Adeyemi-Fowode Oluyemisi, Lin Emily G, Syed Fatima, Sangi-Haghpeykar Haleh, Zhu Huirong, Dietrich Jennifer E
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
J Pediatr Adolesc Gynecol. 2019 Feb;32(1):64-69. doi: 10.1016/j.jpag.2018.07.003. Epub 2018 Nov 12.
Adnexal torsion (AT) requires urgent surgical intervention to preserve ovarian function. Historically, treatment for AT was oophorectomy because of concerns related to leaving a nonviable ischemic ovary. No published studies support these theoretical concerns and current literature supports conservative management. The aim of this study was to review the institutional outcomes for AT cases, including salvage rates and complications. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This study was approved by the institutional review board at Baylor College of Medicine. A retrospective chart review on cases of AT from 2007 to 2016 at a single Children's hospital was performed on the basis of International Classification of Diseases, 10th revision and Current Procedural Terminology codes. A standardized chart review form was used in data extraction. Statistical analysis was performed using SAS version 9.4 (SAS Institute).
Chart review identified 245 torsion cases in 237 patients. The mean age was 12.4 ± 3.29 years. Of the participants, 230 (94%) underwent minimally invasive laparoscopy with ovarian preservation in 233 (95%) of the cases. There were no complications due to detorsion of the affected adnexa. Intraoperatively, the right adnexa was affected in 134 (55%) cases and a lesion was noted in 193 (79%) cases, most commonly paratubal cysts and mature teratomas. The malignancy rate was low, noted only in 4/245 patients at (1.2%). Pediatric gynecology performed most of the cases (n = 214; 87%).
The findings of our study continue to support the conservative management of patients with AT.
附件扭转（AT）需要紧急手术干预以保留卵巢功能。从历史上看，由于担心留下无活力的缺血性卵巢，AT的治疗方法是卵巢切除术。目前尚无已发表的研究支持这些理论上的担忧，而当前的文献支持保守治疗。本研究的目的是回顾AT病例的机构治疗结果，包括挽救率和并发症。
设计、地点、参与者、干预措施及主要观察指标：本研究经贝勒医学院机构审查委员会批准。根据国际疾病分类第10版和当前手术操作术语编码，对一家儿童医院2007年至2016年的AT病例进行回顾性图表审查。在数据提取过程中使用了标准化的图表审查表格。使用SAS 9.4版（SAS研究所）进行统计分析。
图表审查确定了237例患者中的245例扭转病例。平均年龄为12.4±3.29岁。在参与者中，230例（94%）接受了微创腹腔镜检查，其中233例（95%）保留了卵巢。患侧附件扭转未引起并发症。术中，右侧附件受累134例（55%），发现病变193例（79%），最常见的是输卵管旁囊肿和成熟畸胎瘤。恶性率较低，仅在4/245例患者中发现（1.2%）。大多数病例由小儿妇科进行治疗（n = 214；87%）。
我们的研究结果继续支持对AT患者进行保守治疗。
