The Clinical And Experimental Study Of Reserved Ovarian Surgery For Adnexal Torsion

ObjectiveTo evaluate the incidence and clinical features of adnexal torsion, and we usingligation of the ovarian vein, followed by reverse the adnexal, besides we observed thefollicles viability and the fertility of oocytes were derived from rabbits,which take theconservative surgery.Method1. The incidence,clinical features of adnexal torsion, and the study of improvedoperation: the records of16cases suffering from adnexal torsion and presented to No.202Hospital of the Chinese People’s Liberation Army between February2008andDecember2012, were take a clinical analysis..2.The study of the rabbit follicles viability and fertility after the conservativesurgery:twenty-four New Zealand were randomly divided into three groups. The controlgroup (sham operation, n=8) only accepts laparotomy, then removed ovaries after48h.the AT48h group(AT48h, n=8):the bilateral adnexas of rabbits were reversed3(1080°)laps in a clockwise direction and fixed on the poaterior abdominal walls,then removedafter48h;the reset group(AT48h+4w) the bilateral adnexas of rabbits were reversed3(1080°) laps in a clockwise direction and fixed on the poaterior abdominal walls,thenreleased after48h and removed after four weeks(28days).All the removed ovaries wereused the cutting mothod to recover oocytes,counted the number of oocytes andhigh-quality oocytes, fertilized in vitro to observe fertilization rate, cleavage rate andhigh-quality embryo rate.Result1. The clinical features of adnexal torsion and the improved operation1.In sixteen cases,7cases (43.75%) occurred in the left side,9cases(56.25%)occured in the right side; in surgery the size of ovary tumor is about6~14cm, an average of9.94±2.62cm; all the cases were associated with pathology, among theresult,5cases (31.25%) were mature ovarian teratoma,3cases (18.75%) were ovarianserous cystadenoma,4cases (25%) were ovarian mucinous cystadenoma, one cases(6.25%) association of ovarian chocolate cysts,theca cell tumor andcorpus luteum cystin each ovary.2. All the patients have lower abdominal pain to started surgical treatment for8to72hours, no patient occur embolism after ligation ovarian vein, the ipsilateral ovarianblood flow returned to normal in about15days, and the ultrasonography can check theipsilateral ovary follicle growth about60~90days.2.The study of the rabbit follicles viability and fertility after the conservativesurgeryThe number of oocytes in the control group and the reset group(37.63±10.78,32.18±16.9) were higher than AT48h group(29.56±7.62), but the differencewas not statistically significant (P>0.05). However the high-quality oocytes(19.86±7.97,14.63±10.46) were higher than AT48h group (5.3±4.63), the difference wasstatistically significant (P <0.05); after in vitro fertilization, the rate of fertilization(58%,52.8%), cleavage (45.6%,43.8%), high-quality embryos (38.4%,32.8%) in the controlgroup and the reset group was significantly higher than AT48h group (31.5%,20.8%,6.5%), the difference is significant(P <0.05).Although the number of oocytes, the rate offertilization, cleavage, high-quality embryos in the control group were higher than thereset group,they have not significan difference.Conclusion1. When women come for emergency diagnosis and treatment is acute pelvic pain,clinicians must be carefully asking detailed history, especially the patient have sufferingfrom adnexal in previous history, combined with a specialist gynecological examinationand imaging laboratory examinations, the clinicians should be diagnosis in timely andaccurately. To youth and fertility women, the clinicians should combined with thepatient condition and tumor cases, as well as the ovarian section have active bleeding ornot, to determine Ipsilateral ovary vitality, as much as possible to retain the ipsilateralfallopian tubes and ovaries.2. Take the upper end of the tumor pedicle position ligation of the ovarian vein,helicase and recovery twisted pedicle, nuclear a tumor, repair the remaining ovary totreat the patients with adnexal torsion, it is safe, effective and worth gynecologist to use.3. The rabbit ovaries occur injure after adnexal torsion, the number of high-quality oocytes, the rate of fertilization, cleavage, high-quality embryos were all declined; butwith adnexal torsion were reversed, the number of high-quality oocytes, the rate offertilization, cleavage, high-quality embryos can be normal, it prompt that the ovarianscould be successfully retain and the development ability of oocytes,embroys could benormol after adnexal torsion implement surgery within48h.