经脐单孔腹腔镜手术治疗小婴儿卵巢囊肿的疗效分析
张文果1,王大佳1,张志波1,苏朋俊1,黄 英1,王维林1,刘彩霞2

1.中国医科大学附属盛京医院小儿外科(辽宁省沈阳市, 110004); 2.中国医科大学附属盛京医院妇产科(辽宁省沈阳市,110004)

腹腔镜; 卵巢囊肿; 外科手术; 婴儿,新生

Treatment of infantile ovarian cyst by laparoscopic-assisted transumbilical extracorporeal cystectomy.
Zhang Wenguo1, Wang Dajia1, Zhang Zhibo1, Su Pengjun1, Huang Ying1, Wang Weilin1, Liu Caixia2.

1.Department of Pediatric Surgery; 2.Department of Gynecology & Obstetrics, Shengjing Hospital of China Medical University, Shenyang 110004, China. Corresponding author:Wang Dajia, Email:wangdj@sj-hospital.org

Laparoscopes; Ovarian Cysts; Surgical Procedures,Operative; Infant,Newborn

DOI: 10.3969/j.issn.1671— 6353.2017.05.015

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目的 总结本院近4年来应用经脐单孔腹腔镜辅助下微创治疗28例新生儿以及小婴儿卵巢囊肿的诊疗经验。 方法 收集2012年6月至2016年6月4年间由本院新生儿外科收治的年龄6个月以下新生儿及小婴儿卵巢囊肿患儿28例,回顾性分析其临床症状、发现时间、住院时间、囊肿大小、包块性质、影像学检查特点、产前干预措施、外科处理方式、术后病理检查及随访结果。 结果 28例患儿中单侧23例,双侧5例。年龄1个月以下者11例,1～3个月者11例,3～6个月者6例。27例表现为腹部肿块,1例表现为腹胀。产前发现20例,其中1例行产前超声引导下囊肿穿刺减压。住院时间4～20 d,平均7.5 d。彩超示囊肿大小为4～5 cm者11例,5～10 cm者15例,>10 cm者2例。28例患儿均采取经脐单孔腔镜协助下微创手术治疗。行患侧附件切除术15例,行单纯囊肿切除术13例。病理回报卵巢单纯性囊肿21例,卵巢滤泡囊肿4例,卵巢浆液性囊肿3例。本组患儿均获治愈,随访无复发。 结论 经脐单孔腹腔镜辅助下微创治疗新生儿及小婴儿卵巢囊肿安全易行,疗效较好。对于腹腔囊性包块>5 cm者或随访观察囊肿不能消退甚至增长者,需采取手术治疗; <5 cm不能排除来源于卵巢或其他部位者应予探查性手术治疗。对于产前已发现的巨大囊肿,必要时可行胎儿期穿刺减压等微创手术治疗。
Objective To summarize the clinical experiences of 28 infants ovarian cysts treated by laparoscopic-assisted transumbilical extracorporeal cystectomy(LATEC)in the last 4 years. Methods Twenty-eight neonatal and small infancy ovarian cysts were collected from June 2012 to June 2016. Retrospective analysis their clinical symptoms, discovery time, length of hospitalization, cyst size and nature, imaging characteristics, prenatal intervention, surgical treatment, postoperative pathological examination and follow-ups. Results The involved sides were unilateral(n=23)and bilateral(n=5). The monthly ages were <1(n=11), 1-3(n=11)and 3-6(n=6). The manifestations included abdominal mass(n=27)and abdominal distension(n=1). 20 cases were found in fetal period, of which 1 case was treated by prenatal ultrasound guided cyst decompression. The average length of hospitalization was 7.5(4-20)days. The sizes of ovarian cyst size were 4-5 cm(n=11), 5-10 cm(n=15)and >10 cm(n=2). All patients underwent laparoscopic-assisted transumbilical extracorporeal cystectomy(LATEC), including excision of ipsilateral appendectomy(n=15)and simple cystectomy(n=13). The natures of ovarian cyst were simple(n=21), follicular(n=4)and serous(n=3). All 28 cases were cured and remained recurrence-free during follow-ups. Conclusion LATEC is both safe and effective for neonatal and infantile ovarian cysts. When abdominal cystic mass is larger than 5 cm or cysts fail to disappear and even expand further, surgery is required. When cyst size is<5 cm but its origin comes from ovary or other sites, exploratory surgery is indicated. For huge cysts in fetus, it is necessary to perform such a fetal mini-invasive procedure as puncture decompression.