目的:以系统的方式结合所有描述成人非妊娠患者孤立性输卵管扭转的文献,优化诊断和管理的知识和实践。
方法:EMBASE和PubMed数据库中的术语\'输卵管\'或\'输卵管\'和\'孤立\'和\'扭转\'从这些数据库开始到2023年7月5日。包括所有病例报告或病例系列的成年患者(18岁或以上)的孤立输卵管扭转。排除标准包括:所有其他研究类型;涉及儿童和青少年(18岁以下)的病例;所有三个月的怀孕患者;输卵管卵巢扭转;未发表英文研究;重复和文本中没有的。在数据库搜索之后,两名作者独立筛选了研究,随后按照PRISMA指南报告了检索结果.数据由两位作者独立提取,并使用Excel进行分析。使用Murad等人提出的改进版本的工具评估所有病例的偏倚。结果:本系统评价中纳入了92篇独特的文章,共招募了131例病例。孤立性输卵管扭转最常发生在18至45岁之间的生殖年龄。在绝经后妇女中并不常见。最常见的症状包括患侧的单侧下腹或盆腔疼痛,伴有恶心和呕吐。风险因素可以是内在的或外在的,可以包括诸如输卵管积水,灭菌,盆腔炎或囊肿。超声是最佳的成像模态,然而也可以使用计算机断层摄影和磁共振成像。一般成像灵敏度低,然而,孤立的输卵管扭转可以通过适当的专业知识来识别。孤立性输卵管扭转管理的金标准是腹腔镜检查和扭转,但目前,最常见的干预是输卵管切除术.
结论:孤立性输卵管扭转是一种罕见但重要的妇科急症,具有重要的生育意义。这项研究总结了最常见的介绍,孤立性输卵管扭转患者的调查结果和手术干预。这项研究还强调了临床医生对早期腹腔镜干预保持高度怀疑和低阈值以保留生育能力的重要性。
OBJECTIVE: To combine all literature describing cases of
isolated fallopian tube torsion in adult non pregnant patients in a systematic manner, to optimize knowledge and practice both for diagnosis and management.
METHODS: EMBASE and PubMed databases were searched for the terms \'tubal\' OR \'fallopian tube\' AND \'
isolated\' AND \'torsion\' from the inception of these databases to July 5, 2023. All
case reports or
case series of adult patients (18 years or older) with
isolated fallopian tube torsion were included. Exclusion criteria included: all other study types; cases involving children and adolescents (less than 18 years old); pregnant patients of all trimesters; tubo-ovarian torsion; studies not published in English; duplicates and those not available in text. Following the database search, two authors independently screened the studies and search results were subsequently reported in accordance with PRISMA guidelines. Data was extracted independently by two authors and analysed using Excel. All cases were assessed for bias using a modified version of the tool proposed by Murad et al. RESULTS: 92 unique articles enrolling 131 individual cases were included in this systematic review.
Isolated fallopian tube torsion most commonly occurs during reproductive ages between 18 and 45 years. It is uncommon in postmenopausal women. The most common presenting symptoms include unilateral lower abdominal or pelvic pain along the affected side with nausea and vomiting. Risk factors can be intrinsic or extrinsic and can include conditions such as hydrosalpinx, sterilization, pelvic inflammatory disease or cysts. Ultrasound is the optimal imaging modality however Computed Tomography and Magnetic Resonance Imaging can also be used. Imaging in general has low sensitivity, however isolated fallopian tube torsion can be identified with appropriate expertise. The gold standard for
isolated fallopian tube torsion management is laparoscopy and detorsion however currently, the most common intervention performed is salpingectomy.
CONCLUSIONS: Isolated fallopian tube torsion is a rare but important gynaecological emergency with significant fertility implications. This study summarizes the most common presentations, investigation findings and surgical interventions in patients with isolated fallopian tube torsion. This study also emphasizes the importance of clinicians maintaining a high degree of suspicion and low threshold for early laparoscopic intervention to retain fertility.