Deneysel over torsiyonu modelinde over iskemi-reperfüzyon hasarında aşamalı detorsiyon ve hipoterminin overi koruyucu etkisinin karşılaştırılması
Comparison of protective effect of gradual detorsion and hypothermia in ovarian ischemia-reperfusion injury
Yazar: ŞULE DOĞAN
Danışman: PROF. DR. SEZEN KARACA ÖZKISACIK
Adnan Menderes Üniversitesi / Tıp Fakültesi / Çocuk Cerrahisi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2019
Konu: Çocuk Cerrahisi = Pediatric Surgery
Dizin: Hipotermi = Hypothermia ; Over = Ovary ; Over hastalıkları = Ovarian diseases ; Reperfüzyon = Reperfusion ; Reperfüzyon lezyonu = Reperfusion injury ; Torsiyon = Torsion ; İskemi = Ischemia

Özet:
Over torsiyonu, acil servise akut karın ağrısı şikayeti ile başvuran çocuk ve adölesan 
hastaların %0,02'sini oluşturan, akut jinekolojik  bir acildir.  Torsiyon; premenarş, postmenarş 
kızlarda da görülebilir.  Ameliyat olanların yaş ortalaması 10'dur(1).Over torsiyonu normal 
overlerde  meydana  gelebilir  ancak  sıklıkla  torsiyon  ihtimalini  artırdığına  inanılan  ovaryan 
kitlelerle  ilişkilidir(2).  Torsiyonun derecesi ve geçen süre,  yönetim ve prognoz için önemli 
faktörlerdir.  Fertiliteyi  korumak,  over  kaybını  önlemek  için  erken  tanı  ve  hızlı  cerrahi 
düzeltme gereklidir (3). 
Bir  organ  veya  dokuya  gelen  kan  akımında  azalma  olduğunda  bu  durum  dokuda 
hipoksiye  neden  olur.  Hipoksi;  laktik  asit,  hipoksantin  ve  lipid  peroksidaz  düzeylerinin 
yükselmesi  ile  sonuçlanır. Lipid  peroksidasyondan  sonra  kan  akımındaki  artış,  süperoksit
dismutaz  (SOD),  katalaz(CAT),  glutatyon  peroksidaz(GPx)  gibi  enzimatik  antioksidan 
savunma  sistemleri  ile  ortadan  kaldırılamayacak  büyük  miktarda  oksijen  kaynaklı  serbest 
radikal oluşumuna yol açar.  Bu nedenle reperfüzyon dokuya iskemiden daha fazla zarar verir 
ve bu durum reperfüzyon hasarı olarak bilinir (4). 
Over  torsiyonunun  cerrahi  tedavisi,  dönmüş  segmentin  düzeltilmesini  içerir.  Eğer
torsiyon  enfarkttan  önce  düzeltilirse,  normal  kan  akımı  geri  dönebilir (5).  Detorsiyondan 
sonra  büyük  miktarlarda  oksijen  kaynaklı  serbest  radikallerden  kaynaklanan  reperfüzyon 
hasarı başta oluşan iskemiden daha fazla doku hasarına neden olur.Bu nedenle reperfüzyon 
hasarı over torsiyonunda, over hasarıyla ilgili major rol oynar (6; 7). 
İ/R  sırasında  gelişen  doku  hasarında  çeşitli  mekanizmalar  tanımlanmıştır (8).  Bu 
çalışmada; overtorsiyonunda  aşamalı detorsiyonun ve eş zamanlı hipotermi uygulamasının 
reperfüzyon hasarını azaltıcı etkisi araştırılmıştır.

Abstract:
Ovarian  torsion  is  the  fifth  most  common  gynecological  emergency  in  girls  and 
adolescents. Today, ovarian detorsion is the treatment of ovarian torsion and ovary is tried to 
be protected as much as possible. Duration passed after torsion is important to prevent ovarian 
loss. Early diagnosis and timely surgical intervention are necessary to maintain fertility. If the 
torsioned  ovary  is  detorsed  before  any  infarction  develops,  normal  blood  flow  can  be 
recovered.  However,  following  detorsion,  reperfusion  injury  caused  by  high  amounts  of 
oxygen-derived  free  radicals  causes  more  tissue  damage  than  initial  ischemia.  Reperfusion 
injury  plays  a  major  role  in  ovarian  torsion  for  ovarian  damage.  Various  mechanisms  have 
been  described  to  prevent  tissue  damage  during  ischemia-reperfusion.  In  this  experimental 
study,  we  aimed  to  show  the  effect  of  gradual  detorsion  and  hypothermia  on  ischemia 
reperfusion injury in a rat model of ovarian torsion-detorsion. In this study, 40 adult Wistar 
female  rats  were  used.  Groups  were  numbered  as  Group  I  (sham  group),  Group  II  (control 
group)  and  Group  III  (gradual  detorsion),  Group  IV  (hypothermia),  Group  V  (gradual 
detorsion  +  hypothermia).  After  the  approval  of  the  ethics  committee,  by  intramuscular 
injection,  50  mg  /  kg  ketamine  and  3  mg  /  kg  xylazine  were  used  for  anesthesia.  After 
laparotomy  was  performed  on  the  rats  in  Group  I,  the  left  ovary  was  removed  and  the 
abdomen  was  closed  without  any  other  procedure.  The  right  ovary  was  removed  30  hours 
later.  The  rats  in  Group  II-III-IV-V  were  subjected  to  laparotomy  after  the  left  ovary  was 
removed  and  the  right  ovary  was  torsioned  by  1080  degrees.  The  right  ovary  was  left 
ischemic for 30 hours.  After laparotomy, full detorsion was performed  in Group  II  and the 
reperfusion was achieved. In Group III, the right ovary was performed detorsion 360 degrees 
and waited for 5 minutes and this procedure was repeated 3 times until the right ovary was 
became completely detorsed and then the abdomen was closed. In Group IV, cold application 
was performed for a total of twenty minutes at the beginning and after the full detorsion of the 
right ovary.  In Group  II-III-IV-V, abdomens were closed for one week  and the laparotomy 
was performed again in order to remove the right ovary. After oopherectomy, ovarian tissues 
were  examined  histopathologically  for  vascular  occlusion,  interstitial  edema,  bleeding, 
IV
leukocyte  infiltration.  Superoxide  Dismutase  (SOD),  Myeloperoxidase  (MPO), 
Malondialdehyde  (MDA),  Catalase  (CAT),  Glutathione  Peroxidase  (GPx)  values  were 
examined in tissue samples and serum. 
The  results  of  our  study  show  that  gradual  detorsion  and  hypothermia  may  be 
effective in reducing both biochemical and histopathological damage due to I / R damage. 
Key  words:  Ovary,  Torsion,  Ischemia-Reperfusion  Injury,  Hypothermia,  Gradual 
detorsion