Galinier Philippe, Carfagna Luana, Delsol Martine, Ballouhey Quentin, Lemasson Frederique, Le Mandat Aurélie, Moscovici Jacques, Guitard Jacques, Pienkowski Catherine, Vaysse Philippe
Department of Pediatric Surgery, Chidren's Hospital, TSA 70034, 31059 Toulouse Cedex 9, France.
J Pediatr Surg. 2009 Sep;44(9):1759-65. doi: 10.1016/j.jpedsurg.2008.11.058.
BACKGROUND/PURPOSE: Ovarian torsion in childhood and adolescence is a rare entity. Traditionally, treatment is oophorectomy. The aim of this study was to evaluate ovarian outcome and to propose a decision-making protocol for suspected ovarian torsion.
Between January 1986 and December 2007, 45 ovarian torsion cases in 40 girls were operated on. In all the cases, when the ovary was preserved, patients were clinically and ultrasonographically followed up for several months.
Median age was 11 years. Median delay between the first symptoms and surgical procedure was 3 days. There was a statistical difference (P = .0003) between the mean of the largest diameter of twisted normal ovary and the mean of the largest diameter of twisted diseased ovary. Underlying pathology was benign in 22 cases and low-grade malignancy in 2 (one grade II immature teratoma and one steroid cell tumor). Conservative management was performed in 26 cases. At follow-up, 17 ovaries were follicular, 7 being black-bluish during surgery.
Conservative approach after detorsion of black-bluish ovaries is safe and effective in children. Although very unlikely, the fear of missing malignancy must incite to proceed with caution and can lead, when the size of the twisted ovary is greater than 75 mm, to prefer laparotomy to laparoscopy.
背景/目的：儿童及青少年卵巢扭转是一种罕见疾病。传统上，治疗方法为卵巢切除术。本研究的目的是评估卵巢预后，并针对疑似卵巢扭转提出决策方案。
1986年1月至2007年12月期间，对40名女孩的45例卵巢扭转病例进行了手术。在所有病例中，当卵巢得以保留时，对患者进行了数月的临床及超声随访。
中位年龄为11岁。首次症状出现至手术的中位延迟时间为3天。扭转正常卵巢的最大直径均值与扭转病变卵巢的最大直径均值之间存在统计学差异（P = .0003）。22例潜在病理为良性，2例为低度恶性（1例II级未成熟畸胎瘤和1例类固醇细胞瘤）。26例采取了保守治疗。随访时，17个卵巢呈卵泡样，其中7个在手术时呈黑蓝色。
对于儿童黑蓝色卵巢扭转后采取保守治疗是安全有效的。尽管可能性极小，但对漏诊恶性肿瘤的担忧必须促使谨慎行事，并且当扭转卵巢大小大于75 mm时，可能导致更倾向于开腹手术而非腹腔镜手术。
