The classical teaching was that twisted adnexa should be resected and not untwisted, so as not to increase the risk of pulmonary embolism (PE).A patient recently was seen who developed PE after adnexal resection. Because this complication followed the conventional management of salpingo-oophorectomy, the literature was examined for cases of adnexal torsion and PE to see if the operative management (untwisting vs. excision without untwisting) could be implicated as a contributing factor. Three hundred nine cases of adnexal torsion managed by untwisting and 672 cases treated by adnexectomy without detorsion (untwisting) were found. The incidence of PE after adnexal torsion was 0.2 percent, and this incidence was not increased when the adnexa were untwisted. Therefore, we conclude that detorsion of twisted adnexa does not increase the risk of PE, compared with excision without untwisting. PE does occur in cases in which adnexal resection is performed without untwisting. Thus, detorsion of twisted adnexa should be considered at laparoscopy or laparotomy without fear of increasing the incidence of PE.Target AudienceObstetricians Gynecologists, Family PhysiciansLearning ObjectivesAfter completion of this article, the reader will be able to understand the incidence of pulmonary embolus associated with adnexal torsion reported in the English literature and to understand the various operative options for the management of adnexal torsion.
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机译:经典的教导是,扭曲的附件应该切除而不是解开,以免增加肺栓塞 (PE) 的风险。最近有一名患者在附件切除术后出现肺栓塞。由于这种并发症遵循输卵管卵巢切除术的常规治疗,因此检查了附件扭转和 PE 病例的文献,以确定手术治疗(解开与切除而不解开)是否可能与促成因素有关。309例通过解开治疗的附件扭转和672例通过不扭转(解开)的附件切除术治疗。附件扭转后PE的发生率为0.2%,当附件解开时,该发生率不会增加。因此,我们得出结论,与不解开扭曲的切除相比,扭转的附件不会增加 PE 的风险。PE确实发生在进行附件切除术而不解开的情况下。因此,在腹腔镜检查或剖腹手术时应考虑扭转性附件的复位,而不必担心增加 PE 的发生率。目标受众妇产科医生、家庭医生学习目标完成本文后,读者将能够了解英文文献中报道的与附件扭转相关的肺栓塞的发生率,并了解治疗附件扭转的各种手术选择。
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