| Objective: To investigate the effect and the prognosis of the laparoscopic new surgical approach named “Oophorocystectomy with Gradualness Detorsion”(OCGD)which use oophorocystectomy with gradually releasing torsional pedicle one circle per 5 minutes until full detorsion is achieved to treat adnexal torsion.Methods: A total of 211 patients who were suspected to have adnexal torsion and treated by gynecological surgery in Shengjing Hospital were collected from September 2015 to September 2019.According to the preoperative inclusion criteria and exclusion criteria,a total of 174 patients were selected.Then 89 patients were selected according to the intraoperative conditions.According to the different surgical approaches decided by the consent signed before surgery,they were divided into three groups.Group A used the new surgical approach(n=20),group B used the traditional conservative surgical method which used oophorocystectomy after directly releasing the torsional pedicle(n=29),group C used traditional adnexectomy(n=25).The general data(age,sexual life history,preoperative abdominal pain duration,average diameter of the mass under ultrasound,preoperative laboratory examination index,preoperative Kupperman Score,torsional side,torsional degree),curative effect related data(intraoperative bleeding volume,surgical duration,postoperative exhausting time,postoperative first underground activity time,postoperative hospital stay,postoperative laboratory examination index,complications incidence)and prognostic data(menstrual condition after six months of the surgery,postoperative Kupperman Score,postoperative pregnancy rate)were collected and compared among the three groups.One-factor ANOVA analysis,the rank sum test of non-parametric multiple independent samples,chi-square test with multiple independent samples were used for calculation.Results: Compared the general data among three groups,the differences did not have statistical significance(P>0.05).On the aspect of the curative effect,the intraoperative bleeding volume among the three groups had statistical significant differences(P<0.05).Multiple comparative results indicated that both group A and group B,group A and group C had statistical significantdifferences(P<0.05).Group B and group C did not have statistical significant differences(P>0.05).The postoperative hospital stay among the three groups had statistical significant differences(P<0.05).Results of multiple comparison indicated that group A and group B had statistical significant differences(P<0.05).Group A and group C,group B and group C did not have statistical significant differences(P>0.05).The surgery duration,postoperative laboratory examination index,postoperative exhausting time and postoperative first underground activity time among the three groups did not have statistical significant differences(P>0.05).The incidence of postoperative complications among the three groups,group A 30%(6/20),group B 48.2%(14/29),and group C 40%(10/25),did not have statistical significant differences(P>0.05).On the prognosis of the new surgical approach,the incidence of postoperative abnormal menstruation among the three groups with group A 10%(2/20),group B 20.7%(6/29),and group C 52%(13/25)had statistic significant differences(P<0.05).Results of multiple comparison indicated that group A and group C,group B and group C had statistical significant differences(P<0.0167,after Bonferroni Correction).Group A and group B did not have statistical significant differences(P>0.0167).There were no significant differences in Kupperman Scores among the three groups(P>0.05).But the results of the preoperative and postoperative scores compared longitudinally within the single group,group C had statistical significant differences(P<0.0167).Three patients in group A,three in group B,four in group C desired to have a baby.The pregnancy rate in patients who desire to have a baby in each group were all 100%.There were no significant differences in the postoperative pregnancy rate among the three groups.Conclusion: Firstly,in terms of surgical curative effect,the new surgical approach(OCGD)had less intraoperative bleeding volume compared to the two traditional surgical approaches.The surgical duration of the new surgical approach(OCGD)was shorter than the traditional conservative surgical approach.There were no significant differences in the surgical duration,postoperative exhausting time,postoperative first underground activity time,incidence of postoperative complications and postoperative laboratory examination index among the three groups.The new surgical approach(OCGD)has important clinical application value.Secondly,in terms of surgical prognosis,the new surgical approach(OCGD)hadlower abnormal menstruation incidence,better postoperative self-feeling than the traditional approach of adnexectomy to treat adnexal torsion.There were no significant differences in the postoperative pregnancy rate among the three groups.The new surgical approach(OCGD)provides an ideal treatment for patients in reproductive age with adnexal torsion... |
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