付属器茎捻転に対する一期的あるいは二期的腹腔鏡下保存手術

Conservative laparoscopic management of adnexal torsion through a 1-stage or 2-stage operation

◆要旨：付属器茎捻転に対しては付属器摘出術が第一選択の治療法とされてきた．しかし若年患者や挙児希望例などでは妊孕性の保存という点で問題がある．2005年12月～2011年4月の期間に，筆者らが腹腔鏡下手術を行った39例の付属器茎捻転患者のうち，妊孕性の保存が必要で付属器保存手術（捻転解除＋原因腫瘤の核出）を試みた20例について，その有効性を検討した．付属器保存手術の成功率は傍卵巣囊胞では3/3例（100％），卵巣腫瘤では11/17例（65％）であった．茎捻転による浮腫，うっ血が著しい例でも，捻転を解除し一期的あるいは二期的に原因腫瘤を摘出することにより付属器の保存が可能であることが示唆された．

　Adnexectomy has long been the standard treatment option for adnexal torsion. However, conservative management with gentle untwisting of the pedicle and possible cystectomy is now becoming increasingly common to preserve future fertility. We report the effectiveness of conservative surgery by reviewing our experience with 20 patients. Between December 2005 and April 2011, we performed 39 laparoscopic procedures for unilateral adnexal torsion. We tried to untwist and conserve the adnexa in 20 patients who were under the age of 45. We excluded the cases where malignancy was suspected, the patient was pregnant, or the patient did not request the conservative operation. We evaluated and compared the patients' medical charts for laparoscopic findings, histological features of the mass causing adnexal torsion, and operative methods. Adnexal torsion was caused by ovarian masses in 17 patients （85％） and parovarian cysts in 3 patients （15％）. Among the 20 patients, the adnexa could be conserved in 100％ （3/3） of the patients with parovarian cysts and could be salvaged in 65％ （11/17） of the patients with ovarian masses through 1-stage or 2-stage conservative surgery. In conclusion, conservative laparoscopic management of adnexal torsion was effective in all patients caused by parovarian cysts, and in more than 60％ of the patients with ovarian masses. We did not observe any adverse effect such as pulmonary embolism from the management.