Bagolan Pietro, Giorlandino Claudio, Nahom Antonella, Bilancioni Elena, Trucchi Alessandro, Gatti Claudia, Aleandri Vincenzo, Spina Vincenzo
Department of Neonatal Surgery, "Bambino Gesù" Pediatric Hospital, Rome, Italy.
J Pediatr Surg. 2002 Jan;37(1):25-30. doi: 10.1053/jpsu.2002.29421.
BACKGROUND/PURPOSE: Ovarian torsion causing the loss of an ovary represents the most common complication of fetal ovarian cysts and occurs more frequently before than after birth. Thus, treatment of fetal simple ovarian cysts should be performed antenatally; however, criteria for prenatal decompression still need to be evaluated. Previous experience of the authors showed that large simple cysts have a poor outcome, whereas preliminary attempts of their "in utero" aspiration were all successful and uneventful. The authors evaluated the outcome of fetal simple ovarian cysts after prenatal aspiration and considered criteria for this procedure. The outcome of cysts showing a prenatal ultrasound pattern of torsion also was studied.
This prospective study includes 73 ovarian cysts (48 simple, 25 showing torsion) diagnosed in 72 fetuses from June 1992 to June 1999, and followed up until spontaneous resolution or surgery. Prenatal aspiration was performed in the case of simple cysts >/=5 cm in diameter. The outcome of these cysts was compared with that of similar cysts not aspirated in the authors previous study (X(2). Cysts with an US pattern of torsion persisting at birth were operated on. The outcome of simple cysts less than 5 cm and cysts with a prenatal ultrasound appearance of torsion also was evaluated.
Prenatal decompression was performed without any complications in 14 cases: 12 (86%; 95% CI: 0.68 to 1.00) regressed subsequently; 2 (14%; 95% CI: 0.00 to 0.32) showed torsion postnatally. This outcome is significantly better than that of similar cysts not aspirated in the authors' previous study(10) (P =.0002). Among the 34 simple cysts less than 5 cm, 26 (76%; 95% CI: 0.62 to 0.90) resolved spontaneously; 8 (24%; 95% CI: 0.10 to 0.38) had complications, 7 of which showing torsion (diameter at evidence of torsion, 4.4 cm [median]; range, 3.3 to 5.2 cm). Among the 34 cysts showing torsion (25 with initial US pattern of torsion + 9 subsequently complicated simple cysts), 24 (71%; 95% CI: 0.56 to 0.86) required oophorectomy; 9 (26%; 95% CI: 0.11 to 0.41) spontaneously disappeared at ultrasound, one of which required surgery for intestinal obstruction secondary to adhesion of a necrotic ovary; one patient (3%; 95% CI: 0.00 to 0.09) was lost to follow-up.
Prenatal aspiration of ovarian cysts appears effective and safe: a "cutoff" of 4 cm should be investigated. Cysts with ultrasound pattern of torsion persisting postnatally require surgery; options for their management, when sonographically disappearing and asymptomatic, need to be investigated.
背景/目的：卵巢扭转导致卵巢丧失是胎儿卵巢囊肿最常见的并发症，且在出生前比出生后更频繁发生。因此，胎儿单纯性卵巢囊肿应在产前进行治疗；然而，产前减压的标准仍需评估。作者之前的经验表明，大型单纯性囊肿预后不佳，而其“宫内”抽吸的初步尝试均成功且顺利。作者评估了产前抽吸后胎儿单纯性卵巢囊肿的预后，并考虑了该操作的标准。还研究了显示产前超声扭转模式的囊肿的预后。
这项前瞻性研究纳入了1992年6月至1999年6月在72例胎儿中诊断出的73个卵巢囊肿（48个单纯性囊肿，25个显示扭转），并随访至自发消退或手术。对于直径≥5 cm的单纯性囊肿进行产前抽吸。将这些囊肿的预后与作者之前研究中未抽吸的类似囊肿的预后进行比较（X²）。出生时仍存在超声扭转模式的囊肿进行手术。还评估了小于5 cm的单纯性囊肿以及产前超声显示扭转的囊肿的预后。
14例进行了产前减压且无任何并发症：12例（86%；95%置信区间：0.68至1.00）随后消退；2例（14%；95%置信区间：0.00至0.32）出生后出现扭转。这一结果明显优于作者之前研究中未抽吸的类似囊肿的结果（P = 0.0002）。在34个小于5 cm的单纯性囊肿中，26个（76%；95%置信区间：0.62至0.90）自发消退；8个（24%；95%置信区间：0.10至0.38）出现并发症，其中7个显示扭转（扭转时的直径，4.4 cm[中位数]；范围，3.3至5.2 cm）。在34个显示扭转的囊肿中（25个最初有超声扭转模式 + 9个随后并发的单纯性囊肿），24个（71%；95%置信区间：0.56至0.86）需要进行卵巢切除术；9个（26%；95%置信区间：0.11至0.41）在超声检查中自发消失，其中1个因坏死卵巢粘连继发肠梗阻而需要手术；1例患者（3%；95%置信区间：0.00至0.09）失访。
产前抽吸卵巢囊肿似乎有效且安全：应研究4 cm的“临界值”。出生后仍存在超声扭转模式的囊肿需要手术；当超声检查中囊肿消失且无症状时，其管理方案需要进一步研究。
