妊娠期附件扭转临床分析  

Clinical cases analysis of adnexal torsion in pregnant women

作　　者：王永学[1] 尹婕[1] 邓姗[1] WANG Yong-xue;YIN Jie;DENG Shan(Department of Obstetrics & Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences/Peking Union Medical College,National Clinical Research Center for Obstetric & Gynecologic Diseases,Beijing 100730)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,国家妇产疾病临床研究中心,北京100730

出　　处：《生殖医学杂志》2021年第6期706-709,共4页Journal of Reproductive Medicine

摘　　要：目的总结并分析妊娠期附件扭转的临床特点、治疗和妊娠结局。方法回顾性分析2008年1月至2018年1月于北京协和医院经手术确诊的82例妊娠期附件扭转患者的临床资料,分析患者的临床特征、手术干预以及妊娠结局。结果患者的中位年龄28岁(18~38岁),发病中位孕周为11周(6~32周)。53例(64.6%)发生在妊娠早期,21例(25.6%)发生在妊娠中期,8例(9.8%)在妊娠晚期。最常见的症状和体征是突发盆腔疼痛(100%)和盆腔肿块(97.6%),其次是恶心和呕吐(61.0%)。63例(76.8%)接受腹腔镜手术,19例(23.2%)接受开腹手术。53例(64.6%)患者接受了保守性手术,其中48例囊肿剔除,2例囊肿穿刺引流,2例输卵管切除术,1例仅进行了囊肿复位;29例(35.4%)患者接受了单侧附件切除术。无出现术后血栓形成、自然流产和扭转复发的病例。7例患者同时进行了人工流产手术;1例患者发生胎儿宫内死亡,74例患者为活产。结论一旦考虑为妊娠期附件扭转,需要尽快进行手术干预;腹腔镜手术是安全可行的,术中应尽可能保留卵巢功能。Objective:To summarize and analyze the clinical characteristics,treatment and pregnant outcomes of adnexal torsion in pregnant women.Methods:The clinical characteristics,surgical interventions and pregnancy outcomes of 82 patients with surgically confirmed adnexal torsion during pregnancy in Peking Union Medical College Hospital from January 2008 to January 2018 were retrospectively analyzed.Results:The median age of the patients was 28 years(18-38 years).The median gestational age was 11 weeks(6-32 weeks):53 patients(64.6%)were in the first trimester,21 patients(25.6%)were in the second trimester,and 8 patients(9.8%)were in the third trimester.The most common symptoms and signs were sudden pelvic pain(100%)and pelvic masses(97.6%),followed by nausea and vomiting(61.0%).Sixty-three patients(76.8%)underwent laparoscopy,and 19 patients(23.2%)underwent laparotomy.Fifty-three patients(64.6%)underwent conservative surgery.Among them,48 patients’cysts were removed,2 patients’cysts were punctured and drained and two patients underwent salpingectomies and 1 patient underwent detorsion only.Twenty-nine patients(35.4%)received unilateral salpingo-oophorectomy.There were no cases of postoperative thrombosis,spontaneous abortion or recurrence of torsion.Seven patients underwent simultaneous artificial abortion.One patient experienced intrauterine fetal death,and 74 patients had live births.Conclusions:Surgical intervention is required as soon as possible once adnexal torsion in pregnancy is considered.Laparoscopic surgery is safe and feasible,and ovarian function should be preserved intraoperatively whenever possible.

关 键 词：附件扭转 妊娠 结局 

分 类 号：R713.1[医药卫生—妇产科学]