妊娠期附件扭转诊治

Diagnosis and Treatment of Adnexal Torsion during Pregnancy

附件扭转是指卵巢或者输卵管及其韧带在其血管上的轴向旋转,是罕见的妇科急症。妊娠期延误治疗可导致流产、早产、出血、感染,威胁母儿生命安全,远期影响女性生育能力。因此,需要对其尽早诊断及治疗。辅助生殖技术导致的卵巢过度刺激及卵巢肿物是附件扭转最常见原因。附件扭转临床表现及实验室检查不具有特异性,最常见的症状为急性或亚急性下腹痛,其次为恶心、呕吐。超声可用于诊断妊娠早期发生的扭转,扭转血管蒂的“漩涡征”是其特异性表现。妊娠中晚期由于子宫的遮挡不易诊断,而核磁共振的诊断价值较高,并且弥散加权成像可用于评估附件扭转的严重程度。目前对于妊娠期附件扭转的治疗方式有手法复位及手术治疗。手术是妊娠期附件扭转的主要确诊及治疗手段,腹腔镜保守治疗对于获得母儿良好结局及挽救女性生育能力具有重要意义。

Adnexal torsion refers to axial rotation of the ovary or fallopian tube and its ligaments on its blood vessels,which is a rare gynecologic emergency.Delayed treatment can lead to abortion,premature delivery,hemorrhage and infection,which threats the safety of mother and fetal life and female fertility.Thus,we need early diagnosis and treatment for it.Ovarian hyperstimulation caused by assisted reproductive technology and ovarian masses are the most common causes of adnexal torsion.The clinical manifestations and laboratory tests of adnexal torsion were not specific.The most common symptoms are acute or subacute lower abdominal pain,followed by nausea and vomiting.Ultrasound can be used to diagnose torsion in the first trimester."Whirlpool sign"of twisted vascular pedicle is the specific finding.In the second and third trimester of pregnancy,it is difficult to diagnose because of uterine occlusion while MRI is of high diagnostic value.And the diffusion-weighted imaging can be used to assess the severity of adnexal torsion.At present,the treatment methods for the adnexal torsion during pregnancy include manual reduction and surgical treatment.Operation is the main diagnosis and treatment method of adnexal torsion during pregnancy.Laparoscopic conservative treatment is of great significance for achieving a good outcome of mother and child and saving female fertility.