Clinical Analysis Of9Cases Of Paraovarian Cyst Torsion

Objective:To study the clinical features,various operation treatments ofparaovarian cyst with torsion,and to observe the curative effect of high ligation of theovarian vessels in curing paraovarian cyst with torsion.Methods:There were213paraovarian cyst patients,including9cases of secondarytorsion,which were clinically and pathologically diagnosed and operation cured in thegynecology and obstetrics department of the202ndmilitary hospital of PLA from2005March to2013February.We retrospective analyzed the clinical data as well as thefollow-up information of the9patients with paraovarian cyst torsion.Results:⑴The incidence of paraovarian cyst torsion was4.2%(9/213).Themean±SD age of the study population was29.9±6.5(range,20-43)years.There were6cases occurred in the right side（66.7%）,5cases related with exercises（55.6%） and4cases in pregnancy（44.4%）.⑵All of the study patients had lower abdominal pain，7cases with nausea or vomiting,2cases with radiating pain in the lower limbs,1caseswith abdominal distension，1cases with fever and anal bulge.5patients had ipsilaterallower abdominal tenderness,no obvious muscle tension and rebounding pain;while theother4patients had obvious ipsilateral lower abdominal tenderness,mild muscletension and rebounding pain.Gynecological examinations(including digital rectalexamination),8patients had ipsilateral adnexal masses,soft or medium,tension andlimitation of activity,5cases had obvious tenderness.⑶4patients in pregnancyunderwent abdominal ultrasound examination,while the other5patients underwent bothabdominal ultrasound and transvaginal ultrasound examinations.All of the examinationreports showed ipsilateral adnexal masses,round or oval,cystic and tension.There wereno ipsilateral ovary detected in4pregnancy women,while the others detected theipsolateral ovary(2cases with unclear boundaries and3cases with well-definedboundaries between the cyst and ovary).⑷C ombined the clinical manifestation withultrasound examination,6patients were diagnosed as ovarian tumor torsion and3patients were diagnosed as paraovarian cyst torsion.The coincidence with the operation and pathology was33.3%.⑸D uring the operation,we saw5casesof the ovary andparaovarian cyst twist together(including3pregnancy women).The mean±SD cystdiameter of these five was11.8±3.1㎝,one had unilateral adnexectomy due to thenecrosis of fallopian tube and ovary,while the other three had high ligation of ovaryvessel followed by reposition plus excision of paraovarian cysts.The mean±SD cystdiameter of another4cases was6.3±2.6㎝,in which3cases with paraovarian cyst twistalone had excision of paraovarian cysts,while the other1case with oviduct andparovarian cyst twist together had excision of cyst and oviduct.⑹The blood flow of allof the affected ovaries was reduced in one week,and would recover in three monthsafter operation.3cases with cyst excision and3cases with ovarian vein ligation wouldrecover in two weeks,1case with fallopian tube and cyst excision would recover in onemonth,while1case with ligation of both ovarian artery and vein would recover in threemonths after operation.⑺Three healthy neonates were delivered at term,while one ofpremature delivery.Another five patients were observed normal ovulation byultrasound examination3~6months postoperation.Conclusion:⑴T he clinical incidence of parovarian cyst torsion is low.It oftenhappens at right side.Pregnancy and activity would be its risk factors. Most of thepatients are during the reproductive years from（29.9-6.5）to（29.9+6.5）years of age.⑵T he clinical manifestation and ultrasound image in paraovarian cyst torsion patientsare nonspecific,easy to confuse with ovarian tumor torsion.The coincidence ofpreoperative diagnosis with postoperative and pathologic diagnosis is low.Patients atpregnancy or with giant paraovarian cyst would diagnose more difficult.⑶Paraovariancyst torsion include simple cyst twist,fallopian tube and cyst twist together,ovary andcyst twist together and so on.Paraovarian cyst about12㎝large would easy to twisttogether with ipsolateral ovary.Different operation would be perform at different twistsituation.⑷High ligation of ovary vessel followed by reposition plus excision ofparaovarian cysts can prevent ovarian vein thrombus falling off,suitable for the patientswith ovary and parovarian cyst twist together.Follow-up data demonstrated that thismethod is safe and effective.Ligation of the ipsilateral ovarian vein would give priorityto use according to its blood flow recovery before the ligation of both ovarian artery andvein.