Over Torsiyonu ve Cerrahi Tedavisi: Tersiyer bir merkezin 5 yıllık deneyimi

Yıl 2018, Cilt: 13 Sayı: 2, 33 - 42, 15.07.2018

Taner Günay , Oğuz Devrim Yardımcı Meryem Hocaoğlu , Ergül Demirçivi Bör Gamze Erdem

https://doi.org/10.17517/ksutfd.423102

Cited By: 2

Öz

Amaç:
Çalışmamızda son 5 yılda hastanemizde over torsiyonu tanısı ile opere ettiğimiz
hastaların klinik ve laboratuvar bulguları ile uygulanan cerrahi tedavi
yöntemlerinin incelenmesi amaçlanmıştır.

Gereç ve Yöntemler: Elektronik
ortamda arşiv taraması yapılarak Ocak 2013 ile Ocak 2018 tarihleri arasında
hastanemizin acil servis servisine başvuran ve over torsiyonu tanısı ile opere
edilen hastaların demografik özelliklerinin yanı sıra klinik ve laboratuvar
bulguları ile uygulanan cerrahi tedavi yaklaşımları kaydedildi ve bulguların
analizi yapıldı.

Bulgular: Kayıtlarına
ulaşılan toplam 32 hastanın yaş ortalaması 27.2±10.5 olarak
bulundu ve 9(%28.1) hasta virgo idi. Acil servise başvuran bütün hastalarda
abdominal ve/veya pelvik ağrı mevcut olup, 15(%46.8) hastada bulantı, 7(%21.8)
hastada kusma ve 2(%6.2) hastada ateş görüldü. Over torsiyonu saptanan 2
hastada gebelik mevcuttu. Olguların 19(%59.3)’unda torsiyon sağ tarafta iken
13(%40.7) olguda sol taraftaydı. Torsiyone olan kitlenin boyutu ortalama 92.5±46.3
mm olup olguların 15(%46.8)’inde ultrasonografik incelemede ovaryen akım
saptanmadı. Hastaların 23(%71.9)’ünde laparoskopik yaklaşım uygulanırken
9(%28.1) hastada laparatomi tercih edildi.

Sonuç: Over torsiyonu jinekolojik acil bir durum olup hastanın
fizik muayene bulguları başta olmak üzere laboratuvar ve görüntüleme sonuçları ile değerlendirilerek erken müdahalesi torsiyone olmuş organların korunabilmesi ve
fonksiyonlarını devam ettirebilmesi için kritik önemdedir. Cerrahi yaklaşımda
da laparoskopi ön planda tercih edilmeli ve organ koruyucu yaklaşımlar tedavide
ilk seçenek olmalıdır.

Anahtar Kelimeler

over torsiyonu, laparoskopik cerrahi, ultrason

Ovarian Torsion and Surgical Treatment: Five-year’s experience of a tertiary center

Öz

Objective:
In
current study, we aimed to evaluate the clinical and laboratory findings and
surgical methods in patients treated with a surgical approach for ovarian torsion
in a period of five years in our institute.

Materials
and Methods: The demographic characteristics, clinical
and laboratory findings of patients who admitted to emergeny unit of our
hospital and underwent a surgery for a diagnosis of ovarian torsion in between
January 2013 and January 2018 and surgical methods used were collected via
digital patient database. The relevant data was assessed.

Results:
The
mean age of the patient 32 patients who had eligible medical records was 27.2±10.5.
Nine (28.1%) of 32 patients was virgo. All the patients had abdominal or pelvic
pain. 15 (46.7%) patients had nausea, 7 (6.2%) had vomitting and 2 (6.2%) had
fever. Two of patients were pregnant during diagnosis. 19 (59.35) patients had
righ-sided ovarian torsion and 13(40.7) had left-sided. The mean average
diameter of the torsioned ovary was 92.5±46.3 mm. Ovarian
blood flow was compromised in 15 (46.8%) patients in color doppler sonographic
evaluation. Laparoscopic surgery was preferred for 23 (71.9%) patients and
laparotomy for 9.

Conclusion: The
early intervention of a torsioned ovary, a gynecologic emergency, has a
critical role to secure the affected organ and to preserve its functions with the
evaluation of the patient’s physical examination findings, laboratory and
imaging findings. Organ-sparing surgery should be the first choice preferably
with a laparoscopic approach.

