78例儿童及青少年女性附件扭转病例临床病理特点分析  

Clinicopathological analysis of 78 cases of adnexal torsion in female children and adolescence

作　　者：刘倩[1] 周慧梅[1] 曹冬焱[1] 杨佳欣[1] 沈铿[1] 郎景和[1] LIU Qian;ZHOU Hui-mei;CAO Dong-yan;YANG Jia-xin;SHEN Keng;LANG Jing-he(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,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7期866-870,共5页Journal of Reproductive Medicine

基　　金：中国医学科学院医学与健康科技创新工程项目(2017-I2M-1-002)。

摘　　要：目的探讨儿童及青少年女性附件扭转病例的临床病例特点。方法回顾性分析2012年8月至2020年3月于我院妇产科接受治疗的78例附件扭转的儿童及青少年患者的病史资料。根据手术探查时扭转的附件是否发生坏死分为坏死组(n=23)和未坏死组(n=55),比较两组间相关指标,分析与坏死相关的因素。结果患者平均年龄(14.0±3.8)岁,其中尚未初潮者18例(23.1%),已月经初潮者60例(76.9%)。附件包块平均直径(8.7±3.1)cm;右侧附件扭转43例(55.1%),左侧33例(42.3%),囊肿为双侧且其中一侧发生扭转2例(2.6%)。49例(62.8%)患者行囊肿剔除术,24例(30.8%)行患侧附件切除,3例(3.8%)行患侧输卵管切除,2例(2.6%)行患侧附件切除+可疑部位活检。最常见病理类型为成熟畸胎瘤(29.5%),恶性肿瘤占6.4%。比较坏死组和非坏死组的相关指标,结果提示两组患者月经初潮者比例有显著差异(P=0.03),而患者年龄、疼痛特点、肿瘤大小、扭转度数、肿瘤侧别等方面均无显著差异(P>0.05)。单因素分析结果提示年龄、月经初潮、肿瘤大小、手术方式、手术途径是扭转后坏死的影响因素(P<0.05),而多因素分析结果为以上因素均与坏死无相关性(P>0.05)。结论可适当提前儿童及青少年人群的妇科常规检查时间,若发现附件包块,经全面评估明确是否为病理性,及时进行必要的手术干预。附件区包块合并腹痛发生,特别是腹痛急性起病、持续不能缓解或疼痛反复发生,应高度警惕附件扭转可能,需积极进行急诊手术。不能除外恶性病变时,需全面评估,谨慎选择手术方式及手术途径。Objective:To investigate the clinicopathological features of adnexal torsion in female children and adolescent.Methods:The clinical data of 78 children and adolescent with adnexal torsion who received treatment in the genecology department of our hospital from August 2012 to March 2020 were retrospectively analyzed.The patients were divided into necrotic group(n=23)and non-necrotic group(n=55)according to whether necrosis occurred in the adnexal torsion during surgical exploration.The related indexes between the two groups were compared and the factors related to necrosis were analyzed.Results:The mean age of the patients was(14.0±3.8)years old.Among them,18 patients(23.1%)had not menarche,and 60 patients(76.9%)had menarche.The mean diameter of adnexal masses was(8.7±3.1)cm.Forty-three(55.1%)patients had right adnexal torsion and 33(42.3%)patients had left adnexal torsion.Two patients(2.6%)had bilateral cysts,and torsion occurred in one side.Forty-nine patients(62.8%)underwent cyst removal,24 patients(30.8%)lateral adnexectomy,3 patients(3.8%)lateral salpingectomy,and two patients(2.6%)underwent lateral adnexectomy and biopsy of the suspicious site.The most common pathological types were mature teratoma cyst(29.5%),followed by malignant tumor(6.4%).There was significant difference in the occurrence of menarche between the two groups(P=0.03).However,there were no significant differences in age,pain characteristics,tumor size,torsion angles,and tumor side between the two groups(P>0.05).Univariate analysis showed that age,menarche,tumor size,surgical method and surgical approach were the influencing factors of the necrosis after torsion(P<0.05).However,multivariate analysis showed no correlation between the above factors and the necrosis(P>0.05).Conclusions:The time of routine gynecological examination for children and adolescents can be appropriately advanced.If adnexal masses are found,necessary surgical intervention can be carried out in time after a comprehensive evaluation.Adnexal mass combined with abdominal

关 键 词：儿童 青少年 附件扭转 腹痛 

分 类 号：R711.75[医药卫生—妇产科学]