Wang J-H, Wu D-H, Jin H, Wu Y-Z
Department of Gynecology, Women's Hospital, The School of Medicine, Zhejiang University, Hangzhou, China.
Eur J Pediatr Surg. 2010 Sep;20(5):298-301. doi: 10.1055/s-0030-1254110. Epub 2010 Jun 7.
BACKGROUND/PURPOSE: Consensus has not been reached regarding the treatment of ovarian torsion in premenarchal girls. If viable adnexa can be salvaged, the future reproductive potential of the girl is maximized. The authors determined the predominant etiology, evaluated the restoration of ovarian function and anatomic structure postoperatively in premenarchal girls with adnexal torsion, and discuss the most appropriate treatment.
Sixty-six premenarchal girls with twisted adnexa underwent salpingoophorectomy (27 cases), or detorsion and adnexal conservation surgery (39 cases), according to the extent of adnexal damage found intraoperatively. These patients' data were collected and analyzed. The typical presentation, predominant etiology, surgical outcome, and restoration of ovarian function postoperatively were investigated.
Of all torsive ovaries, histopathology verified that 2 (3.0%) cases were malignant, 8 (12.1%) cases were normal, and 56 (84.9%) cases were benign. After operation and menarche, ultrasound showed that the involved ovaries were of normal size with normal follicular development in 33 of the 35 (94.3%) patients who received detorsion and adnexal conservation surgery. In the remaining two (5.7%) of the 35 detorsion patients, the affected ovaries were atrophied (small sized) and there was no ultrasound evidence of follicular development.
Premenarchal girls with adnexal torsion more commonly had a benign ovarian tumor or no underlying abnormality as an etiology; ovarian malignancy was rare. In the management of these cases, detorsion and adnexal conservation surgery should be considered in cases with adnexa appearing to be ischemic or hemorrhagic infarction.
背景/目的：关于青春期前女孩卵巢扭转的治疗尚未达成共识。如果能挽救有活力的附件，女孩未来的生殖潜力将得到最大程度发挥。作者确定了主要病因，评估了青春期前附件扭转女孩术后卵巢功能和解剖结构的恢复情况，并讨论了最合适的治疗方法。
66例青春期前附件扭转女孩根据术中发现的附件损伤程度接受了输卵管卵巢切除术（27例）或扭转复位及附件保留手术（39例）。收集并分析了这些患者的数据。调查了典型表现、主要病因、手术结果及术后卵巢功能的恢复情况。
在所有扭转的卵巢中，组织病理学证实2例（3.0%）为恶性，8例（12.1%）正常，56例（84.9%）为良性。手术及初潮后，超声检查显示，在35例接受扭转复位及附件保留手术的患者中，33例（94.3%）受累卵巢大小正常，卵泡发育正常。在35例扭转复位患者中的其余2例（5.7%）中，患侧卵巢萎缩（体积小），超声检查无卵泡发育迹象。
青春期前附件扭转女孩更常见的病因是良性卵巢肿瘤或无潜在异常；卵巢恶性肿瘤罕见。在这些病例的处理中，对于附件出现缺血或出血性梗死的情况，应考虑扭转复位及附件保留手术。
