Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
Fertil Steril. 2023 Dec;120(6):1257-1258. doi: 10.1016/j.fertnstert.2023.08.012. Epub 2023 Aug 11.
To analyze characteristics of acute and chronic ovarian torsion, review treatment recommendations, and present possible surgical techniques for fertility preservation in young women.
Literature review and demonstration of perioperative management of ovarian torsion using radiologic images and intraoperative video footage. Ovarian torsion is mostly mentioned in context of gynecologic emergencies, where acute ovarian torsion with arterial obstruction leads to ovarian ischemia and necrosis. However, ovarian torsion can also occur as a partial or intermittent torsion with venous and lymphatic obstruction, followed by ovarian swelling. In both cases, surgical management of ovarian torsion commonly includes oophorectomy, although leading guidelines recommend preservation of the ovary. We here aimed to raise awareness for the clinical features of ovarian torsion and demonstrate adequate perioperative management, thereby avoiding surgical overtreatment in young women.
Medical University of Vienna, Department of Obstetrics and Gynecology.
PATIENT(S): We present a case of acute ovarian torsion with a consequently ischemic ovary as well as a case of chronic ovarian torsion with related massive ovarian edema. The patients included in this video gave consent for publication of the video and posting of the video online, including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.), and other applicable sites.
INTERVENTION(S): Laparoscopic management with detorsion of the torquated ovaries, cystectomy on an ischemic ovary and oophoropexy to the pelvic side wall and utero-ovarian ligament to prevent recurrence.
Postoperative relief of pain and normalization of ovarian size and morphology on ultrasound imaging.
The current cases show successful conservative surgical management of ovarian torsion, hence preserving hormonal function and fertility in young women.
Although it is recommended to preserve fertility in young women affected by ovarian torsion, surgical overtreatment by means of oophorectomy is still common in clinical routine. Increasing awareness for the clinical characteristics of acute and chronic ovarian torsion, as well as for the importance of preservation of the ovary, is crucial. We therefore believe that ovarian torsion and its surgical management deserve increased attention in the future.
分析急性和慢性卵巢扭转的特征，综述治疗建议，并介绍年轻女性生育力保存的可能手术技术。
文献复习并结合影像学图像和术中视频演示卵巢扭转的围手术期处理。卵巢扭转主要在妇科急症中提及，其中动脉阻塞导致的急性卵巢扭转可导致卵巢缺血和坏死。然而，卵巢扭转也可能发生部分或间歇性扭转，伴有静脉和淋巴阻塞，随后出现卵巢肿胀。在这两种情况下，卵巢扭转的手术治疗通常包括卵巢切除术，尽管主要指南建议保留卵巢。我们旨在提高对卵巢扭转临床特征的认识，并展示适当的围手术期处理，从而避免年轻女性的手术过度治疗。
维也纳医科大学，妇产科。
我们介绍了一例急性卵巢扭转病例，随后发生缺血性卵巢，以及一例慢性卵巢扭转病例，伴有相关的巨大卵巢水肿。纳入本视频的患者同意发表该视频并将视频上传至线上，包括社交媒体、期刊网站、科学文献网站（如 PubMed、ScienceDirect、Scopus 等）和其他适用网站。
腹腔镜下扭转卵巢复位术、缺血卵巢的囊肿切除术和卵巢悬韧带固定术。
术后疼痛缓解和超声影像学上卵巢大小和形态恢复正常。
目前的病例显示，成功地对卵巢扭转进行了保守手术治疗，从而保留了年轻女性的激素功能和生育能力。
尽管建议对受卵巢扭转影响的年轻女性保留生育能力，但手术过度治疗，即卵巢切除术，在临床常规中仍很常见。提高对急性和慢性卵巢扭转的临床特征以及保留卵巢重要性的认识至关重要。因此，我们认为卵巢扭转及其手术管理在未来应得到更多关注。
