及时的手术干预可保留卵巢功能,达到最佳预后。尽管由于担忧扭转复位导致血栓脱落的潜在风险,以往一直主张切除卵巢,但这一观点没有文献资料的支持。采用微创手术,如腹腔镜下松解扭转的附件有望完全恢复正常卵巢功能和生育力。[42]Way S. Ovarian cystectomy of twisted cysts. Lancet. 1946;2:47-48.[43]McGovern PG, Noah R, Koenigsberg R, et al. Adnexal torsion and pulmonary embolism: case report and review of the literature. Obstet Gynecol Surv. 1999;54:601-608.http://www.ncbi.nlm.nih.gov/pubmed/10481857?tool=bestpractice.com
生育力
很多研究显示了受累卵巢复位后具有功能的证据。[2]Oelsner G, Shashar D. Adnexal torsion. Clin Obstet Gynecol. 2006;49:459-463.http://www.ncbi.nlm.nih.gov/pubmed/16885653?tool=bestpractice.com[12]Bider D, Mashiach S, Dulitzky M, et al. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. Surg Gynecol Obstet. 1991;173:363-366.http://www.ncbi.nlm.nih.gov/pubmed/1948585?tool=bestpractice.com[25]Mashiach S, Bider D, Moran O, et al. Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril. 1990;53:76-80.http://www.ncbi.nlm.nih.gov/pubmed/2295348?tool=bestpractice.com[45]Ben-Rafael Z, Bider D, Mashiach S. Laparoscopic unwinding of twisted ischemic hemorrhagic adnexum after in vitro fertilization. Fertil Steril. 1990;53:569-571.http://www.ncbi.nlm.nih.gov/pubmed/2137796?tool=bestpractice.com[48]Cohen SB, Wattiez A, Seidman DS, et al. Laparoscopy versus laparotomy for detorsion and sparing of twisted ischemic adnexa. JSLS. 2003;7:295-299.http://www.ncbi.nlm.nih.gov/pubmed/14626393?tool=bestpractice.com[57]Descargues G, Tinlot-Mauger F, Gravier A, et al. Adnexal torsion: a report on forty-five cases. Eur J Obstet Gynecol Reprod Biol. 2001;98:91-96.http://www.ncbi.nlm.nih.gov/pubmed/11516806?tool=bestpractice.com[58]Shalev E, Mann S, Romano S, et al. Laparoscopic detorsion of adnexa in childhood: a case report. J Pediatr Surg. 1991;26:1193-1194.http://www.ncbi.nlm.nih.gov/pubmed/1838120?tool=bestpractice.com在一项研究中,93% 的患者卵巢功能得到恢复。[2]Oelsner G, Shashar D. Adnexal torsion. Clin Obstet Gynecol. 2006;49:459-463.http://www.ncbi.nlm.nih.gov/pubmed/16885653?tool=bestpractice.com[48]Cohen SB, Wattiez A, Seidman DS, et al. Laparoscopy versus laparotomy for detorsion and sparing of twisted ischemic adnexa. JSLS. 2003;7:295-299.http://www.ncbi.nlm.nih.gov/pubmed/14626393?tool=bestpractice.com儿童卵巢扭转保守治疗也得到了相同的结果。[18]Cass DL. Ovarian torsion. Semin Pediatr Surg. 2005;14:86-92.http://www.ncbi.nlm.nih.gov/pubmed/15846564?tool=bestpractice.com[58]Shalev E, Mann S, Romano S, et al. Laparoscopic detorsion of adnexa in childhood: a case report. J Pediatr Surg. 1991;26:1193-1194.http://www.ncbi.nlm.nih.gov/pubmed/1838120?tool=bestpractice.com[59]Templeman C, Hertweck SP, Fallat ME. The clinical course of unresected ovarian torsion. J Pediatr Surg. 2000;35:1385-1387.http://www.ncbi.nlm.nih.gov/pubmed/10999708?tool=bestpractice.com
复发
同侧扭转复发或非同期对侧卵巢发生扭转的准确风险尚未可知。似乎处于 2% 至 5% 之间。[20]Beaunoyer M, Chapdelaine J, Bouchard S, et al. Asynchronous bilateral ovarian torsion. J Pediatr Surg. 2004;39:746-749.http://www.ncbi.nlm.nih.gov/pubmed/15137011?tool=bestpractice.com[47]Oelsner G, Cohen SB, Soriano D, et al. Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function. Hum Reprod. 2003;18:2599-2602.http://humrep.oxfordjournals.org/content/18/12/2599.fullhttp://www.ncbi.nlm.nih.gov/pubmed/14645177?tool=bestpractice.com复发更常见于儿童卵巢扭转手术时未发现基础病变者,文献报告风险为 2% 至 11.4%。[18]Cass DL. Ovarian torsion. Semin Pediatr Surg. 2005;14:86-92.http://www.ncbi.nlm.nih.gov/pubmed/15846564?tool=bestpractice.com[20]Beaunoyer M, Chapdelaine J, Bouchard S, et al. Asynchronous bilateral ovarian torsion. J Pediatr Surg. 2004;39:746-749.http://www.ncbi.nlm.nih.gov/pubmed/15137011?tool=bestpractice.com