medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-542medsovet-8841Research ArticleГИНЕКОЛОГИЯGYNECOLOGYСовременный подход к лечению перекрута придатков маткиCurrent approach to the management of adnexal torsionhttps://orcid.org/0000-0003-2786-6181ДоброхотоваЮ. Э.DobrokhotovaJ. E.

Доброхотова Юлия Эдуардовна - д.м.н., профессор, заслуженный врач РФ, заведующая кафедрой акушерства и гинекологии лечебного факультета.

117997, Москва, ул. Островитянова, д. 1

Julia E. Dobrokhotova - Dr. Sci. (Med.), Professor, Honoured Doctor of the Russian Federation, Head of the Department of Obstetrics and Gynecology.

1, Ostrovityanov St., Moscow, 117997

pr.dobrohotova@mail.ruhttps://orcid.org/0000-0001-6427-4295ЩеголевА. А.ShchegolevA. A.

Щеголев Александр Андреевич - д.м.н., профессор, заведующий кафедрой госпитальной хирургии педиатрического факультета.

117513, Москва, ул. Островитянова, д. 1

Aleksandr A. Shchegolev - Dr. Sci. (Med.), Professor, Head of the Department of Hospital Surgery of the Pediatric Faculty.

1, Ostrovityanov St., Moscow, 117997

ashegolev57@mail.ruhttps://orcid.org/0000-0002-0392-8280МаркаровА. Э.MarkarovA. E.

Маркаров Арнольд Эдуардович - к.м.н., главный врач. 105187, Москва, ул. Фортунатовская, д. 1

Arnold E. Markarov - Cand. Sci. (Med.), Chief Medical Officer.

1, Fortunatovskaya St., Moscow, 105187

gkb36@zdrav.mos.ruhttps://orcid.org/0000-0002-5660-2380КотоминаТ. С.KotominaT. S.

Котомина Татьяна Сергеевна - к.м.н., заместитель главного врача по акушерско-гинекологической помощи.

105187, Москва, ул. Фортунатовская, д. 1

Tatiana S. Kotomina - Cand. Sci. (Med.), Deputy Chief Physician for Obstetrics and Gynecology Care.

1, Fortunatovskaya St., Moscow, 105187

gkb36@zdrav.mos.ruhttps://orcid.org/0000-0003-1554-3633ХлыноваС. А.KhlynovaS. A.

Хлынова Светлана Анатольевна - к.м.н., доцент кафедры акушерства и гинекологии лечебного факультета, Российский НИМУимени Н.И. Пирогова;  врач – акушер-гинеколог, ГКБ имени Ф.И. Иноземцева;

117997, Москва, ул. Островитянова, д. 1; 105187, Москва, ул. Фортунатовская, д. 1

Svetlana A. Khlynova - Cand. Sci. (Med.), Associate Professor of the Department of Obstetrics and Gynecology, Faculty of General Medicine, Pirogov Russian NRMU; Obstetrician-Gynecologist, Inozemtsev City Clinical Hospital;

1, Ostrovityanov St., Moscow, 117997; 1, Fortunatovskaya St., Moscow, 105187

doc-khlinova@mail.ruДимитроваВ. И.DimitrovaV. I.

Димитрова Валентина Ивановна - к.м.н., заведующая гинекологическим отделением.

105187, Москва, ул. Фортунатовская, д. 1

Valentina I. Dimitrova, Cand. Sci. (Med.), Head of the gynecological department.

1, Fortunatovskaya St., Moscow, 105187

dimitrovav@mail.ruhttps://orcid.org/0000-0002-9491-9303МарковаЭ. А.MarkovaE. A.

Маркова Элеонора Александровна - к.м.н., доцент кафедры акушерства и гинекологии лечебного факультета, Российский НИМУ имени Н.И. Пирогова; врач – акушер-гинеколог, ГКБ имени Ф.И. Иноземцева.

117997, Москва, ул. Островитянова, д. 1; 105187, Москва, ул. Фортунатовская, д. 1

Eleonora A. Markova - Cand. Sci. (Med.), Associate Professor of the Department of Obstetrics and Gynecology, Faculty of General Medicine, Pirogov Russian NRMU; Obstetrician-Gynecologist, Inozemtsev CCH.

1, Ostrovityanov St., Moscow, 117997; 1, Fortunatovskaya St., Moscow, 105187

markova.eleonora@mail.ruhttps://orcid.org/0000-0001-9279-7851СлюсареваО. А.SlyusarevaO. A.

