当院における付属器腫瘍茎捻転症例の検討

Laparoscopic treatment for adnexal torsion

◆要旨：付属器腫瘍茎捻転は婦人科救急疾患のなかでも頻度の多い疾患の一つであり，卵巣機能の温存のためには迅速な診断および治療が重要である．2004年～2009年までに当科で付属器腫瘍茎捻転と診断され緊急腹腔鏡下手術を行った17例を対象とした．来院時の症状，検査所見，発症から手術までの時間，術後経過について検討した．全症例に下腹部痛を認め2例に発熱および便秘を認めた．12例に捻転解除後にcystectomyを行い，5例では付属器切除を行った．卵巣を温存した症例のうち追跡可能であった全例で卵胞形成を認めたことより生殖可能年齢の患者に対しては，捻転解除後に腫瘍摘出のみを行う付属器温存療法を第一選択とすべきであると考えられた．

　Ovarian torsion is a common disease of gynecologic emergency. Considering that women of reproductive age have the highest incidence of ovarian torsion, expeditious diagnosis and treatment is important to preserve ovarian function and to prevent adverse result. From 2004 to 2009, patients who had adnexal torsion were treated by laparoscopic surgery at the Juntendo University Hospital. All patients underwent emergency laparoscopic surgery. Patients' symptoms, objective findings, time from the onset of pain to operation, and surgical outcomes were examined for those who underwent laparoscopic surgery. The most common symptom and sign was lower abdominal pain（100%）, followed by constipation（12.5%）and fever（12.5%）. Twelve patients underwent detorsion with cystectomy and 5 patients underwent oophorectomy. Normal follicular development was observed in all patients who underwent detorsion with cystectomy. Our data suggest that detorsion and ovarian preservation is a safe operation that should be considered in premenoposal patients.