Mashiach S, Bider D, Moran O, Goldenberg M, Ben-Rafael Z
Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Fertil Steril. 1990 Jan;53(1):76-80. doi: 10.1016/s0015-0282(16)53219-1.
A series of 201 cycles of ovarian hyperstimulation syndrome (OHSS) in 154 women were reviewed. Pregnancy occurred in 75 of 201 cycles. Twelve pregnant women (16%) presented with torsion of hyperstimulated ovary, but only 3 out of 126 patients (2.3%) who did not conceive had torsion. Because diagnosis of adnexal torsion is usually uncertain and surgical intervention is likely to be delayed, these infertile women risk losing their ovaries. The clinical picture of torsion of adnexa in patients with OHSS is presented here. The combination of ovarian enlargement, abdominal pain, nausea, progressive leukocytosis, and anemias might indicate torsion of adnexa. Although during operation the adnexa appears dark, hemorrhagic and ischemic, we suggest that it can be saved by simply unwinding it. In 11 such cases intraoperative unwinding of the adnexa was performed, and in 8 patients it was the only operative procedure. No postoperative complications were noted and in all the cases the ovaries were proven functional by ultrasonography. We concluded that torsion of hyperstimulated adnexa in patients who conceived after gonadotropin therapy, is a special entity that requires more attention to achieve early diagnosis. Nevertheless even with delayed diagnosis, the ovary can still be saved.
回顾了154名女性的201个卵巢过度刺激综合征（OHSS）周期。201个周期中有75个周期发生妊娠。12名孕妇（16%）出现了过度刺激卵巢扭转，但126名未受孕患者中只有3名（2.3%）发生扭转。由于附件扭转的诊断通常不明确，手术干预可能会延迟，这些不孕女性有失去卵巢的风险。本文介绍了OHSS患者附件扭转的临床表现。卵巢增大、腹痛、恶心、进行性白细胞增多和贫血可能提示附件扭转。尽管手术中附件看起来呈暗红色、出血且缺血，但我们建议通过简单地解开扭转即可挽救。在11例此类病例中进行了术中附件松解，其中8例患者这是唯一的手术操作。未发现术后并发症，所有病例经超声检查证实卵巢功能正常。我们得出结论，促性腺激素治疗后受孕患者的过度刺激附件扭转是一种特殊情况，需要更多关注以实现早期诊断。然而，即使诊断延迟，卵巢仍可挽救。
