年轻女性卵巢扭转的保守手术：围手术期并发症和全国趋势。
Conservative surgery for ovarian torsion in young women: perioperative complications and national trends.
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
出版信息
BJOG. 2020 Jul;127(8):957-965. doi: 10.1111/1471-0528.16179. Epub 2020 Mar 9.
OBJECTIVE
To analyse populational trends and perioperative complications following conservative surgery versus oophorectomy in women <50 years of age with ovarian torsion.
DESIGN
Population-based retrospective observational study.
SETTING
Nationwide Inpatient Sample in the USA (2001-2015).
POPULATION
In all, 89 177 ovarian torsions including 20 597 (23.1%) conservative surgeries and 68 580 (76.9%) oophorectomies.
METHODS
(1) Trend analysis to assess utilisation of conservative surgery over time, (2) multivariable binary logistic regression to identify independent factors associated with conservative surgery and (3) inverse probability of treatment weighting with a generalised estimating equation to analyze perioperative complications.
MAIN OUTCOME MEASURES
Trends, characteristics and complications related to conservative surgery.
RESULTS
Performance of conservative surgery increased from 18.9 to 25.1% between 2001 and 2015 (32.8% relative increase, P = 0.001) but decreased steadily after age 15, and sharply declined after age 35 (P < 0.001). On multivariable analysis, younger age exhibited the largest effect size for conservative surgery among the independent factors (adjusted odds ratios 3.39-7.96, P < 0.001). In the weighted model, conservative surgery was associated with an approximately 30% decreased risk of perioperative complications overall (10.0% versus 13.6%, odds ratio 0.73, 95% confidence interval 0.62-0.85, P < 0.001) and was not associated with venous thromboembolism (0.2 versus 0.3%, P = 0.457) or sepsis (0.4 versus 0.3%, P = 0.638).
CONCLUSION
There has been an increasing utilisation of conservative surgery for ovarian torsion in the USA in recent years. Our study suggests that conservative surgery for ovarian torsion may not be associated with increased perioperative complications.
TWEETABLE ABSTRACT
Conservative surgery for ovarian torsion may not be associated with increased perioperative complications.
目的
分析年龄<50 岁卵巢扭转患者行保守手术与卵巢切除术的人群趋势和围手术期并发症。
设计
基于人群的回顾性观察性研究。
地点
美国全国住院患者样本（2001-2015 年）。
人群
共纳入 89177 例卵巢扭转患者，其中 20597 例（23.1%）行保守手术，68580 例（76.9%）行卵巢切除术。
方法
（1）趋势分析评估随时间推移保守手术的应用情况，（2）多变量二项逻辑回归确定与保守手术相关的独立因素，（3）采用广义估计方程进行逆概率治疗加权分析围手术期并发症。
主要结局测量指标
与保守手术相关的趋势、特征和并发症。
结果
2001 年至 2015 年，保守手术的实施比例从 18.9%增至 25.1%（相对增加 32.8%，P=0.001），但 15 岁后呈稳步下降趋势，35 岁后急剧下降（P<0.001）。多变量分析显示，年轻是独立因素中对保守手术影响最大的因素（调整后比值比 3.39-7.96，P<0.001）。在加权模型中，保守手术总体上与围手术期并发症风险降低约 30%相关（10.0%对 13.6%，比值比 0.73，95%置信区间 0.62-0.85，P<0.001），与静脉血栓栓塞症（0.2%对 0.3%，P=0.457）或脓毒症（0.4%对 0.3%，P=0.638）无关。
结论
近年来，美国卵巢扭转保守手术的应用有所增加。本研究表明，卵巢扭转行保守手术可能不会增加围手术期并发症。
推文摘要
卵巢扭转行保守手术可能不会增加围手术期并发症。
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