Tajiri Tatsuro, Souzaki Ryota, Kinoshita Yoshiaki, Yosue Ryota, Kohashi Kenichi, Oda Yoshinao, Taguchi Tomoaki
Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Pediatr Surg Int. 2012 Jan;28(1):27-31. doi: 10.1007/s00383-011-3004-3.
The aim of this study was to assess the surgical intervention strategies for pediatric ovarian tumors.
The clinical features and treatment were analyzed for 60 children with ovarian tumors treated at our institution between 2000 and 2010.
Twenty-one of the 60 patients were prenatally diagnosed neonatal cases with cystic lesions. Of the 21 neonates, surgery included ultrasound-guided aspiration in 14 cases, salpingo-oophorectomy by umbilical crease incision in 6 cases with torsions, and cystectomy with ovarian preservation in one case with torsion. The mean age of the other 39 patients was 9.3 years. For 31 of these patients with benign lesions, surgery included tumor resection with ovarian preservation after aspiration of the cystic lesion through a modified Rocky Davis incision in 21 cases containing 3 torsion cases, and salpingo-oophorectomy in 10 cases, including 8 torsion cases. A salpingo-oophorectomy was performed for all eight of the patients with malignant tumors, including borderline lesions of mucinous or serous cyst adenoma, and postoperative chemotherapy was administered for two yolk sac tumors and one dysgerminoma. Only one case demonstrating a yolk sac tumor with lung metastasis at initial diagnosis died of disease after recurrence.
The majority of pediatric ovarian tumors were benign disease, and the patients with malignant lesions had a good prognosis. In neonatal cases, an umbilical crease incision approach is feasible and provides excellent cosmesis. We recommend tumor resection with ovarian preservation through a minimally invasive approach (modified Rocky Davis incision) as the first line treatment for older pediatric patients with ovarian tumors other than those preoperatively diagnosed as malignant.
本研究旨在评估小儿卵巢肿瘤的手术干预策略。
分析了2000年至2010年间在我院接受治疗的60例小儿卵巢肿瘤患者的临床特征及治疗情况。
60例患者中有21例为产前诊断的新生儿病例，伴有囊性病变。在这21例新生儿中，手术方式包括14例行超声引导下穿刺抽吸，6例扭转患者经脐褶切口行输卵管卵巢切除术，1例扭转患者行囊肿切除术并保留卵巢。其他39例患者的平均年龄为9.3岁。对于其中31例良性病变患者，手术方式包括21例（其中3例扭转）经改良Rocky Davis切口抽吸囊性病变后行肿瘤切除术并保留卵巢，10例（其中8例扭转）行输卵管卵巢切除术。8例恶性肿瘤患者（包括黏液性或浆液性囊腺瘤交界性病变）均行输卵管卵巢切除术，2例卵黄囊瘤和1例无性细胞瘤术后接受化疗。仅1例初诊时表现为伴有肺转移的卵黄囊瘤患者复发后死于疾病。
小儿卵巢肿瘤多数为良性疾病，恶性病变患者预后良好。在新生儿病例中，脐褶切口入路可行且美容效果极佳。对于术前未诊断为恶性的大龄小儿卵巢肿瘤患者，我们推荐通过微创入路（改良Rocky Davis切口）行肿瘤切除术并保留卵巢作为一线治疗方法。
