摘要
目的探讨妊娠期附件扭转的临床特点、手术治疗以及对妊娠结局的影响。方法对2009年1月至2015年6月北京妇产医院妇科收治的经手术证实为妊娠期附件扭转的患者进行回顾性分析,总结其临床特点、治疗方法以及对妊娠结局的影响。结果 （1）临床特点：共41例患者经手术证实为附件扭转,发病孕周为孕5-36周,孕早期18例,孕中期19例,孕晚期4例,中位孕周为12周。主要的临床症状和体征包括：突发下腹疼痛（97.56%）,附件区有固定压痛点（97.56%）,可触及的附件区肿物（82.93%）,恶心、呕吐（60.98%）,发热（2.44%）,白细胞升高〉12×109个/L（31.72%）,超声示囊肿平均直径为（7.29±2.30）cm。（2）手术情况：开腹手术35例,腹腔镜手术6例。患侧附件复位＋卵巢囊肿剔除术29例,患侧附件切除术10例,单纯输卵管切除2例。（3）术后病理：生理性囊肿13例（31.71%）,单纯性囊肿12例（29.27%）畸胎瘤6例（14.63%）,卵巢交界性肿瘤2例（4.88%）,无卵巢恶性肿瘤。（4）妊娠结局及新生儿健康状况：开腹手术和腹腔镜手术围手术期均无手术并发症出现。术后继续妊娠者38例,足月分娩30例,早孕流产1例,中期引产1例,早产2例,失访4例。新生儿均无出生缺陷及严重并发症发生,中位随访时间33个月,随访至今婴儿均体健。结论妊娠期附件扭转由于临床表现及检查结果缺乏特异性常常延误诊断及治疗。生理性卵巢囊肿在妊娠期附件扭转的病理类型中占比较高（31.7%）。妊娠各期行附件手术都是相对安全的,并不明显增加流产及母婴不良结局的发生。
Objective To review the clinical features,surgical management,andobstetric outcomes of adnexaltorsion in pregnancy.Methods We retrospectively reviewed the clinicalrecords of patients withadnexal torsion during pregnancy between Januray 2009 to June 2015 at Beijing Obstetrics and Gynecology Hospital. The patients＇ clinical features,management and pregnancy outcome were followed-up and analyzed. Results（ 1） Clinical features： Totally 41 patients were included into this study. The median gestational age at surgery was 12 weeks,with a range of 5 weeks to 36 weeks. The mainfeaturesofadnexal torsionwere acuteonset of abdominal pain（ 97. 56 %）,fixed tenderness in the lower abdomen（ 97. 56%）,palpableenlarged adnexa（ 82. 93%）,nausea,vomiting（ 60. 98%）,and fever（ 2. 44%）. A slight leukocytosis was observedin 31. 72% of patients. The mean diameter of adnexal mass is（ 7. 29 ± 2. 30） cm.（ 2）Surgery management： Thirty-five patients received Laparotomysurgeries and 6 patients received laparoscopic surgeries. Twenty-nine patients receiveddetorsion with cyst removal,10 patients receivedsalpingo-oophorectomy,and 2 patients receivedsalpingectomy only. The pathological reports revealed that 13 cases（ 31. 71%） were physiological cysts,12 cases were Simple cysts,6 cases were dermoid tumors and 2 cases were borderline ovarian tumors.（ 3） The pregnancy outcomes： No severe complication during the perioperative periods. Among the 37 patients proceed pregnancy after the operation,30 achieved term delivery,1 had an induction at the middle gestational ageand 2 premature births,the rest 4 patients dropped out of follow-up. All the babies were followed with a median 33 month-follow-up. No congenital defects or complications were observed at birth,and all were reported to be healthy at the last follow-up. Conclusion It is still difficult to make an early andaccurate diagnosis ofadnexal torsion,due to the lack of specific symptoms or examinations. Physiological cyst is an important cause of ovaria
出处
《临床军医杂志》
CAS
2016年第8期832-835,共4页
Clinical Journal of Medical Officers
基金
首都医科大学附属北京妇产医院青年基金专项课题资助项目(FCCYQN-201507)
关键词
附件扭转
妊娠期
妊娠结局
Ovarian torsion adnexal torsion
Gestatin period
Pregnancy outcome
