Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osaka, Japan.
Tohoku J Exp Med. 2011 Nov;225(3):211-4. doi: 10.1620/tjem.225.211.
Most cases of ovarian torsion require emergency surgery; the ovary has become necrotic and cannot be conserved. Preoperative determination of the ovarian necrosis extent is difficult but it may increase the likelihood of the ovary conservation. In this study, we retrospectively evaluated the findings in ovarian torsion among patients with ovarian tumors who underwent emergency surgery at a single hospital for possible preoperative indicators of ovarian viability. We thus evaluated 77 patients who were intraoperatively diagnosed with torsion of ovarian tumor between 1995 and 2010. These patients were classified into three groups depending on the postoperative histopathological findings: necrotic, congestive, and normal. Preoperative C-reactive protein (CRP) level, leukocyte count, and body temperature, along with tumor size, degree of torsion, time from the onset of abdominal pain to surgery, and incidence of acute abdomen were compared among the three groups. The sensitivity, specificity, and positive and negative predictive values of the preoperative serum CRP levels for ovarian necrosis were calculated. The CRP level, degree of torsion, and time from the onset of abdominal pain to surgery were significantly higher in the necrotic group than in the normal group. The sensitivity and specificity of the CRP level for necrosis were 35% and 83%, respectively, and positive and negative predictive values were 38% and 82% respectively. The potential for ovary conservation in suspected ovarian torsion should be greater if the tumor is non-malignant, the time from the onset of abdominal pain to operation is short, and the CRP level is < 0.3 mg/dl.
大多数卵巢扭转病例需要紧急手术；卵巢已经坏死，无法保留。术前确定卵巢坏死程度很困难，但这可能会增加保留卵巢的可能性。在这项研究中，我们回顾性评估了在一家医院因卵巢肿瘤接受紧急手术的卵巢扭转患者的发现，以寻找可能的术前卵巢存活指标。我们评估了 1995 年至 2010 年间术中诊断为卵巢肿瘤扭转的 77 例患者。这些患者根据术后组织病理学结果分为三组：坏死组、充血组和正常组。比较三组患者的术前 C 反应蛋白（CRP）水平、白细胞计数、体温、肿瘤大小、扭转程度、腹痛至手术的时间以及急腹症的发生率。计算术前血清 CRP 水平对卵巢坏死的敏感性、特异性、阳性预测值和阴性预测值。坏死组的 CRP 水平、扭转程度和腹痛至手术的时间明显高于正常组。CRP 水平对坏死的敏感性和特异性分别为 35%和 83%，阳性预测值和阴性预测值分别为 38%和 82%。如果肿瘤为良性、腹痛至手术的时间短且 CRP 水平<0.3mg/dl，则怀疑卵巢扭转时保留卵巢的可能性更大。
