附件扭转患者的特点及不同手术方式的效果比较

Characteristics of the patients with adnexal torsion and outcomes of different surgical procedures

目的探讨附件扭转患者的特点及评估不同手术方式对卵巢储备功能的影响。方法回顾性分析2016年6月至2020年6月在无锡市妇幼保健院行手术治疗的91例附件扭转患者的临床特点、手术方式及术后恢复情况,根据手术方式分组,复位或囊肿剥除组为A组,附件切除组为B组。结果(1)91例患者中90例(98.90%)术前超声提示有附件包块,包块直径(8.76±3.12)cm,其中69例(77.53%)为卵巢良性肿瘤,12例(13.48%)为生理性囊肿。(2)91例患者中排除绝经期、单纯输卵管扭转以及病理为交界性肿瘤患者,余下74例患者中,单纯复位2例,卵巢囊肿剥除39例,均纳入A组(41例),附件切除33例,纳入B组,两组从腹痛到手术时间、缺血等级比较,差异有统计学意义(P<0.05),均无任何并发症,A组16例缺血等级3~4级,在超声随访中,均显示卵泡和血管。(3)A、B两组术前血清AMH水平分别为(3.95±2.42)ng/mL、(2.92±1.82)ng/mL,差异无统计学意义(P>0.05),两组术后1周内血清AMH水平与术前比较差异有统计学意义(P<0.05),而术后1月仅B组血清AMH水平(1.29±1.15)ng/mL与术前(2.92±1.82)ng/mL比较,差异有统计学意义(P<0.05)。结论临床中,通常根据缺血等级、腹痛到手术间隔时间,判断是否可保留卵巢;术后血清AMH水平提示,附件扭转保留卵巢是安全且不损害卵巢储备功能的手术方式。

Objective To explore the characteristics of patients with adnexal torsion and to assess the effect of different surgical modalities on ovarian reserve function.Methods A retrospective analysis was conducted on 91 patients who underwent surgery for adnexal torsion in Wuxi Maternal and Child Health Hospital from June 2016 to June 2020,in order to analyze the patients'clinical characteristics,surgical procedures,and postoperative recovery.Patients were grouped into 2 groups according to the surgical procedures:adnexa preservation(group A)and adnexectomy(group B).Result(1)In 90 patients(98.90%)of 91 patients,preoperative ultrasound showed adnexal masses with a diameter of(8.76±3.12)cm.Among them,69 cases(77.53%)were benign ovarian tumors and 12 cases(13.48%)were physiological cysts.(2)In 91 patients,menopausal stage,isolated tubal torsion,and pathological borderline tumors were excluded,among the remaining 74 patients,2 cases received retorsion,and 39 cases received ovarian cystectomy,all of which were included in group A(41 cases),and 33 cases of adnexectomy were included in group B.There was a significant difference in abdominal pain to the surgical time,and the grade of ischemia between two groups(P<0.05).None of the patients had any complication.16 cases in group A had ischemia grade 3~4,and follicles and blood vessels were shown in ultrasound follow-up.(3)The preoperative serum AMH levels of groups A and B were(3.95±2.42)ng/mL and(2.92±1.82)ng/mL,respectively,with no significant difference(P>0.05).There was a significant difference between the serum AMH levels in the two groups within one week after surgery and before surgery(P<0.05),while only the serum AMH level in group B at one month after surgery(1.29±1.15)ng/mL was statistically different from the preoperative level(2.92±1.82)ng/mL(P<0.05).Conclusions In clinical practice,ovarian preservation is usually judged based on the grade of ischemia,interval of abdominal pain to surgery.Postoperative serum AMH levels suggest that preservation of the ovaries in treating adnexal torsional is a safe surgical modality that does not impair ovarian reserve function.