62例小儿输卵管卵巢扭转的诊治与分析

目的探讨小儿输卵管卵巢扭转的临床特征和诊治要点。方法对收治的62例患者进行回顾性分析。结果所有患者表现有下腹痛,病程2 h至半年不等,48例可查及下腹压痛；彩色多普勒超声检查均发现在盆腔一侧有不均质肿块,其中30例提示有扭转可能。所有患者均行手术治疗,其中行腹腔镜手术者14例；术中见47例为右侧附件扭转,15例为左侧扭转；渗出粘连明显者24例；35例行患侧附件切除,27例行附件复位、肿瘤剔除和冰冻切片检查后保留附件。在保留附件患儿中,有22例得到随访,除1例卵巢萎缩外,其余21例卵巢功能均良好。结论小儿输卵管卵巢扭转较少见,无特殊临床表现,易致误诊。一经诊断应立即行手术探查,扭转的附件应根据扭转时间、供血障碍程度、病变性质来决定取舍。

Diagnosis and treatment of tubo-ovarian torsion in children

Objective To investigate the clinical characteristics and treatment of tubo-ovarian torsion in children.Methods Clinical data of 62 patients with tubo-ovarian torsion were analyzed.Results All patients had lower abdominal pain with 2 hours to half a year.Forty-eight patients had tenderness on the lower abdomen. Heterogeneous solid masses were found by Doppler sonography in all patients and sonographic findings suggested adnexal torsion in 30 patients.Operation were performed in all patients and laparoscopy was used in 14 patients.It was found that torsion on right-side adnexa in 47 patients and on left-side adnexa in 15 patients.A one-sided salpingo-oophorectomy was performed in 35 patients and conservative surgery successfully saved normal ovarian tissue.Followlng-up was available in 22 of the 27 patients who had normal tissue showed normal ovary with follicular development except one.Conclusion Torsion of adnexa is uncommon,especially in children.It is seldom diagnosed before operation because it lacks specific clinical manifestations.Operation should be performed as soon as possible.The course of disease and ischemia decide whether to reserve the adnexa or not.