Steyaert H, Meynol F, Valla J S
Department of Pediatric Surgery, Hôpital Lenval, 57, Av. de la Californie, F-06200 Nice, France.
Pediatr Surg Int. 1998 Jul;13(5-6):384-7. doi: 10.1007/s003830050345.
Experience with adnexal torsion in neonates and children is often disappointing. Delay between the first symptoms and operation is important, and adnexal loss the rule. The authors reviewed their experience and the literature to assess the appropriate diagnostic and therapeutic approach. Diagnostic procedures (standard ultrasonography [US], color Doppler US, computed tomography, magnetic resonance imaging, endorectal US, and diagnostic laparoscopy) are discussed; for neonates and premenarcheal girls a specific surgical approach is proposed. Twenty-seven adnexal torsions treated between 1985 and 1995 in the same institution were retrospectively reviewed. Neonatal (7) and premenarcheal cases (20) were separated. The neonatal cases (7) were all operated upon: 4 adnexectomies, 2 oophorectomies, and 1 detorsion with cystectomy were performed. In the premenarcheal group (20) 8 adnexectomies, 6 oophorectomies, 5 detorsions with cystectomy, and 1 salpingectomy were performed. There were only 6 salvaged adnexa in this series. In the neonatal group, US seemed accurate in predicting complicated cases. Prenatal puncture of large (>40 mm) ovarian cysts is possible. The authors advocate a laparoscopic approach in the first days of life of all uncomplicated cysts independent of size in order to increase the percentage salvaged. In ultrasonic complicated cases a delayed operation is proposed in the premenarcheal group, endorectal US will probably become the diagnostic method of choice for complicated ovaries; other methods were disappointing. In order to increase adnexal salvage, the authors recommend a laparoscopic approach in the emergency situation if a clinical examination is positive as well as better medical (pediatricians, gynecologists) and general (girls, parents) information. They suggest controlateral oophoropexy in cases of torsion of a normal adnexum.
新生儿和儿童附件扭转的治疗效果往往不尽人意。首发症状与手术之间的延误至关重要，附件切除很常见。作者回顾了他们的经验及相关文献，以评估合适的诊断和治疗方法。文中讨论了诊断程序（标准超声检查[US]、彩色多普勒超声、计算机断层扫描、磁共振成像、直肠内超声和诊断性腹腔镜检查）；针对新生儿和初潮前女孩，提出了一种特定的手术方法。回顾性分析了1985年至1995年在同一机构治疗的27例附件扭转病例。将新生儿病例（7例）和初潮前病例（20例）分开。所有新生儿病例（7例）均接受了手术：4例行附件切除术，2例行卵巢切除术，1例行扭转复位及囊肿切除术。在初潮前组（20例）中，8例行附件切除术，6例行卵巢切除术，5例行扭转复位及囊肿切除术，1例行输卵管切除术。该系列中仅6例附件得以保留。在新生儿组中，超声似乎能准确预测复杂病例。产前可穿刺大的（>40mm）卵巢囊肿。作者主张，对于所有单纯性囊肿，无论大小，在出生后的头几天采用腹腔镜手术方法，以提高保留率。对于初潮前组超声检查提示复杂的病例，建议延迟手术，直肠内超声可能会成为复杂卵巢病变的首选诊断方法；其他方法效果不佳。为了提高附件保留率，作者建议，如果临床检查呈阳性，在紧急情况下采用腹腔镜手术方法，并加强医学（儿科医生、妇科医生）及大众（女孩、家长）教育。他们建议对于正常附件扭转的病例行对侧卵巢固定术。
