当科における付属器捻転65例の後方視的検討

抄録

Objective: This study aimed to describe the appropriate diagnosis and management of adnexal torsion.

Methods: All patients who were surgically proven to have adnexal torsion between July 2015 and December 2021 were retrospectively investigated. We used their clinical backgrounds, blood test results, imaging test results, and surgical findings.

Results: During the study period, 65 patients suffered from adnexal torsion. The white blood cell count and CRP (C-reactive protein) at hospitalization did not necessarily rise, but the NLR (neutrophil-to-lymphocyte ratio) increased significantly. In an emergency, a CT (Computed Tomography) study was helpful for diagnosis, showing typical signs of adnexal torsion. Forty-one patients had laparoscopic surgeries, and 24 had laparotomies. They had significantly different sizes of adnexal swelling (89.37±28.96 mm and 122.25±55.76 mm, p=0.0268). Ovaries were preserved in 27 patients, while 38 underwent salpingo-oophorectomy. Among patients under 50 years of age, 27 had their ovaries preserved, while 26 had salpingo- oophorectomy. These patients had significant differences in age and parity (29.0±8.5 years vs. 37.9±7.1 years; p<0.01/ 0.30±0.11 vs. 1.1±0.23, p<0.01). The frequency of laparoscopic surgery and ovary preservation has been increasing year by year.

Conclusion: Imaging and blood tests, in addition to clinical features and a physical examination, were helpful in correctly diagnosing adnexal torsion, especially given the typical findings of a CT study and an increase in NLR. Furthermore, we should be cautious about ovary preservation and try to avoid a hasty decision on whether the adnexa are necrotic or not based solely on gross surgical findings.