Division of Gynecologic Specialties, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
J Minim Invasive Gynecol. 2011 Mar-Apr;18(2):194-9. doi: 10.1016/j.jmig.2010.12.002. Epub 2011 Feb 3.
To review the clinical presentation, surgical and pathologic findings, and long-term outcomes after excision of ovarian remnants using a predominantly laparoscopic approach.
Retrospective medical record review and long-term follow-up via telephone interview (Canadian Task Force classification II-3).
Large academic medical institution.
Thirty women who underwent excision of pathologically confirmed ovarian remnants by a single surgeon between 2001 and 2009.
Excision of ovarian remnants, 29 at laparoscopy and 1 at laparotomy.
Of the 30 patients, 29 had pain and 1 had a persistent adnexal mass. Of the 29 patients who underwent preoperative ultrasonography, 26 (89.6%) had an adnexal mass on the side of previous salpingo-oophorectomy. Masses ranged in size from 0.8 to 7.4 cm in greatest diameter and most commonly contained debris-filled cysts. Intraoperatively, 29 excisions (96.7%) required retroperitoneal dissection, 27 (90.0%) required enterolysis, 28 (93.3%) required ureterolysis, and 20 (66.7%) required ligation of the uterine artery at its origin. All pathology reports confirmed ovarian tissue, often associated with endometriosis, corpus luteal cysts, and simple cysts. Four bowel injuries and 2 bladder injuries were laparoscopically repaired by the primary surgeon. Three patients required bowel resections by a general surgeon. Records from postoperative visits were available for 28 patients, of whom 17 (60.7%) reported resolution of pain, 9 (32.1%) reported improvement, and 2 (7.1%) reported persistent pain. Of the 18 women who returned written consent for the telephone interview, 11 (61.1%) reported resolution of pain, 5 (27.8%) reported improvement, and 2 (11.1%) reported persistent pain.
While laparoscopic excision of ovarian remnants is feasible, the procedure almost always requires a retroperitoneal dissection and is associated with high risk of complications. Careful surgical planning and preparation are essential.
通过主要采用腹腔镜方法切除卵巢残部，回顾其临床表现、手术和病理发现以及长期结果。
回顾性病历审查和通过电话访谈进行长期随访（加拿大任务组分类 II-3）。
大型学术医疗中心。
2001 年至 2009 年间，由一位外科医生切除经病理证实的卵巢残部的 30 名女性。
切除卵巢残部，29 例在腹腔镜下进行，1 例在剖腹手术下进行。
30 名患者中，29 名有疼痛，1 名有持续性附件肿块。在接受术前超声检查的 29 名患者中，26 名（89.6%）在既往输卵管卵巢切除术的同一侧有附件肿块。肿块大小从最大直径的 0.8 厘米到 7.4 厘米不等，最常见的是含有碎屑的囊肿。术中，29 例（96.7%）需要腹膜后解剖，27 例（90.0%）需要肠松解术，28 例（93.3%）需要输尿管松解术，20 例（66.7%）需要在子宫动脉起源处结扎。所有病理报告均证实为卵巢组织，常伴有子宫内膜异位症、黄体囊肿和单纯囊肿。4 例肠损伤和 2 例膀胱损伤由主刀医生腹腔镜修复。3 例患者需要普外科医生进行肠切除术。28 名患者的术后就诊记录可用，其中 17 名（60.7%）报告疼痛缓解，9 名（32.1%）报告有所改善，2 名（7.1%）报告持续疼痛。在返回书面同意进行电话访谈的 18 名女性中，11 名（61.1%）报告疼痛缓解，5 名（27.8%）报告有所改善，2 名（11.1%）报告持续疼痛。
虽然腹腔镜切除卵巢残部是可行的，但该手术几乎总是需要腹膜后解剖，并且与高并发症风险相关。仔细的手术计划和准备至关重要。
