in six (11.5%, 95% CI 10.5-12.5%) cases. Ultrasound was performed in 31 (59.6%, 95% CI 51.7-67.6%) cases. Underlying pathologies included: ovarian cysts (27, 51.9%, 95% CI 44.9-59.0%) and tumours (16, 30.8%, 95% CI 26.9-34.6%)--mostly benign. Ovarian preservation occurred in 16 (30.8%, 95% CI 26.9-34.6%) cases with no demonstrable association to patient age, time to diagnosis or known risk factors.
The diagnosis of ovarian torsion remains challenging. Clinical characteristics lack sensitivity and specificity and ultrasound diagnosis is not definitive. Laparoscopy remains the investigation of choice. Despite delays in diagnosis this study demonstrates relatively high ovarian salvage rates compared with most published data.
明确在一家三级妇产医院经手术证实的卵巢扭转病例的临床表现及临床进展情况。
对1990年5月8日至2000年5月8日期间墨尔本皇家妇女医院经手术证实的卵巢扭转病例进行回顾性分析。
共确定52例病例。就诊时的中位年龄为33.5岁（四分位间距[IQR]：28.7 - 39.3）。16例（30.8%，95%置信区间：26.9 - 34.6%）病例存在已知的风险因素，其中6/49例（12.2%，95%置信区间11.1 - 12.4%）患有卵巢过度刺激综合征。主要临床特征包括：突发疼痛（20/23，87%，95%置信区间75 - 98.9%）、恶心/呕吐（23/39，59%，95%置信区间49.9 - 68.1%）以及可触及的腹部肿块（23/37，62.2%，95%置信区间52.4 - 71.9%）。症状持续时间的中位数为3天（IQR：1 - 7.25）。诊断的中位时间为22小时（IQR：7.8 - 55.0）。大多数诊断在手术时做出（36例，69.2%，95%置信区间60.5 - 77.9%），10例（19.2%，95%置信区间17.2 - 21.3%）临床怀疑，6例（11.5%，95%置信区间10.5 - 12.5%）超声怀疑/确诊。31例（59.6%，95%置信区间51.7 - 67.6%）进行了超声检查。潜在病理情况包括：卵巢囊肿（27例：51.9%，95%置信区间44.9 - 59.0%）和肿瘤（16例，30.8%，95%置信区间26.9 - 34.6%）——大多为良性。16例（30.8%，95%置信区间26.9 - 34.6%）病例保留了卵巢，与患者年龄、诊断时间或已知风险因素无明显关联。
卵巢扭转的诊断仍然具有挑战性。临床特征缺乏敏感性和特异性，超声诊断也不明确。腹腔镜检查仍是首选的检查方法。尽管诊断存在延迟，但与大多数已发表数据相比，本研究显示卵巢挽救率相对较高。
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