当科における付属器腫瘤茎捻転に対する機能温存手術―second look laparoscopy（SLL）所見を含めて―

抄録

Objective: In our department, we actively perform laparoscopic conservative surgery for adnexal torsion. We have also performed second look laparoscopy (SLL) to observe the preserved adnexa after conservative surgery. In this study, we investigated cases in which SLL was performed after conservative surgery and cases in which two-stage conservative surgery was performed, and examined the usefulness and complications of laparoscopic conservative surgery.

Methods: We retrospectively reviewed the medical and surgical records of patients who underwent laparoscopic surgery for adnexal torsion between June 2009 and April 2020.

Results: Conservative laparoscopic surgery was performed in 48 (46.6%) of 103 patients who underwent laparoscopic surgery for adnexal torsion. Among the 48 cases undergoing conservative laparoscopic surgery, SLL was performed in 13 (27.0%) cases. In 12 (25%) cases, the morphological color tone of the preserved ovaries was restored. We were able to confirm fallopian tube patency in eight cases with peri-adnexal adhesions in 11 cases. Salpingectomy was performed in three cases, including cases of oviductal edema and strong adhesions of the oviductal arches.

Conclusions: Laparoscopic conservative surgery for adnexal torsion is useful to preserve ovarian function in many cases. However, in numerous cases, we observed peritubal adhesions which result in hydrosalpinx. In laparoscopic conservative surgery, measures to prevent adhesions are essential, and postoperative follow-ups are required not only for ovarian function but also for postoperative adhesions and the condition of the fallopian tubes.