目的 探讨体外受精胚胎移植（IVF-ET）促排卵治疗过程中,发生卵巢扭转后继续取卵的患者与无卵巢扭转不孕症患者行IVF治疗的临床结局差异。方法 收集2010年12月—2020年12月在同济大学附属同济医院生殖医学科行IVF治疗,并在促排卵过程中发生卵巢扭转后继续取卵的患者5例作为卵巢扭转组,并选择同时期不孕因素相同的20例无卵巢扭转不孕症患者作为对照组,比较两组患者的临床一般资料、实验室检测指标、促排卵治疗情况、胚胎发育及母胎临床结局。结果 卵巢扭转组与对照组患者的年龄、体质量指数（BMI）、基础窦卵泡数（AFC）、不孕年限、基础性激素水平、促性腺激素（Gn）天数、Gn总量、扳机日成熟卵泡数、扳机日雌二醇（E2）水平、劣质胚胎数、正常受精率、优胚率、每周期移植胚胎数、临床妊娠率、流产率、活产率、分娩孕周及胎儿出生体质量比较均无统计学差异（P>0.05）。卵巢扭转组患者的获卵数[（14.8±4.8）枚对（24.8±6.3）枚]、D3胚胎数[（8.6±1.5）枚对（14.8±5.7）枚]、优质胚胎数[（3.2±1.9）枚对（6.8±3.2）枚]均显著低于对照组（P<0.05）。结论 IVF助孕取卵前发生的早期卵巢扭转,继续取卵后行急诊腹腔探查术是经济、安全和有效的治疗方法。促排卵治疗过程中应密切监测患者对药物的刺激反应情况,减少各种并发症的发生。
Objective To investigate the differences in clinical outcomes of in vitro fertilization （IVF） and embryo transfer （ET） ovarian stimulation treatment between the patients with or without ovarian torsion. Methods Five patients with oocyte retrieval after ovarian torsion caused by ovarian stimulation who underwent IVF treatment in the Reproductive Medical Center of Tongji Hospital of Tongji University from December 2010 to December 2020 were selected as ovarian torsion group. Another 20 infertile patients without ovarian torsion were selected as control group. The clinical general characteristics, laboratory examination results, ovulation induction, embryo development, and maternal clinical outcomes were compared between the two groups. Results There were no significant differences in age, body mass index （BMI）, antral follicle count （AFC）, infertility years, basic sex hormone levels,gonadotropin （Gn） days, Gn doses, mature follicle numbers of the trigger day, estrogen （E2） level of the trigger day, low quality embryo numbers, normal fertilization rate, high quality embryo rate, average number of embryos transfer per cycle, clinical pregnancy rate, abortion rate, live birth rate, gestational weeks of delivery, and birth weight between the two groups （P>0.05）. The number of oocytes retrieved [（14.8±4.8） vs.（24.8±6.3）], the number of D3 embryos [（8.6±1.5） vs.（14.8±5.7）], and the number of high quality embryos [（3.2±1.9） vs.（6.8±3.2）] in the ovarian torsion group were significantly lower than those in the control group （P<0.05）. Conclusion Oocyte retrieval and abdominal exploration are economical, safe, and effective for the patients with early ovarian torsion who underwent IVF treatment. During the ovulation induction therapy, the stimulation responses of patients to drugs should be closely monitored to reduce the occurrence of various complications.
[1] Oelsner G, Cohen S B, Soriano D, et al.Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function[J].Hum Reprod, 2003,18(12):2599-2602.
[2] 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.
[3] Asfour V, Varma R, Menon P.Clinical risk factors for ovarian torsion[J].Obstet Gynaecol, 2015,35(7):721-725.
[4] Gupta A, Gadipudi A, Nayak D.A five-year review of ovarian torsion cases: lessons learnt[J].Obstet Gynaecol India, 2020,70(3):220-224.
[5] Grunau G L, Harris A, Buckley J, et al.Diagnosis of ovarian torsion: is it time to forget about doppler?[J].J Obstet Gynaecol Can, 2018,40(7):871-875.
[6] Sasaki K J, Miller C E.Adnexal torsion: review of the literature[J].J Minim Invasive Gynecol, 2014,21(2):196-202.
[7] Hasiakos D,Papakonstantinou K, Kontoravdis A,et al.Adnexal torsion during pregnancy: report of four cases and review of the literature[J].J Obstet Gynaecol Res, 2008,34(4):683-687.
[8] 林金芳,冯缵冲,丁爱华主编.实用妇科内镜学[M].上海:复旦大学出版社, 2001:245-247.
[9] Huchon C, Fauconnier A.Adnexal torsion: a literature review[J].Eur J Obstet Gynecol Reprod Biol, 2010,150(1):8-12.
[10] Spinelli C, Piscioneri J, Strambi S.Adnexal torsion in adolescents: update and review of the literature[J].Curr Opin Obstet Gynecol, 2015,27(5):320-325.
[11] 张云山,邱璇,李馨,等.彩色多普勒超声对促卵排卵后卵巢扭转的诊断价值[J].转化医学杂志,2013,2(1):35-37.
[12] Jeffrey RB.急症影像学[M].唐光健,译.北京:中国医药科技出版社,2000:189.
[13] 张敏,景香香.卵巢扭转的诊断及治疗进展[J].海南医学, 2019,30(21):2828-2831.
[14] Oelsner G, Shashar D.Adnexal torsion[J].Clin Obstet Gynecol, 2006,49(3):459-463.
[15] Cass D L.Ovarian torsion[J]. Semin Pediatr Surg,2005,14(2):86-92.
[16] Kokoska E R, Keller M S, Weber TR.Acute ovarian torsion in children[J].Am J Surg, 2000,180(6):462-465.
[17] Rouzi AA, Mousa A, Sahly N, et al.Laparoscopic treatment of ovarian torsion in ovarian hyperstimulation syndrome in pregnancy[J].J Minim Invasive Gynecol, 2015,22(6S):S216-S216.
[18] Rody A, Jackisch C, Klockenbusch W, et al.The conservative management of adnexal torsion—a case-report and review of the literature[J].Eur J Obstet Gynecol Reprod Biol,2002,101(1):83-86.
[19] 张莹. 周期中取卵前的急性附件扭转[J].国外医学计划生育分册, 2001,1(3):191.
[20] 许定飞,伍琼芳.体外受精-胚胎移植取卵前卵巢扭转例报道[J].江西医药, 2018,53(4):369-370.
[21] Orvieto R.A simplified universal approach to COH protocol for IVF: ultrashort flare GnRH-agonist protocol with tailored mode and timing of final follicular maturation[J].J Ovarian Res, 2015,8(1):69.
[22] Pacchiarotti A, Selman H, Valeri C, et al.Ovarian stimulation protocol in IVF: an up-to-date review of the literature[J].Curr Pharm Biotechnol,2016,17(4):303-315.
[23] 戴芳芳,郑波,郭钰英,等.多囊卵巢综合征患者不同促排卵方案助孕结局分析及经济评价[J].生殖医学杂志, 2020,29(9):1156-1161.
