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A evolução da arte na torção ovárica infantil : revisão sistemática de literatura
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A torção ovárica é uma emergência cirúrgica nas meninas em idade pré-puberal, representando cerca de 2,7 % de todos os casos de dor abdominal aguda na infância. Quando não tratada, esta patologia poderá evoluir para isquémia, resultando em necrose do ovário, da trompa de Falópio ou de toda a estrutura anexial. A abordagem cirúrgica utilizada passava pela ooforectomia ou pela salpingo-ooforectomia, no entanto ao longo dos anos tem sido adoptada uma técnica cirúrgica conservadora de órgão. O objetivo deste estudo é analisar e discutir os dados da literatura vigente para avaliar se a cirurgia conservadora do ovário constitui a melhor abordagem cirúrgica a adotar nos casos de torção ovárica infantil relativamente à técnica gold-standard (ooforectomia), independentemente do grau de isquémia à apresentação, tendo em conta os outcomes a curto e longo prazo. Relativamente aos métodos realizar-se-á uma revisão sistemática da literatura tendo por base a ferramenta PRISMA. A pesquisa será efetuada na base de dados PubMed e Scopus. Para compor a fórmula de busca, irão ser utilizados os descritores “ovarian torsion”, “pediatric” e “conservative surgery” contidos no DeCS (Descritores em Ciências da Saúde) e correspondentes ao tema do estudo, além do operador boleano “AND”. Serão incluídos todos os estudos alusivos à abordagem cirúrgica da torção ovárica na infância nos últimos 15 anos (entre 2008 e 2023). Esta revisão demonstra que a cirurgia conservadora revelou-se uma opção segura e eficaz a adotar na população infantil, ainda que o ovário se apresente necrótico no momento cirúrgico. A adoção de uma abordagem conservadora de órgão minimamente invasiva adquire extrema importância pela possibilidade de preservação da fertilidade futura, tendo a arte evoluído no sentido da cirurgia conservadora de órgão por laparoscopia.
Ovarian torsion is a surgical emergency in prepubertal girls, accounting for around 2.7% of all cases of acute abdominal pain in childhood. If left untreated, this condition can develop into ischaemia, resulting in necrosis of the ovary, fallopian tube or the entire adnexal structure. The surgical approach used to be oophorectomy or salpingooophorectomy, but over the years an organ-conserving surgical technique has been adopted. The aim of this study is to analyse and discuss data from the current literature to assess whether ovarian conserving surgery is the best surgical approach to adopt in cases of infantile ovarian torsion compared to the gold-standard technique (oophorectomy), regardless of the degree of ischaemia at presentation, considering short and long-term outcomes. In terms of methods, a systematic review of the literature will be carried out using the PRISMA tool. The search will be carried out in the PubMed and Scopus databases. The search formula will use the descriptors "ovarian torsion", "paediatric" and "conservative surgery" contained in the DeCS (Descriptors in Health Sciences) and corresponding to the subject of the study, as well as the Boolean operator "AND". All studies relating to the surgical approach to ovarian torsion in childhood over the last 15 years (between 2008 and 2023) will be included. This review shows that conservative surgery has proven to be a safe and effective option for children, even if the ovary is necrotic at the time of surgery. Adopting a minimally invasive organ-conserving approach is extremely important due to the possibility of preserving future fertility, and the art has evolved towards laparoscopic organconserving surgery.
Ovarian torsion is a surgical emergency in prepubertal girls, accounting for around 2.7% of all cases of acute abdominal pain in childhood. If left untreated, this condition can develop into ischaemia, resulting in necrosis of the ovary, fallopian tube or the entire adnexal structure. The surgical approach used to be oophorectomy or salpingooophorectomy, but over the years an organ-conserving surgical technique has been adopted. The aim of this study is to analyse and discuss data from the current literature to assess whether ovarian conserving surgery is the best surgical approach to adopt in cases of infantile ovarian torsion compared to the gold-standard technique (oophorectomy), regardless of the degree of ischaemia at presentation, considering short and long-term outcomes. In terms of methods, a systematic review of the literature will be carried out using the PRISMA tool. The search will be carried out in the PubMed and Scopus databases. The search formula will use the descriptors "ovarian torsion", "paediatric" and "conservative surgery" contained in the DeCS (Descriptors in Health Sciences) and corresponding to the subject of the study, as well as the Boolean operator "AND". All studies relating to the surgical approach to ovarian torsion in childhood over the last 15 years (between 2008 and 2023) will be included. This review shows that conservative surgery has proven to be a safe and effective option for children, even if the ovary is necrotic at the time of surgery. Adopting a minimally invasive organ-conserving approach is extremely important due to the possibility of preserving future fertility, and the art has evolved towards laparoscopic organconserving surgery.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Ovarian torsion Pediatric Conservative surgery