Basaranoglu S, Agacayak E, Tune S Y, Icen M S, Turgut A, Peker N, Evsen M S, Gul T
Clin Exp Obstet Gynecol. 2016;43(3):345-9.
The purpose of this study was to present data on clinical and operational management and postoperative outcomes of pregnancies complicated by adnexal torsion (AT).
Twenty-four pregnant women who presented to the present clinic between January 2007 to December 2013 and were intraoperatively diagnosed with AT were included in this study. Demographic data such as age and data on obstetric history, gestational week, current trimester, previous gynecologic and non-gynecologic operations, type of surgery that was performed, average size, location and number of adnexal masses, surgical techniques that were employed, postoperative complications, and pathology results were investigated and noted.
In this study, 132 patients were operated due to AT, and the rate of pregnant women with AT was 18.2% (24/132). The mean age of the patients was 29.25 ± 6.27 years, and the mean gestational week was 18.25 ± 7. Eight patients were in their first trimester (33.3%) whereas 13 were in their second trimester (54.2%), and three were in their third trimester (12.5%) when they presented to the hospital. The mean AT size was 95.3 ± 53.9 mm, as measured by ultrasonography. All the patients were operated by laparotomy. Regarding the types of abdominal incision, 13 patients (54.2%) had a Pfannenstiel incision, three patients (12.5%) had an infra-umbilical median incision, and eight patients (33.3%) had a pararectal incision. Duration of operation was significantly shorter in patients with pararectal incisions (p < 0.01) compared to those with Pfannenstiel and infra-umbilical median incisions. Regarding the types of treatment, ten patients (41.7%) underwent unilateral salpingo-oophorectomy (USO), eight patients (33.3%) underwent adnexal detorsion+cystectomy, and six patients (25%) underwent adnexal detorsion only.
AT is a gynecologic emergency that requires early diagnosis and treatment, as it is capable of complicating the pregnancy. Determination of the current gestational week prior to the surgical intervention will assist and guide the surgeon in identifying the suitable type of surgery for a particular patient. Pararectal incision should be the incision of choice for a shorter duration of operation, which is crucial in pregnant women for reduced exposure to anesthesia.
本研究旨在呈现妊娠合并附件扭转（AT）的临床及手术管理情况以及术后结局的数据。
纳入2007年1月至2013年12月期间到本诊所就诊且术中诊断为AT的24例孕妇。调查并记录年龄等人口统计学数据、产科病史数据、孕周、当前妊娠阶段、既往妇科及非妇科手术史、所施行的手术类型、附件包块的平均大小、位置及数量、所采用的手术技术、术后并发症及病理结果。
本研究中，132例患者因AT接受手术，AT孕妇的比例为18.2%（24/132）。患者的平均年龄为29.25±6.27岁，平均孕周为18.25±7周。8例患者处于妊娠早期（33.3%），13例处于妊娠中期（54.2%），3例处于妊娠晚期（12.5%）时入院。经超声测量，AT的平均大小为95.3±53.9mm。所有患者均行剖腹手术。关于腹部切口类型，13例患者（54.2%）采用耻骨联合上横切口，3例患者（12.5%）采用脐下正中切口，8例患者（33.3%）采用直肠旁切口。与采用耻骨联合上横切口和脐下正中切口的患者相比，采用直肠旁切口的患者手术时间明显更短（p<0.01）。关于治疗类型，10例患者（41.7%）接受单侧输卵管卵巢切除术（USO），8例患者（33.3%）接受附件扭转复位+囊肿切除术，6例患者（25%）仅接受附件扭转复位术。
AT是一种需要早期诊断和治疗的妇科急症，因为它会使妊娠复杂化。在手术干预前确定当前孕周将有助于并指导外科医生为特定患者确定合适的手术类型。直肠旁切口应作为手术时间较短的首选切口，这对孕妇减少麻醉暴露至关重要。
