青春期女性附件扭转临床诊疗分析

目的　分析青春期女性附件扭转的临床表现、诊疗情况及病理类型。方法　选取2006年1月—2016年10月温州医科大学附属第一医院收治的10~18岁附件扭转患者32例，回顾性分析患者的一般情况、临床表现、实验室检查及诊疗情况等。结果　患者临床表现以腹痛，恶心呕吐为主，可有白细胞计数、中性粒细胞计数、肿瘤标志物等升高，超声及CT检查可发现盆腔包块或提示附件扭转。30例行腹腔镜手术治疗，其中12例行腹腔镜患侧附件切除术，10例行腹腔镜下囊肿剔除术，8例行腹腔镜患侧输卵管切除术；2例行传统开腹手术。术后病理类型包括成熟畸胎瘤、卵巢囊肿、卵巢冠囊肿、卵巢黏液性囊腺瘤等。患者首次症状出现到入住本院时间<3 d组与≥3 d组患者年龄、扭转侧别、腹痛发生率、恶心呕吐发生率、白细胞计数、中性粒细胞计数、超声未探及明显血流信号比例、术后住院时间、术中见扭转部位明显坏死、粘连、扭转圈数、术中包块直径、手术时间比较，差异均无统计学意义（P>0.05）；<3 d组中性粒细胞与淋巴细胞比值（NLR）、术前诊断扭转率较≥3 d组升高（P<0.05）。结论　青春期附件扭转临床症状、实验室检查不典型，超声和CT有一定的诊断价值，部分患者因误诊或未予重视从而延误治疗。对就诊的青春期女性应进行详细体检，及早对附件扭转做出诊断，尽快治疗，以最大限度降低对患者身心的影响。

Diagnostic and Treatment Analysis of Adnexal Torsion in Adolescent Patients

Objective　To investigate the clinical features，diagnosis，treatment，and pathology of adnexal torsion in adolescent patients.Methods　This study involved a total of 32 adolescent patients，aged 10-18 years，who had adnexal torsion and treated in the First Affiliated Hospital of Wenzhou Medical University between January 2006 and October 2016.For each patient，we retrospectively analyzed general information，clinical features，laboratory tests，diagnosis and treatment data.Results　Symptoms mainly presented as abdominal pain，nausea and vomiting.In some cases，there was an increase in white blood cells，neutrophils and tumor biomarkers.Ultrasound and computed tomography（CT） examination revealed a pelvic mass or suggested adnexal torsion.In terms of treatment，30 cases underwent laparoscopic surgery.Of these，12 cases received laparoscopic ipsilateral adnexectomy，10 cases received laparoscopic cyst removal surgery，and 8 cases received laparoscopic ipsilateral salpingectomy.Two cases underwent conventional laparotomy.Postoperative pathology included mature teratoma，ovarian cyst，ovarian crown cyst，and ovarian mucinous cystadenoma.Patients were further divided into a <3 days group and a ≥3 days group based on the interval between the first onset of symptoms and admission.There were no significant differences between the two groups in terms of age，torsional side，incidence of abdominal pain，nausea or vomiting，white blood cell count，neutrophil count，the proportion of patients in whom significant blood flow signals were not detected，length of stay，obvious necrosis and adhesion of the torsion part，torsion turns，the diameter of torsional mass or the duration of operation time（P>0.05，for all parameters）．The preoperative neutrophil/lymphocyte ratio（NLR），and the rate of torsion diagnosis before surgery were higher in the <3 days group compared with the ≥3 days group（P<0.05）．Conclusion　The symptoms and laboratory tests of adolescent adnexal torsion are non-specific.Ultrasound and CT have certain diagnostic value.However，some patients may be misdiagnosed which delays treatment.In suspected cases，extensive examinations should be carried out，along with diagnosis and treatment，as early as possible in order to minimize the negative impact of the disease.