辅助生殖技术助孕后卵巢过度刺激综合征合并卵巢扭转一例

doi:10.12280/gjszjk.20240138

摘要/Abstract

摘要：

随着辅助生殖技术（assisted reproductive technology，ART）的发展，其主要的医源性并发症卵巢过度刺激综合征的出现亦是难以避免的，也进一步增加了卵巢扭转的风险。卵巢过度刺激综合征合并卵巢扭转患者的临床症状及影像学检查等特异度较低，故对该类急腹症的早期识别和诊断比较困难。本文报告1例ART治疗的患者，在取卵前发生卵巢过度刺激综合征合并卵巢扭转，在取卵后保守治疗效果欠佳，最终仍不可避免地需行手术治疗。该案例提示，ART治疗中加强对卵巢过度刺激综合征合并卵巢扭转的认识，对此类急腹症做到早识别、早诊断及早治疗。

关键词: 卵巢扭转, 卵巢过度刺激综合征, 生殖技术，辅助, 多囊卵巢综合征, 病例报告

Abstract:

With the development of assisted reproductive technology (ART), ovarian hyperstimulation syndrome (OHSS) as a main iatrogenic complication is also inevitable, which further increases the risk of ovarian torsion. The clinical symptoms and imaging characteristics of the patient with OHSS combined with ovarian torsion are relatively atypical, which means that the early identification and diagnosis of this acute abdomen is difficult. We report a case of OHSS combined with ovarian torsion before egg retrieval during ART treatment. The conservative treatment after egg retrieval was ineffective, and ultimately surgical treatment was still inevitable. This case suggests that the understanding of OHSS complicated with ovarian torsion should be strengthened during ART treatment, so as to achieve the early identification, early diagnosis and early treatment of this acute abdomen.

Key words: Ovarian torsion, Ovarian hyperstimulation syndrome, Reproductive techniques, assisted, Polycystic ovary syndrome, Case reports

朱海英, 齐丹丹, 孙平平, 孙娜, 栾素娴. 辅助生殖技术助孕后卵巢过度刺激综合征合并卵巢扭转一例[J]. 国际生殖健康/计划生育杂志, 2024, 43(5): 401-405.

ZHU Hai-ying, QI Dan-dan, SUN Ping-ping, SUN Na, LUAN Su-xian. A Case Report of Ovarian Hyperstimulation Syndrome Combined with Ovarian Torsion after Assisted Reproductive Technology Assisted Pregnancy[J]. Journal of International Reproductive Health/Family Planning, 2024, 43(5): 401-405.

图/表 4

图1 突发腹痛2 h妇科彩色超声（2023年12月26日）注：A 左侧卵巢；B 右侧卵巢。

图2 腹腔镜探查术术中所见（2023年12月29日）注：A 左侧卵巢；B 右侧卵巢；C 右侧卵巢剥离坏死组织后。

图3 出院前妇科超声（2024年1月12日）注：A 左侧卵巢；B 右侧卵巢。

图4 出院后门诊复查妇科超声（2024年1月21日）注：A 左侧卵巢；B 右侧卵巢。

参考文献 16

[1]	Yu M, Liu Y, Jia D, et al. Adnexal torsion in pregnancy after in vitro fertilization: Case report and literature review[J]. Medicine(Baltimore), 2021, 100(3):e24009. doi: 10.1097/MD.0000000000024009.
[2]	Psilopatis I, Damaskos C, Garmpis N, et al. Ovarian Torsion in Polycystic Ovary Syndrome: A Potential Threat?[J]. Biomedicines, 2023, 11(9):2503. doi: 10.3390/biomedicines11092503.
[3]	Tomás C, Colmorn L, Rasmussen S, et al. Annual incidence of severe ovarian hyperstimulation syndrome[J]. Dan Med J, 2021, 68(2):A12190738.
[4]	Berkkanoglu M, Coetzee K, Bulut H, et al. Risk of ovarian torsion is reduced in GnRH agonist triggered freeze-all cycles: a retrospective cohort study[J]. J Obstet Gynaecol, 2019, 39(2):212-217. doi: 10.1080/01443615.2018.1479381. pmid: 30230393
[5]	吕燕, 程旭珍, 吴伊青, 等. 促排卵后卵巢扭转18例临床分析[J]. 中华危重症医学杂志(电子版), 2021, 14(5):400-402. doi: 10.3877/cma.j.issn.1674-6880.2021.05.009.
[6]	Sun B, Ma Y, Li L, et al. Factors Associated with Ovarian Hyperstimulation Syndrome (OHSS) Severity in Women With Polycystic Ovary Syndrome Undergoing IVF/ICSI[J]. Front Endocrinol(Lausanne), 2020, 11:615957. doi: 10.3389/fendo.2020.615957.
[7]	Warwar RE, Schmidt GE. Bilateral ovarian torsion with ovarian fusion in the setting of polycystic ovarian syndrome: A case report[J]. Case Rep Womens Health, 2019, 23:e00129. doi: 10.1016/j.crwh.2019.e00129.
[8]	Smith LP, Oskowitz SP, Barrett B, et al. IVF and embryo development subsequent to ovarian torsion occurring during the resumption of meiosis[J]. Reprod Biomed Online, 2010, 21(3):418-421. doi: 10.1016/j.rbmo.2010.03.030. pmid: 20638908
[9]	Novoa M, Friedman J, Mayrink M. Ovarian torsion: can we save the ovary?[J]. Arch Gynecol Obstet, 2021, 304(1):191-195. doi: 10.1007/s00404-021-06008-8. pmid: 33638663
[10]	Drakopoulos P, Khalaf Y, Esteves SC, et al. Treatment algorithms for high responders: What we can learn from randomized controlled trials, real-world data and models[J]. Best Pract Res Clin Obstet Gynaecol, 2023, 86:102301. doi: 10.1016/j.bpobgyn.2022.102301.
[11]	ESHRE Guideline Group on Ovarian Stimulation, Bosch E, Broer S, et al. ESHRE guideline: ovarian stimulation for IVF/ICSI[J]. Hum Reprod Open, 2020, 2020(2):hoaa009. doi: 10.1093/hropen/hoaa009.
[12]	Vloeberghs V, Peeraer K, Pexsters A, et al. Ovarian hyperstimulation syndrome and complications of ART[J]. Best Pract Res Clin Obstet Gynaecol, 2009, 23(5):691-709. doi: 10.1016/j.bpobgyn.2009.02.006. pmid: 19632900
[13]	Naert MN, Baker S, Attaman J, et al. Ovarian torsion during ovarian stimulation prior to trigger followed by successful oocyte retrieval: A case report[J]. Case Rep Womens Health, 2023, 37:e00495. doi: 10.1016/j.crwh.2023.e00495.
[14]	Inoue D, Asada Y. Successful Oocyte Retrieval After Follicular Fluid Aspiration in Suspicious of Ovarian Torsion[J]. Cureus, 2020, 12(12):e12192. doi: 10.7759/cureus.12192.
[15]	Narayansingh G, Hoh J. The eventual successful management of ovarian torsion in a hyperstimulated ovary following in vitro fertilization: A case report[J]. Case Rep Womens Health, 2019, 26:e00166. doi: 10.1016/j.crwh.2019.e00166.
[16]	Mandelbaum RS, Smith MB, Violette CJ, et al. Conservative surgery for ovarian torsion in young women: perioperative complications and national trends[J]. BJOG, 2020, 127(8):957-965. doi: 10.1111/1471-0528.16179.