Слюсарева Ольга Александровна - к.м.н., врач – акушер-гинеколог.

105187, Москва, ул. Фортунатовская, д. 1

Olga A. Slyusareva - Cand. Sci. (Med.), Obstetrician-Gynecologist.

1, Fortunatovskaya St., Moscow, 105187

Lelechka.86@mail.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationГородская клиническая больница имени Ф.И. ИноземцеваРоссияInozemtsev City Clinical HospitalRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Городская клиническая больница имени Ф.И. ИноземцеваРоссияPirogov Russian National Research Medical University; Inozemtsev City Clinical HospitalRussian Federation202422012025023160166Copyright © Доброхотова Ю.Э., Щеголев А.А., Маркаров А.Э., Котомина Т.С., Хлынова С.А., Димитрова В.И., Маркова Э.А., Слюсарева О.А., 20242024Доброхотова Ю.Э., Щеголев А.А., Маркаров А.Э., Котомина Т.С., Хлынова С.А., Димитрова В.И., Маркова Э.А., Слюсарева О.А.Dobrokhotova J.E., Shchegolev A.A., Markarov A.E., Kotomina T.S., Khlynova S.A., Dimitrova V.I., Markova E.A., Slyusareva O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8841Введение

Введение. В структуре ургентной гинекологической практики перекрут придатков матки, который обычно диагностируют у женщин в репродуктивном возрасте, занимает 5-е место. На сегодняшний день не существует единого стандарта для оценки жизнеспособности яичника и выбора консервативной или радикальной операции для пациенток с перекрутом придатков, в связи с этим возникает необходимость в поиске потенциальных предикторов, определяющих обоснованность выбора объема хирургического вмешательства.

Цель

Цель. Оптимизировать тактику ведения пациенток с перекрутом придатков матки.

Материалы и методы

Материалы и методы. В ретроспективном исследовании проведен анализ 55 историй болезни пациенток, поступивших в гинекологический стационар с диагнозом «перекрут придатков матки». В зависимости от проведенного органосохраняющего и органоуносящего хирургического лечения пациентки были разделены на 2 группы. Анализ изучаемых показателей проведен с использованием корреляционного, регрессионного, факторного и ROC-анализа.

Результаты

Результаты. Результаты исследования продемонстрировали, что только визуальная оценка состояния придатков матки приводит к неоправданным органоуносящим вмешательствам у 57,1% пациенток. На основании корреляционного, факторного, регрессионного и ROC-анализа определены диагностически значимые предикторы, определяющие объем хирургического вмешательства.

Выводы

Выводы. На основании ретроспективного анализа разработан алгоритм ведения пациенток с перекрутом придатков матки: при стадии А и В по клинической классификации повреждения придатков матки, независимо от исследуемых критериев, необходимо проводить органосохраняющее лечение – деторсио; при стадии С особое внимание уделяется показателям Д-димера: при Д-димере <1450 нг/мл – деторсио придатков матки, и лишь при Д-димере >1490 нг/мл – органоуносящую операцию.

Introduction

Introduction. In the structure of urgent gynecological practice, ovarian torsion ranks fifth, which is usually diagnosed in women of reproductive age. To date, there is no single standard for assessing the viability of the ovary and choosing a conservative or radical operation for patients with ovarian torsion, in this regard, there is a need to search for potential predictors that determine the validity of the choice of the volume of surgical intervention.

Aim

Aim. To optimize management tactics for patients with uterine torsion.

Materials and methods

Materials and methods. In a retrospective study, an analysis of 55 case histories of patients admitted to a gynecological hospital with a diagnosis of ovarian torsion was carried out. Depending on the organ-preserving and organ-removing surgical treatment, the patients were divided into two groups. The analysis of the studied indicators was carried out using correlation, regression, factor and ROC analysis.

Results

Results. The results of the study demonstrated that only a visual assessment of the state of the ovarian torsion to unjustified organ-removing interventions in 57.1% of patients. Based on correlation, factor, regression and ROC analysis, diagnostically significant predictors determining the volume of surgical intervention were determined.

Conclusions

Conclusions. Based on the retrospective analysis, an algorithm for managing patients with ovarian torsion was developed: at stages A and B according to the clinical classification of ovarian torsion damage, regardless of the studied criteria, organpreserving treatment – detorsion must be performed; at stage C, special attention is paid to D-dimer values: at D-dimer <1450 ng/ml – detorsion, and only at D-dimer >1490 ng/ml – organ-preserving surgery.

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The authors declare that there are no conflicts of interest present.