小児患者における付属器捻転後の卵巣温存
Andrew Mudreac1,2, Spencer E Kim3, Rosa Hwang1
1Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Purpose:
In 2017, the American Pediatric Surgical Association (APSA) published a systematic review that supported ovarian detorsion rather than oophorectomy for children with ovarian torsion. We evaluated our institutional ovarian salvage rate and outcomes following ovarian detorsion before and after publication of these APSA recommendations.
Methods:
Electronic Medical Record data for patients who underwent operative intervention for adnexal torsion and between 01/01/2010 and 12/31/2023 at a single pediatric center were reviewed. Patients with antenatal torsion were excluded. Patient characteristics, operative findings, and postoperative outcomes were examined.
Results:
A total of 238 patients were included. Mean age was 10.9 years (range 0.1-20.0). Mean time from presentation to OR was 9.5 h (SD 8.9). Ovarian detorsion was performed in 186 patients (78.2%). Oophorectomy was performed in 52 (21.8%); of these, 33 (63.5%) demonstrated evidence of necrosis and 14 (26.9%) were associated with a tumor. There were no intraoperative complications. There were no thromboembolic events following detorsion. Pregnancy data were available for 10 patients, with 7 live births.
Conclusion:
Ovarian salvage is the preferred treatment for torsion. Our rates of ovarian salvage have improved over the past 10 years with no negative sequelae and no missed malignancies.
