| Background and ObjectiveOvarian cyst pedicle torsion is the fifth most common acute abdominal disease in gynecology,accounting for 2.7%of emergency gynecological operations.It is more common in women of reproductive age than in postmenopausal women.The main performance is sudden abdominal pain,it is often induced by the change of position or strenuous exercise,and can be accompanied by nausea,vomiting,fever,anal distension,gastrointestinal symptoms.In recent years,due to various reasons,the incidence of ovarian cyst pedicle torsion is gradually increasing,because that it belongs to gynecological acute abdomen,and will threaten the function of the ovary and affect the fertility of patients,the disease has been paid more and more attention by clinical workers.The principle of treatment is to perform surgical treatment as soon as possible once diagnosed.Early diagnosis and timely operation are the key to the treatment of this disease.Since ovarian cyst pedicle torsion may eventually lead to irreversible injury of female ovarian function and influence on fertility,how to improve the intraoperative ovarian retention rate has become the focus of research on this disease.The clinical data about first affiliated hospital of zhengzhou university laparoscopic treatment of 120 patients with ovarian cyst pedicle torsion were analyzed retrospectively this study,according to the operation method,patients were divided into reserve ovary and accessories resection groups,sum up the clinical characteristics of ovarian cyst,through comparing the related indicators and postoperative follow-up,explores the clinical value and curative effect analysis of laparoscopic preserving ovarian surgery of ovarian cyst pedicle torsion.Data and Methods1.Clinical data:Clinical data of 120 patients with ovarian cyst pedicle torsion who underwent laparoscopic surgery in the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2019 were collected and analyzed retrospectively.A total of 120 patients met the inclusion criteria.According to the different surgical methods,the patients were divided into two groups,including 62 cases of laparoscopic torsion reduction and ovarian cyst excision(group A)and 58 cases of laparoscopic adnexectomy(group B).2.The observation indexes:Collecting the clinical data of selected patients,Counting patients’ age distribution,the clinical manifestations and signs,auxiliary examination and the pathological classification of ovarian cysts.The age,torsion time,torsion degree,diameter of the cyst,torsion site,operative time,intraoperative blood loss,postoperative hospital stay,anal exhaust time,incidence of postoperative complications(fever,incision infection,pelvic infection,pulmonary embolism),postoperative reexamination results of ultrasound,postoperative menstruation and postoperative pregnancy were compared between the two groups.3.Statistical Methods:SPSS 23.0 statistical software was used for statistical analysis.S-W test was used for the normality test of measurement data,T test was used for comparison of measurement data with normal distribution.The measurement data that did not follow the normal distribution were represented by the median and quad spacing[M(P25,P75)],Non-parametric test was used for the comparison between groups,and Mann-Whitney U test was used for the non-parametric test of two independent samples.Chi-square test was used to compare the counting data between groups.and P<0.05 was considered that the difference was statistically significant.Results1.All the patients were 6-44 years old,ovarian cyst pedal torsion is most common in women of 20 to 30 years of reproductive age.The main clinical manifestations were lower abdominal pain,among which 96 patients(80.0%)presented acute abdominal pain and 24 patients(20.0%)presented chronic abdominal pain,60 patients(50.0%)presented nausea and vomiting,32 patients(26.67%)were accompanied by anal swelling feeling.There were 4 patients(3.33%)with fever,and no shock occurred.All patients had abdominal tenderness,among them,110 patients(91.67%)could touch pelvic mass,19 patients(15.83%)had slight peritoneal irritation,and there were 67 patients(55.83%)with elevated white blood cell count in preoperative blood routine.All patients received preoperative pelvic ultrasound or transvaginal ultrasound examination,and all of them showed adnexal mass,torsion of ovarian cyst pedicle was found in 49 patients,the detection rate was 40.83%.Some patients underwent abdominal CT and abdominal MRI before surgery,the detection rates were all low.2.There was no significant difference in patients’ age,diameter of the cyst,torsion site between the two groups.Torsion occurred more frequently on the right side than the left side.The torsion time and torsion degree in group A were smaller than those in group B,and the difference was statistically significant(P<0.05).In this study,no special conditions occurred in all patients during the operation,and all operations were successfully completed.There was no significant difference in postoperative hospital stay and anal exhaust time between the two groups(P>0.05).But the difference of operative time and intraoperative blood loss between the two groups was statistically significant(P<0.05),group B was better than group A.3.The most common pathological types of benign ovarian tumors in ovarian cyst pedicle torsion were simple ovarian cyst(31.67%)and mature ovarian cystic teratoma(25.83%),while ovarian follicular cyst(14.17%)and luteal hematoma(10.83%)were also common.4.Fever was the main postoperative complication in both groups,and no serious complications occurred,there was no statistically significant difference in the incidence of postoperative complications between the two groups(P>0.05).All the patients received ultrasound examination in 1 month,3 months and 6 months after surgery,and ultrasound examination in 6 months after surgery indicated that the affected side of the ovary in group A was normal in size,Follicular development was observed in all patients,and no obvious abnormalities were observed.All patients in Group B had follicular development on the healthy side of the ovary,and no obvious abnormalities were observed.Comparison of postoperative menstruation between the two groups showed that the incidence of postoperative abnormality of menstruation in Group A(3.51%)was less than that in Group B(9.09%),and the difference was not statistically significant(P>0.05).Postoperative pregnancy rate of group A was 80.77%.The postoperative pregnancy rate of group B was 50.00%,and the postoperative pregnancy rate of group A was higher than that of group B,the difference was statistically significant(P<0.05).ConclusionThe incidence of ovarian cyst pedicle torsion tends to be younger,preserving ovarian surgery also gradually become a clinical consensus.Preserving ovaries not only gives patients more confidence and comfort,but also can better protect the ovarian function and fertility of patients,and can obtain good therapeutic results like adnexectomy,and do not increase the incidence of postoperative complications,which is worthy of clinical popularization and application. |
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