Surgery is infrequently needed, but if required can be a challenge for the anesthesiologist. Careful positioning of patients during surgery is important as the Trendelenberg position may further compromise the residual pulmonary functional capacity. Establishment of access lines may be necessary in patients with contracted vascular volume. Drainage of pleural effusions may assist in improving pulmonary status.

尽管手术需求量不大，但手术对麻痹师而言是个挑战。由于特伦德伦伯卧位会进一步影响患者的残余肺功能容量，故患者在手术中的体位非常重要。对于血管容量少的患者，建立血管通路很有必要。吸取胸腔积液有助于改善肺部状态。

Surgery for ruptured cysts

卵巢囊肿手术治疗

Laparotomy, in general, should be avoided in OHSS. If deemed necessary, as in cases of hemorrhagic ovariancysts, it should be performed by an experienced gynecologist and only hemostatic measures undertaken so as to preserve the ovaries.

一般情况下，重度卵巢兴奋综合征(OHSS)患者的治疗应避免腹腔镜检查。如有必要，例如在卵巢囊肿出血的情况下，应由经验丰富的妇科医生执行，并且只采取止血措施以保护卵巢。

Ovarian torsion

卵巢扭转

Ovarian torsion is an infrequent complication of ovulation induction, which if unrecognized and untreated, results in loss of one or both ovaries[26]. Presenting symptoms are severe unilateral adenexal pain in a patient with enlarged ovaries due to ovarian stimulation or with multiple pregcy. Sonography with Doppler flow analysis can be diagnostic, but a finding of apparently normal blood flow does not completely rule out ovarian torsion [26].

卵巢扭转是促排过程中一种罕见并发症，如未得到及时诊断和治疗，可造成单侧或双侧卵巢丧失[26]。如果因为卵巢兴奋或多胎妊娠导致卵巢增大，那么患者会感到单侧附件严重疼痛。该病症可通过超声结合多普勒血流分析进行诊断，但即使提示血流正常，也无法完全避免卵巢扭转[26]。

Ovarian torsion in patients with OHSS has varied in incidence between 3% in non-pregt patients [37] and 16% in pregt patients with OHSS[38]. Preservation of the ovary is very important in young and fertile women. Prompt and early diagnosis with laparoscopic unwinding can increase the likelihood of a viable ovary, thus resulting in a successful outcome. Wiser et al. [23] observed a relatively high incidence of ovarian torsion in OHSS patients that required laparoscopy. The clinical decision to operate was based on clinical judgment, with laparoscopy being performed on13 of the 165 IVF patients with OHSS. Ovarian detorsion was required in ten patients. Twin pregcies were iolved 3.5 times more than singletons. Successful outcomes were achieved in all the patients and their pregcies continued without complications related to torsion.

在OHSS患者中，卵巢扭转在非孕妇中的发病率为3%[37]，在孕妇群体的发病率则为16%[38]。对于年轻且生育能力正常的女性而言，保留卵巢至关重要。即早诊断并通过腹腔镜解扭可以增加卵巢保留的成功率。Wiser团队[23]观察到，需要进行腹腔镜检查的OHSS患者中，多数会出现卵巢扭转。165名OHSS患者接受了IVF治疗，其中13人接受了腹腔镜检查，医生基于检查结果，决定对该13人做手术。妊娠概率是单胎的3.5倍。所有患者均成功妊娠，且过程中也未见卵巢扭转相关并发症。

Ovarian torsion in patients with OHSS has varied in incidence between 3% in non-pregt patients [37] and 16% in pregt patients with OHSS[38]. Preservation of the ovary is very important in young and fertile women. Prompt and early diagnosis with laparoscopic unwinding can increase the likelihood of a viable ovary, thus resulting in a successful outcome. Wiser et al. [23] observed a relatively high incidence of ovarian torsion in OHSS patients that required laparoscopy. The clinical decision to operate was based on clinical judgment, with laparoscopy being performed on13 of the 165 IVF patients with OHSS. Ovarian detorsion was required in ten patients. Twin pregcies were iolved 3.5 times more than singletons. Successful outcomes were achieved in all the patients and their pregcies continued without complications related to torsion.

在OHSS患者中，卵巢扭转在非孕妇中的发病率为3%[37]，在孕妇群体的发病率则为16%[38]。对于年轻且生育能力正常的女性而言，保留卵巢至关重要。即早诊断并通过腹腔镜解扭可以增加卵巢保留的成功率。Wiser团队[23]观察到，需要进行腹腔镜检查的OHSS患者中，多数会出现卵巢扭转。165名OHSS患者接受了IVF治疗，其中13人接受了腹腔镜检查，医生基于检查结果，决定对该13人做手术。妊娠概率是单胎的3.5倍。所有患者均成功妊娠，且过程中也未见卵巢扭转相关并发症。

In a review of 77 cases of ovarian torsion at a single hospital, Doppler flow sonography was performed preoperatively in 90% of cases but demonstrated compromised blood flow in only 29% of those scanned[39]. Of these, 30 (51%) required oophorectomy. Ovarian torsion followed ovulation induction in 21 of the 77 cases, and of these only one required oophorectomy possibly because of earlier diagnosis. Twenty-four patients were pregt, two-thirds as a result of ovulation induction. The mean gestational age was 10.4 weeks (range 4-28 weeks) at the time of ovarian torsion. Although the adnexa usually appears dark, hemorrhagic, and ischemic, they can be saved, if the diagnosis is made soon enough, by simply unwinding, often as a laparoscopic procedure.

在同一家医院对77例卵巢扭转病例进行回顾发现，90%的病例在术前进行了多普勒超声检查，少有29%显示血流受损[39]。在这些血流受损的病例中，30例（51%）需进行卵巢切除。77例中，有21例在促排后出现卵巢扭转的情况，由于诊断较早，少有1例需行卵巢切除术。24位患者成功妊娠，其中有2/3经历了促排。卵巢扭转发生时的平均孕龄为10.4周（在4-28周浮动）。尽管附件看起来呈现黑色，出血或缺血状态，只要尽早确诊，仍可通过腹腔镜手术的方式解扭，从而保全卵巢。

参考文献：

23. Wiser A, Levron J, Kreizer D, et al. Outcome of pregcies complicated by severe ovarian hyperstimulation syndrome (OHSS): a follow-up beyond the second trimester. Hum Reprod 2005; 20:910-914.

26. Abramov Y, Fatum M, Abrahamov D, Schenker JG. Hydro.ethylstarch versus human albumin for the treatment of severe ovarian hyperstimulation syndrome: a preliminary report. Fertil Steril 2001; 75:1228-1230.

37. Gorkemli H, Camus M, Clasen K. Adnexal torsion after gonadotrophin ovulation induction for IVF or ICSI and its conservative treatment. Arch Gynecol Obstet 2002; 267:4-6.

38. Mashiach S, Bider D, Moran O, Goldenberg M, Ben-Rafael Z. Adnexal torsion of hyperstimulated ovaries in pregcies after gonadotropin therapy. Fertil Steril1990; 53:76.

39. Eyvazzadeh AD, Ryley DA, Khachadoorian HR, Alper MM, Reindollar RH. Adnexal torsion: a review of 80cases. Fertil Steril 2005; 84: S163-S164.