妊娠合并卵巢囊肿蒂扭转手术方式的选择探讨  

Selectin of Operation Mode in Patient with Ovarian Torsion during Pregnancy

作　　者：吴伟芳[1] 潘勉[1] WU Weifang;PAN Mian(Departm ent of Obstetrics and Gynecology,Fujian Provincial Maternity and Children's Hospital,Affiliated Hospital of Fujian Medical University,Fuzhou Fujian 350001,China)

机构地区：[1]福建省妇幼保健院福建医科大学附属医院妇产科

出　　处：《实用妇产科杂志》2019年第12期937-940,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:对比分析妊娠合并卵巢囊肿蒂扭转保留卵巢和附件切除两种手术治疗方式的相关因素,探讨手术方式的合理选择。方法:回顾性分析2012年1月至2018年6月收住福建省妇幼保健院的妊娠合并卵巢囊肿蒂扭转接受手术治疗患者33例。以手术中是否保留卵巢将其分为保留卵巢组(13例)、附件切除组(20例),对两组患者的临床资料进行统计学分析。结果:两组患者年龄、腹痛时间、手术路径、肿物大小、肿物扭转方向比较,差异均无统计学意义(P>0.05);附件切除组肿物坏死程度重于保留卵巢组(P<0.05),附件切除组中肿物扭转周数明显多于保留卵巢组(P<0.05),附件切除组的发病孕周明显小于保留卵巢组(P<0.05)。保留卵巢组1例术中同时行人工流产,6例术中行剖宫产,6例术后继续妊娠均经阴道分娩;附件切除组2例术中同时行人工流产,2例术中行剖宫产,16例术后继续妊娠均至足月生产。保留卵巢组无一例失访,附件切除组失访3例,余均无明显异常。结论:妊娠期卵巢囊肿蒂扭转一经确诊应及早手术,保留卵巢手术具有一定的可行性,但需注意扭转周数,手术方式应综合腹痛时间、肿物扭转周数、卵巢坏死程度来决定。Objective:To analyze the relative factors of two different operation mode of ovarian torsion in patients during pregnancy between ovarian preservation and adnexectomy,and to investigate the rational choice of surgical mode.Methods:The data of 33 pregnant patients diagnosed as ovarian torsion by surgery from January 2012 to June 2018 in Fujian Provincial Maternity and Children′s Hospital were retrospectively analyzed.According to the ovary preservation during operation,the patients were divided into two groups,one was ovary preservation group with 13 cases and the other was adnexectomy group with 20 cases.The clinical data of these two groups were analyzed.Results:There was no significant difference of the age,the time of abdominal pain,the management of surgery,the tumor size,and the torsion direction in two groups(P>0.05).The degree of tumor necrosis in adnexectomy group was more serious than that in ovary preservation group.The degree of twists in adnexectomy group was more severe than that in ovary preservation group(P<0.05).The gestational age of onset in adnexectomy group was smaller than that in ovary preservation group(P<0.05).In ovary preservation group,1 patient terminated pregnancy during operation,6 patients were performed cesarean section during operation,and 6 patients continued to term pregnancy then undergoing vaginal delivery.In adnexectomy group,2 patients terminated pregnancy during operation,2 patients were performed cesarean section during operation,16 patients continued to term pregnancy then undergoing vaginal delivery.There was none lost follow-up in ovary preservation group,3 patients were lost follow-up in adnexectomy group.The outcomes of all operation were well.Conclusions:Once ovarian torsion is diagnosed during pregnancy,it is imperative that surgical intervention is not delayed.It′s feasible to preserve fertility,but the condition of twists must be considered.The mode of operation also must be considered by the time of pain,the degree of twists and ovarian necrosis.

关 键 词：卵巢囊肿蒂扭转 妊娠 手术方式 保留卵巢 

分 类 号：R711.75[医药卫生—妇产科学]