妊娠期附件扭转手术治疗病例临床特点及妊娠结局分析  

Clinical Characteristics and Obstetric Outcomes of Pregnant Women Who Underwent Surgery for Adnexal Torsion

作　　者：祝彩霞[1] 蔡诗琴 黄晓晴 王冬昱[1] ZHU Cai-xia;CAI Shi-qin;HUANG Xiao-qing;WANG Dong-yu(Department of Obstetrics and Gynecology,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院妇产科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2023年第6期1053-1059,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(2021A1515010411)。

摘　　要：【目的】探讨手术治疗的不同孕周的妊娠期附件扭转的临床特点和妊娠结局。【方法】回顾性分析2013年3月至2023年3月在中山大学附属第一医院住院手术治疗并分娩的39例妊娠期附件扭转患者的临床资料,其中妊娠早期(<14周)18例,妊娠中期(14~27+6周)11例,和妊娠晚期(≥28周)10例,比较3组的临床特点、诊治和妊娠结局的差异。【结果】妊娠早期组辅助生殖技术受孕的比例高于妊娠中、晚期组(P=0.026)。3组患者腹痛、恶心、呕吐、发热等临床表现差异无统计学意义,但妊娠中、晚期组患者白细胞升高更常见。妊娠早、中、晚期发生扭转的直径<5 cm的附件包块分别占0.0%、18.2%和10.0%,具有统计学差异(P=0.014)。但扭转的附件位置、圈数、病理性质均差异无统计学意义。超声对于妊娠早期附件扭转的诊出率显著高于妊娠中、晚期组(77.8%,36.4%,20.0%;P=0.008)。妊娠早期组选用腹腔镜手术比例高于妊娠中、晚期组(55.6%,27.3%,0.0%;P=0.008)。3患者的分娩孕周、分娩方式、新生儿性别、新生儿出生体质量和随访情况均差异无统计学意义,但妊娠晚期组早产风险高于妊娠早、中期组(P=0.050)。【结论】辅助生殖技术受孕更常见于妊娠早期组附件扭转患者,当同时出现腹痛、白细胞升高且无感染征象时,需要警惕附件扭转,超声在妊娠早期附件扭转的诊断价值高,妊娠期附件扭转腹腔镜手术安全,母儿预后良好。【Objective】To explore the clinical characteristics and obstetric outcomes of pregnant women who under‐went surgery for adnexal torsion at different gestational weeks.【Methods】A retrospective study was done on 39 women who underwent surgery for adnexal torsion during pregnancy in the First Affiliated Hospital,Sun Yat-sen University between March 2013 and March 2023,with 18 cases in 1st trimester(<14 weeks),11 in 2nd trimester(14-27+6 weeks)and 10 in 3rdtrimester(≥28 weeks).The clinical characteristics,treatment and obstetric outcomes were compared among the three groups.【Results】The 1st trimester group had higher proportion of assisted reproductive technology(ART)use than the 2nd and 3rd trimester groups(P=0.026).There was no significant difference in the clinical manifestations,including abdominal pain,nausea,vomiting and fever among the three groups,while elevated white blood cells(WBC)counts was more com‐monly seen in the 2nd and 3rd trimester groups.Adnexal masses<5 cm in diameter occurred in 0,18.2%,and 10.0%of cas‐es in 1st,2nd and 3rd trimester groups respectively(P=0.014).No statistical significance was found in the location of twisted adnexa,number of circles or pathological nature.The 1st trimester group had a higher sensitivity of ultrasound in the diag‐nosis of adnexal torsion compared with the 2nd and 3rd trimester groups(77.8%,36.4%,20.0%;P=0.008).More laparo‐scopic surgery were performed in the 1st trimester group than the other two groups(55.6%,27.3%,0.0%;P=0.008).There was no significant difference in gestational week of delivery,delivery mode,newborn gender,neonatal birth weight and follow-up of newborns among the three groups.The 3rd trimester group showed a higher risk of preterm delivery(P=0.050).【Conclusions】During the 1st trimester of pregnancy,adnexal torsion is more common in patients using ART and ul‐trasound plays a crucial role in the diagnosis.During the 2nd and 3rd trimester,adnexal torsion should be suspected in pa‐tients with abdominal pain and elevat

关 键 词：附件扭转 孕周 临床特点 妊娠结局 腹痛 白细胞升高 

分 类 号：R714.7[医药卫生—妇产科学]