Lacher Martin, Kuebler Joachim F, Yannam Govardhana R, Aprahamian Charles J, Perger Lena, Beierle Elizabeth A, Anderson Scott A, Chen Mike K, Harmon Carroll M, Muensterer Oliver J
Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.
J Laparoendosc Adv Surg Tech A. 2013 Mar;23(3):291-6. doi: 10.1089/lap.2012.0380. Epub 2013 Feb 12.
Despite being pioneered by gynecologists, single-incision endosurgery has not been widely reported for the treatment of ovarian and adnexal pathology in neonates, children, and adolescents. We describe our initial experience using single-incision pediatric endosurgery (SIPES) for these indications and discuss advantages and drawbacks.
All children who underwent SIPES with a preoperative diagnosis of ovarian or adnexal pathology were included in the study. Data on age, operative time, complications, length of hospital stay, and outcomes were collected.
From January 2010 until January 2012, 19 girls (mean age, 11.4 years; range, 6 days-17 years; weight range, 4.0-90 kg) underwent SIPES procedures for ovarian or adnexal diagnoses, including hemorrhagic/follicular/paratubal cysts (n=8), torsion (n=7), tumor (n=3), and parauterine cyst (n=1). The operations included cyst unroofing (n=4), detorsion and oophoropexy (n=7), (salpingo)oophorectomy (n=5), marsupialization of cyst (n=2), and cyst aspiration (n=1). Median operative time was 42 ± 29 minutes; there were no conversions to conventional laparoscopy or open surgery. Fifteen patients (79%) were discharged within 24 hours after the procedure. There were no peri- or postoperative complications. Histopathology showed hemorrhagic/follicular/paratubal cyst (n=7), necrotic/calcified ovarian tissue after torsion (n=6), cystadenofibroma (n=1), granulosa cell tumor (n=1), and mature teratoma (Grade 0) (n=1).
SIPES is an excellent alternative to conventional laparoscopy for the treatment of adnexal pathology. Using a single umbilical incision that can be enlarged instead of three smaller trocar sites facilitates the resection and extraction of ovarian masses without compromising cosmesis.
尽管单切口内镜手术由妇科医生率先开展，但在新生儿、儿童及青少年卵巢和附件疾病的治疗中，相关报道并不广泛。我们描述了使用单切口小儿内镜手术（SIPES）治疗这些疾病的初步经验，并讨论其优缺点。
本研究纳入所有术前诊断为卵巢或附件疾病且接受SIPES手术的儿童。收集年龄、手术时间、并发症、住院时间及手术结果等数据。
2010年1月至2012年1月，19名女孩（平均年龄11.岁；范围6天至17岁；体重范围4.0至90千克）因卵巢或附件疾病接受SIPES手术治疗，包括出血性/滤泡性/输卵管旁囊肿（n = 8）、扭转（n = 7）、肿瘤（n = 3）及子宫旁囊肿（n = 1）。手术包括囊肿开窗术（n = 4）、扭转复位及卵巢固定术（n = 7）、（输卵管）卵巢切除术（n = 5）、囊肿袋形缝合术（n = 2）及囊肿穿刺抽吸术（n = 1）。中位手术时间为42±29分钟；无转为传统腹腔镜手术或开放手术的情况。15例患者（79%）术后24小时内出院。无围手术期或术后并发症。组织病理学检查显示出血性/滤泡性/输卵管旁囊肿（n = 7）、扭转后坏死/钙化卵巢组织（n = 6）、囊腺纤维瘤（n = 1）、颗粒细胞瘤（n = 1）及成熟畸胎瘤（0级）（n = 1）。
SIPES是治疗附件疾病的传统腹腔镜手术的极佳替代方法。使用可扩大的单一脐部切口而非三个较小的套管针穿刺部位，便于切除和取出卵巢肿物，且不影响美观。
