Taskin O, Birincioglu M, Aydin A, Buhur A, Burak F, Yilmaz I, Wheeler J M
Department of Obstetrics and Gynaecology, Inonu University Medical School, Malatya, Turkey.
Hum Reprod. 1998 Oct;13(1O):2823-7. doi: 10.1093/humrep/13.10.2823.
This prospective controlled follow-up study was designed to examine the effects of adnexal torsion on long-term ovarian histology and radical scavenger (FRS) activity, and subsequent viability following the detorsion of twisted ischaemic adnexa, in a primate centre of a university clinic. Adnexal torsion/occlusion was created by twisting the adnexa three times and fixing on to the side wall or by applying vascular clips in cycling female rats at 70 days of age. Following an ischaemic period of 4 to 36 h, the twisted adnexas were surgically removed and fixed. In the second group of rats, following the above ischaemic periods, the torsion/occlusion were relieved by detwisting or removing the vascular clips. Then the animals were reperfused for a week and adnexas were extirpated. After both ischaemia and reperfusion, the removed adnexas were examined histologically and tissue concentrations of glutathione peroxidase, superoxide dismutase, catalase and glutathione were determined. Regardless of the ischaemia time, all the twisted adnexas were black-bluish in appearance. Despite the gross ischaemic-haemorrhagic features, histological sections revealed negligible changes, with intact ovarian structure similar to controls in 4-24 h groups. Though decreased compared with controls, the change in tissue concentrations of FRS was not significant in 4-24 h groups. Only the 36 h group showed prominent congestion on all sections and a significant decrease in all radical scavenger concentrations studied. While no long-term reperfusion injury was observed histologically in 4-24 h groups, the 36 h group ended with adnexal necrosis. Our findings support the importance of early diagnosis and conservative surgical management (detorsion) in adnexal torsion. Lack of histological changes and unimpaired FRS metabolism are consistent with the recent data that vascular compromise is caused by venous or lymphatic stasis in early torsion and that adnexal integrity is not correlated with gross ischaemic appearance, thus providing evidence of adnexal resistance against ischaemia.
本前瞻性对照随访研究旨在在一所大学诊所的灵长类动物中心，研究附件扭转对卵巢长期组织学和自由基清除剂（FRS）活性的影响，以及扭转缺血附件扭转解除后的后续生存能力。通过在70日龄的雌性成年大鼠中，将附件扭转三次并固定于侧壁，或应用血管夹来造成附件扭转/阻塞。在4至36小时的缺血期后，手术切除并固定扭转的附件。在第二组大鼠中，在上述缺血期后，通过扭转复位或移除血管夹来解除扭转/阻塞。然后使动物再灌注一周并切除附件。在缺血和再灌注后，对切除的附件进行组织学检查，并测定谷胱甘肽过氧化物酶、超氧化物歧化酶、过氧化氢酶和谷胱甘肽的组织浓度。无论缺血时间如何，所有扭转的附件外观均呈蓝黑色。尽管有明显的缺血性出血特征，但组织学切片显示变化可忽略不计，4至24小时组的卵巢结构完整，与对照组相似。虽然与对照组相比有所下降，但4至24小时组FRS的组织浓度变化并不显著。只有36小时组的所有切片均显示明显充血，且所研究的所有自由基清除剂浓度均显著降低。虽然4至24小时组在组织学上未观察到长期再灌注损伤，但第36小时组最终出现附件坏死。我们的研究结果支持早期诊断和保守手术治疗（扭转复位）在附件扭转中的重要性。缺乏组织学变化和FRS代谢未受损与近期数据一致，即早期扭转时血管受损是由静脉或淋巴淤滞引起的，且附件完整性与明显的缺血外观无关，从而为附件对缺血的耐受性提供了证据。
