孤立性输卵管扭转27例临床分析

Clinical Analysis of 27 Cases of Isolated Fallopian Tube Torsion

目的:探讨孤立性输卵管扭转(isolated fallopian tube torsion,IFTT)的临床特点。方法:回顾性分析2017年1月—2021年12月于北京大学第三医院住院治疗的27例IFTT患者的临床资料。结果:①临床特征:育龄期患者22例,其中7例妊娠期发病。24例以腹痛为首要症状就诊,3例无症状者为择期入院手术术中诊断。②检查、手术及病理情况:所有患者术前均行超声检查,均提示有附件区迂曲管状或囊性无回声。腹腔镜手术21例,开腹手术6例。根据是否生育及输卵管扭转部位选择是否保留输卵管。16例已生育者,2例输卵管系膜囊肿扭转者保留了输卵管,余均行输卵管切除术;11例未生育者,3例输卵管积水计划行辅助生殖技术助孕者切除了输卵管,余均保留输卵管。病理结果符合术前超声诊断,提示输卵管积水或良性囊肿。③妊娠期IFTT:共7例,妊娠中期诊断2例,妊娠晚期诊断5例;腹腔镜手术1例,开腹手术6例;均为输卵管系膜囊肿扭转;3例保留输卵管,行输卵管系膜囊肿剔除术,4例行输卵管切除术;均获得活产儿。结论:合并输卵管积水、输卵管系膜囊肿的育龄期女性突发下腹痛,应考虑IFTT可能。早期诊治可避免输卵管扭转坏死,保留患者的自然妊娠能力。应根据患者的生育要求和术中扭转部位和程度决定是否保留输卵管。

Objective:To investigate the clinical characteristics of isolated fallopian tube torsion(IFTT).Methods:The clinical data of 27 IFTT patients,admitted to Peking University Third Hospital during January 2017 to December 2021,were retrospectively analyzed.Results:①Clinical characteristics:22 women of childbearing age,and 7 women experienced the onset of IFTT during pregnancy.Twenty-four patients presented with abdominal pain as the primary symptom,and 3 patients were diagnosed IFTT during surgery.②Examination,surgery and pathology:All patients underwent preoperative ultrasound examination,suggested tortuosity or cystic anechogenicity in the adnexal area.More specifically,21 patients were operated laparoscopic surgery,while 6 patients underwent laparotomy.The choice of whether to preserve the fallopian tube depends on patient′s fertility requirements and where the torsion site.Of the 16 patients who had given birth,2 cases of mesosalpinx cyst torsion preserved fallopian tubes,and the rest of them underwent salpingectomy.In the 11 cases who did not give birth,salpingectomy was performed in 3 patients of hydrosalpinx who scheduled to undergo assisted reproductive technology assisted pregnancy,and the rest of them were preserved fallopian tubes.The pathological findings were consistent with preoperative ultrasonography,suggesting hydrosalpinx or benign cysts in the fallopian tubes.③There were seven IFTT patients during pregnancy,two were diagnosed during the second trimester pregnancy and five in the third trimester pregnancy.One patient was operated laparoscopic surgery,while the other six underwent laparotomy.However,all seven patients presented mesosalpinx cyst torsion.Three patients were treated with mesothelial cystectomy,with the fallopian tube retained,while four patients were treated with salpingectomy.All neonates showed good outcome.Conclusions:If women of childbearing age with hydrosalpinx and mesosalpinx cysts report sudden abdominal pain,the possibility of IFTT should be considered.Early diagnosis and treatment can avoid fallopian tube torsion and necrosis to preserve the patient′s ability to conceive naturally.The decision to keep the fallopian tube should be determined according to the patient′s fertility requirements and the site and degree of fallopian tube torsion.