Anahtar Kelimeler

ovarian torsion, laparoscopic surgery, ultrasound

Kaynakça

• Pansky M, Smorgick N, Herman A, Schneider D, Halperin R. Torsion of normal adnexa in postmenarchal women and risk of recurrence. Obstet Gynecol 2007;109:355-9.
• White M, Stella J. Ovarian torsion: 10-year perspective. Emerg Med Australas 2005;17:231-7.
• Rousseau V, Massicot R, Darwish AA, Sauvat F, Emond S, Thibaud E, et al. Emergency management and conservative surgery of ovarian torsion in children: a report of 40 cases. J Pediatr Adolesc Gynecol 2008;21:201-6.
• Eitan R, Galoyan N, Zuckerman B, Shaya M, Shen O, Beller U. The risk of malignancy in post-menopausal women presenting with adnexal torsion. Gynecol Oncol 2007;106:211-4.
• Bider D, Mashiach S, Dulitzky M, Kokia E, Lipitz S, Ben-Rafael Z. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. Surg Gynecol Obstet 1991;173:363-6.
• Mazouni C, Bretelle F, Menard JP, Blanc B, Gamerre M. Diagnosis of adnexal torsion and predictive factors of adnexal necrosis]. Gynecol Obstet Fertil 2005;33:102-6.
• Tsafrir Z, Azem F, Hasson J, Solomon E, Almog B, Nagar H, et al. Risk factors, symptoms, and treatment of ovarian torsion in children: the twelve-year experience of one center. J Minim Invasive Gynecol 2012;19(1):29-33.
• Houry D, Abbott JT. Ovarian torsion: a fifteen-year review. Ann Emerg Med 2001;38:156-9.
• Kart C, Aran T, Guven S, Karahan SC, Yulug E. Acute increase in plasma D-dimer level in ovarian torsion: an experimental study. Hum Reprod 2011;26:564-8.
• Tobiume T, Shiota M, Umemoto M, Kotani Y, Hoshiai H. Predictive factors for ovarian necrosis in torsion of ovarian tumor. Tohoku J Exp Med 2011;225:211-4
• Shadinger LL, Andreotti RF, Kurian RL. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. J Ultrasound Med 2008;27(1):7-13
• Lee JH, Park SB, Shin SH, Jang JC, Lee WC, Jeong AK, et al. Value of intraadnexal and extra-adnexal computed tomographic imaging features diagnosing torsion of adnexal tumor. J Comput Assist Tomogr 2009;33:872-6
• Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC. Diagnosis of ovarian torsion with color Doppler sonography:depiction of twisted vascular pedicle. J Ultrasound Med 1998;17(2):83-9.
• Hasson J, Tsafrir Z, Azem F, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol 2010;202(6):536-9.
• Bayer AI, Wiskind AK. Adnexal torsion: can the adnexa be saved? Am J Obstet Gynecol 1994;171(6): 1506-10
• Comerci JT Jr, Licciardi F, Bergh PA, Gregori C, Breen JL. Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol 1994;848(1):22-8.
• Huchon C, Fauconnier A. Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol 2010; 150(1):8-12.
• Descargues G, Tinlot-Mauger F, Gravier A, Lemoine JP, Marpeau L. Adnexal torsion: a report on forty-five cases. Eur J Obstet Gynecol Reprod Biol 2001;98(1): 91-6.
• Mashiach R Melamed N, Gilad N, et al. Sonographic diagnosis of ovarian torsion:accuracy and predictive factors. J Ultrasound Med 2011;30(9):1205-10.
• Albayram F, Hamper UM. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. J Ultrasound Med 2001;20(10):1083-9.
• Oelsner G, Shashar D. Adnexal torsion. Clin Obstet Gynecol 2006;49(3):459-63.
• McGovern PG, Noah R, Koenigsberg R, Little AB. Adnexal torsion and pulmonary embolism: case report and review of the literature. Obstet Gynecol Surv 1999;54(9):601-8.
• Zhai A, Axt J, Hamilton EC, et al. Assessing gonadal function after childhood ovarian surgery. J Pediatr Surg 2012;47:1272–9.).
• Bellati F, Ruscito I, Gasparri ML, et al. Effects of unilateral ovariectomy on female fertility outcome. Arch Gynecol Obstet 2014;290:349–53.)
• Parelkar SV, Mundada D, Sanghvi BV, et al. Should the ovary always be conserved in torsion? A tertiary care institute experience. J Pediatr Surg 2014; 49:465–8)
• Rha SE, Byun JY, Jung SE, et al. CT and MR imaging features of adnexal torsion. Radiographics 2002;22:283–94.
• Galinier P, Carfagna L, Delsol M, et al. Ovarian torsion. Management and ovarian prognosis: a report of 45 cases. J Pediatr Surg 2009;44:1759–65)