Üçüncü Basamak Bir Referans Merkezinde Over Torsiyonu Cerrahisi: Klinik, Laboratuvar ve Operatif İlişkiler

Öz

Amaç: Over torsiyonu, zamanında tedavi edilmediğinde adneksiyal iskemi ve doku kaybına yol açabilen jinekolojik bir acildir. Bu çalışmanın amacı, üçüncü basamak bir merkezde over torsiyonu nedeniyle cerrahi uygulanan hastaların klinik, laboratuvar, görüntüleme ve cerrahi özelliklerini tanımlamak ve seçilmiş laboratuvar ve sonografik bulgular ile histopatolojik nekroz ve cerrahi sonuçlar arasındaki ilişkileri incelemektir. Gereç ve Yöntem: Bu retrospektif çalışmaya, Kasım 2023–Şubat 2025 tarihleri arasında üçüncü basamak bir referans merkezinde over torsiyonu nedeniyle cerrahi tedavi uygulanan 40 hasta dahil edildi. Demografik özellikler, başvuru semptomları, laboratuvar parametreleri, ultrasonografik bulgular, operatif veriler ve histopatolojik sonuçlar geriye dönük olarak incelendi. Over kan akımının değerlendirilmesinde Doppler ultrasonografi kullanıldı. Torsiyon derecesi, inflamatuvar belirteçler, Doppler bulguları ve cerrahi sonuçlar arasındaki ilişkiler tek değişkenli ve korelasyon analizleri ile değerlendirildi. Bulgular: Hastaların büyük çoğunluğu üreme çağındaydı (%90) ve olguların %55’inde adneksiyal kitle mevcuttu. Doppler ultrasonografide olguların %60’ında over kan akımı saptanmadı. Hastaların yarısında mevcut olan histopatolojik incelemede, olguların %40’ında nekrotik over dokusu izlendi. Daha yüksek torsiyon derecesi, artmış C-reaktif protein düzeyleri, daha yüksek nekroz oranları ve laparotomi sıklığında artış ile ilişkiliydi (p < 0,05). Yüksek CRP düzeyleri ve nekroz varlığı, daha uzun hastanede yatış süresi ile orta düzeyde korelasyon gösterdi. Sonuç: Bu üçüncü basamak merkez deneyiminde, torsiyon şiddeti, artmış inflamatuvar belirteçler ve Doppler’de kan akımının izlenmemesi, adneksiyal nekroz ve daha kapsamlı cerrahi girişimler ile ilişkili bulunmuştur. Bu parametreler, over torsiyonunda hastalık şiddetini yansıtabilir. Bulguların doğrulanması için ileriye dönük çalışmalar gereklidir.

Anahtar Kelimeler

• Adneksiyal kitle
• Doppler ultrasonografi
• Laparoskopik cerrahi
• Over torsiyonu
• Ultrasonografi

Ovarian Torsion Surgery in a Tertiary Referral Center: Clinical, Laboratory, and Operative Associations

Abstract

Aim: Ovarian torsion is a gynecological emergency that can lead to adnexal ischemia and tissue loss if not promptly treated. This study aimed to describe the clinical, laboratory, imaging, and surgical characteristics of patients undergoing surgery for ovarian torsion in a tertiary care center and to explore associations between selected laboratory and sonographic findings and histopathologic necrosis and surgical outcomes. Materials and Methods: This retrospective study included 40 patients who underwent surgical treatment for ovarian torsion between November 2023 and February 2025 at a tertiary referral center. Demographic characteristics, presenting symptoms, laboratory parameters, ultrasonographic findings, operative details, and histopathological results were reviewed. Doppler ultrasonography was used to assess ovarian blood flow. Associations between torsion degree, inflammatory markers, Doppler findings, and surgical outcomes were evaluated using univariate and correlation analyses. Results: Most patients were of reproductive age (90%), and adnexal masses were present in 55% of cases. Absent Doppler flow was observed in 60% of patients. Histopathological evaluation, available in half of the cohort, demonstrated necrotic ovarian tissue in 40%. Higher torsion degree was associated with increased C-reactive protein levels, higher necrosis rates, and a greater frequency of laparotomy (p < 0.05). Elevated CRP levels and the presence of necrosis were moderately correlated with longer hospital stay. Conclusion: In this tertiary center experience, torsion severity, elevated inflammatory markers, and absent Doppler flow were associated with adnexal necrosis and more extensive surgical management. These parameters may reflect disease severity in ovarian torsion. Further prospective studies are needed to confirm these findings.

Keywords

• Adnexal mass
• Doppler ultrasonography
• Laparoscopic surgery
• Ovarian torsion
• Ultrasonography

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