Comparetto C, Giudici S, Coccia M E, Scarselli G, Borruto F
Division of Obstetrics and Gynaecology, City Hospital, Prato, Italy.
Clin Exp Obstet Gynecol. 2005;32(2):123-5.
The management of fetal ovarian cysts is still controversial despite the improvement in prenatal diagnosis with ultrasonography. Some studies suggest an aggressive management, while others opt for a conservative one. The prognosis of the majority of congenital ovarian cysts is good since they have a benign origin. Sometimes, however, complications such as torsion or rupture can occur which often require surgical intervention after delivery. In this paper we report our experience and a brief review of the literature.
The authors report on 32 pregnant women in whom ultrasonography revealed the presence of an echo-rare or echo-free area in the fetal abdomen suggestive of an ovarian cyst. All women were followed-up during pregnancy with serial ultrasound examinations. Postnatal ultrasound controls confirmed the prenatal diagnosis in all cases. The diameters of the cysts ranged from 2.7 to 7.5 cm.
In the 16 cases (50%) in which the cyst diameter was below 4 cm, periodic ultrasound examinations revealed a tendency towards spontaneous regression of the cysts. In the other 16 cases (50%) in which the cyst diameter exceeded 4 cm, cystectomy was necessary due to subsequent complications (torsion in 6 cases, 37.5%, and intracystic hemorrhage in the other 10, 62.5%).
The most appropriate clinical approach in the management of benign feto-neonatal ovarian cysts is to adopt a wait-and-see policy, assessing the course of the condition by means of periodic ultrasound monitoring. Only when tumefactions measure more than 4 cm in diameter with attendant complications is surgical therapy indicated. Without complications, however, aspiration of the cystic contents is possible even in ovarian cysts exceeding 4 cm in diameter.
尽管超声产前诊断技术有所进步，但胎儿卵巢囊肿的处理仍存在争议。一些研究建议积极处理，而另一些则倾向于保守处理。大多数先天性卵巢囊肿预后良好，因为其起源为良性。然而，有时会发生诸如扭转或破裂等并发症，这通常需要在分娩后进行手术干预。本文报告了我们的经验并对文献进行简要综述。
作者报告了32例孕妇，超声检查显示胎儿腹部存在低回声或无回声区，提示卵巢囊肿。所有孕妇在孕期均接受系列超声检查随访。产后超声检查证实了所有病例的产前诊断。囊肿直径范围为2.7至7.5厘米。
在囊肿直径小于4厘米的16例（50%）病例中，定期超声检查显示囊肿有自发消退的趋势。在囊肿直径超过4厘米的另外16例（50%）病例中，由于随后出现并发症（6例扭转，占37.5%；另外10例囊内出血，占62.5%），需要进行囊肿切除术。
处理良性胎儿-新生儿卵巢囊肿最合适的临床方法是采取观察等待策略，通过定期超声监测评估病情发展。只有当肿物直径超过4厘米并伴有并发症时才考虑手术治疗。然而，即使囊肿直径超过4厘米且无并发症，也可以抽吸囊内容物。
