Yildiz Abdullah, Erginel Başak, Akin Melih, Karadağ Cetin Ali, Sever Nihat, Tanik Canan, Canmemiş Arzu, Dokucu Ali Ihsan
Department of Pediatric Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
Afr J Paediatr Surg. 2014 Oct-Dec;11(4):304-7. doi: 10.4103/0189-6725.143134.
The aim of this study was to report our results on premenarchal girls with adnexal torsion who were treated with different approaches.
Twenty-six adnexal torsions in children were analysed retrospectively. Group 1 included cases of oophorectomy for the twisted adnexa. Group 2 contained the patients with adnexal torsion who untwisted either with a laparoscopic or open approach. Postoperative restoration of ovarian function was evaluated by Doppler ultrasound at the 6 th month. All oophorectomy and biopsy specimens were also evaluated.
Group 1 consisted of eleven cases that underwent oophorectomy due to gangrenous change and haemorrhagic infarction. Histology was of a mature teratoma in two cases and haemorrhagic necrosis due to torsion in seven. Group 2 consisted of 15 patients. In 10 out of 15 patients, preoperative biopsy is performed in which their histology revealed haemorrhagic necrosis in eight cases, and simple cyst with a benign nature in two cases. In all of the 10 untwisted adnexas, postoperative radiological imaging showed complete recovery with normal follicular development. No malignancy or increased tumour markers were noted in both groups.
Adnexas can be left in place regardless of the preoperative degree of necrosis. Biopsy can be added to the procedure to rule out malignancy.
本研究的目的是报告我们对采用不同方法治疗的青春期前附件扭转女孩的治疗结果。
回顾性分析26例儿童附件扭转病例。第1组包括对扭转附件进行卵巢切除术的病例。第2组包括通过腹腔镜或开放手术使附件扭转自行复位的患者。术后6个月通过多普勒超声评估卵巢功能的恢复情况。所有卵巢切除标本和活检标本也进行了评估。
第1组由11例因坏疽性改变和出血性梗死而接受卵巢切除术的病例组成。组织学检查显示，2例为成熟畸胎瘤，7例为扭转导致的出血性坏死。第2组由15例患者组成。15例患者中的10例进行了术前活检，其中组织学检查显示8例为出血性坏死，2例为良性单纯囊肿。在所有10例扭转复位的附件中，术后影像学检查显示完全恢复，卵泡发育正常。两组均未发现恶性肿瘤或肿瘤标志物升高。
无论术前坏死程度如何，附件均可保留。可在手术中增加活检以排除恶性肿瘤。
