附件扭转131例临床分析

Clinical analysis of 131 cases of adnexal torsion

关键词:  附件扭转  附件坏死  腹腔镜检查术  附件切除术

Key words:  adnexal torsion  adnexal necrosis  laparoscopy  adnexectomy

摘要:

目的　分析因附件扭转行手术治疗患者术中情况与术后镜下病理特点，以探讨附件扭转的处理方式。方法　选择2016年1月至2021年12月大连市妇女儿童医疗中心（集团）收治的附件扭转患者131例，回顾性分析其病史和手术记录中附件情况，统计患者的临床症状、手术方式、附件（及肿物）位置、外观、直径、扭转角度等情况及术后病理情况，分析不同临床症状（恶心、呕吐、疼痛病程）、肿物直径、附件颜色、扭转角度所对应的术后镜下病理出血、炎症及坏死特点之间的关系，并进一步探讨可能导致坏死的因素。 结果　不同疼痛病程、附件颜色、扭转角度所对应的术后镜下病理出血、炎症及坏死特点差异无统计学意义(P＞0.05）。术前有恶心或呕吐症状者组织坏死率高于无恶心或呕吐症状者，起病至手术时长＞24 h者组织坏死率高于≤24 h者，肿物直径＞10 cm的组织坏死率高于肿物直径＜10 cm者，差异均具有统计学意义(P＜0.05）。临床出现恶心症状（OR＝6.147, 95%CI 1.018～37.101）或起病至手术时长＞24 h将增加坏死风险（OR＝5.747, 95%CI 1.265～26.112），具有统计学意义(P＜0.05）。 结论　附件扭转患者出现恶心、呕吐症状或肿物直径＞10 cm时发生坏死的风险更高，起病24 h内行手术治疗可减少坏死的发生率，术中所见附件（及肿物）外观及扭转角度等情况与镜下出血、炎症及坏死改变及卵巢功能无必然联系，因此未绝经患者应尽可能避免切除附件。

Abstract:

Objective　To analyze the intraoperative condition and postoperative pathological features of patients with adnexal torsion in order to explore the treatment options. 　Methods　The cases of adnexal torsion treated in Dalian Women and Children's Medical Center (Group) from January 2016 to December 2021 were analyzed retrospectively. The clinical symptoms, mode of operation, location, appearance, diameter, torsion angle and postoperative pathology of the patients were reviewed. We analyzed the relationship among the characteristics of postoperative pathological hemorrhage, inflammation and necrosis corresponding to different clinical symptoms (nausea, vomiting, pain course), tumor diameter, attachment color and torsion angle, and further explored the factors that may lead to necrosis. 　Results　There was no significant difference in the characteristics of postoperative pathological hemorrhage, inflammation and necrosis corresponding to different pain course, accessory color and torsion angle (P>0.05). The tissue necrosis rate of patients with nausea symptoms or vomiting symptoms before operation was higher than that of patients without nausea symptoms, the tissue necrosis rate of patients with tumor diameter >10 cm was higher than that of patients with tumor diameter <10 cm, and the difference was statistically significant. Clinical nausea symptoms increased the risk of necrosis (OR=6.147, 95%CI 1.018～37.101), and the time from onset to operation >24 hours increased the risk of necrosis (OR=5.747, 95%CI 1.265～26.112). 　Conclusion　Patients with adnexal torsion have a higher risk of necrosis when they have the symptoms of nausea, vomiting or tumor diameter >10 cm. Surgical treatment within 24 hours of onset can reduce the risk of necrosis. The appearance and torsion angle of the adnexa (and tumor) seen during the operation are not necessarily related to microscopic bleeding, inflammation and necrosis and ovarian function, thus premenopausal patients should avoid removing the adnexa as far as possible.