青春期附件扭转29例临床分析

目的总结并分析青春期附件扭转(adnexal torsion,AT)患者的临床特点、手术方式及预后等。方法选择西安交通大学第一附属医院2013年1月至2018年1月收治的29例青春期AT患者的临床资料,对临床特征、手术方式、术中情况、肿瘤病理类型以及术后随访等方面进行回顾性分析。结果①青春期AT患者29例,占我院同期AT患者的11.4%。患者年龄10~18岁,平均(15.2±1.78)岁,患者均以"下腹痛"主诉入院,23例(79.3%)患者表现为急性疼痛(疼痛时间<1月),6例(20.7%)为慢性腹痛(疼痛时间≥1月)。②术前白细胞增高患者12例(41.4%);术前腹部B超诊断准确率为48.3%;腹部CT诊断准确率为0。③20例(69.0%)患者为右侧AT,9例(31.0%)为左侧AT。扭转肿瘤平均直径(10.28±2.89)cm。肿瘤扭转程度平均(711.87±306.82)°。保守性手术率为24.1%。7例保守性手术患者术后卵巢功能恢复良好。无1例血栓事件发生。④29例患者附件肿瘤良性率为96.4%,其中27.6%为输卵管系膜囊肿,20.7%为卵巢冠囊肿,13.8%为卵巢单纯囊肿,13.8%为卵巢成熟型囊性畸胎瘤。结论青春期AT患者B超及腹部CT的诊断率低,诊断主要靠病史及典型的临床表现,术后病理前4位分别是输卵管系膜囊肿、卵巢冠囊肿、卵巢单纯囊肿及卵巢成熟型囊性畸胎瘤。对于青春期患者来说,卵巢或输卵管肿瘤蒂扭转复位并肿瘤剥除术的保守手术是一种可行的治疗方法,可以最大程度上保留青春期患者的内分泌及生育功能。

Clinical analysis of 29 cases of adolescent adnexal torsion

Objective To summarize and analyze the clinical characteristics,surgical methods and prognosis of adolescent adnexal torsion(AT).Methods The clinical data of 29 adolescent AT patients admitted to the First Affiliated Hospital of Xi’an Jiaotong University from January 2013 to January 2018 were selected.The clinical characteristics,surgical methods,intraoperative conditions,tumor pathological types,and postoperative follow-up were reviewed.Results①29 adolescent AT patients,accounting for 11.4% of AT patients in our hospital during the same period.Patients aged 10 to 18 years,with an average(15.2±1.78)years of age.All patients were admitted with"lower abdominal pain".23 patients(79.3%)showed acute pain(pain time<1 month),and 6 patients(20.7%).It is chronic abdominal pain(pain time≥1 month).②12 patients(41.4%)had leukocytosis before surgery;the accuracy of abdominal B ultrasound diagnosis before surgery was 48.3%;the accuracy of abdominal CT diagnosis was 0.③20 patients(69.0%)were right AT and 9 patients(31.0%)were left AT.The mean diameter of twisted tumors was(10.28±2.89)cm.The average degree of tumor twist was(711.87±306.82)°.The conservative surgery rate was 24.1%.Ovarian function recovered well in 7 conservative surgery patients.No one thrombotic event occurred.④The benign tumor rate of attachment tumors in29 patients was 96.4%,of which 27.6% were tubal mesangial cysts,20.7% were ovarian crown cysts,13.8% were simple ovarian cysts,and 13.8% were mature ovarian cystic teratomas.Conclusion The diagnosis rate of B-ultrasound and abdominal CT in adolescent AT patients is low.The diagnosis is mainly based on the history and typical clinical manifestations.The top 4 postoperative pathology are fallopian tube cysts,ovarian crown cysts,ovarian simple cysts,and mature cystic ovarian teratoma.For puberty patients,conservative surgical methods of ovarian or fallopian tube tumor pedicle twist reduction and tumor ablation are a feasible treatment method,which can preserve the endocrine and reproductive functions of puberty patients to the greatest extent.