Rogers Erin M, Casadiego Cubides Giovanny, Lacy Judith, Gerstle J Ted, Kives Sari, Allen Lisa
Division of Pediatric Gynecology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Division of General and Thoracic Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
J Pediatr Adolesc Gynecol. 2014 Jun;27(3):125-8. doi: 10.1016/j.jpag.2013.09.003. Epub 2014 Feb 21.
To characterize preoperative risk stratification with aim of identifying the accurate surgical approach of benign and malignant adnexal masses in pediatric patients.
A retrospective chart review of all cases of adnexal masses surgically managed between January 2001 and December 2006.
The Hospital for Sick Children, Toronto, Canada.
129 cases of 126 pediatric and adolescent patients who underwent operative management of their adnexal masses.
Ultrasonographic characteristics (cyst size and character), surgical approach (laparoscopy vs laparotomy) and method of cyst removal (cystectomy vs oophorectomy). Data was assessed with a Fisher Exact test where appropriate (P < .05).
Malignancies were more frequently treated by laparotomy (n = 14, 98.6%, P < .001), and benign cases by laparoscopy (n = 78, 97%, P < .001). On ultrasonography, malignant masses were more often complex (n = 16, 100%, P = .006) and ≥8 cm (n = 16, 100%, P < .001) than benign masses (≥8 cm n = 60, 53%, complex n = 76, 67%). Combining ultrasonographic measurements of ≥8 cm and complexity identified 100% of malignant masses (n = 16) and 36% of benign masses (n = 41, P < .001, PPV = 37.1, NPV = 100%). Additional imaging including CT/MRI was ordered by pediatric surgeons (n = 17, 77%) more often than pediatric gynecologists (n = 44, 41%, P = .002). Furthermore, pediatric surgeons managed adnexal masses by oophorectomy (n = 12, 55%) more often as compared to pediatric gynecologists (n = 19, 18%, P < .001).
Using preoperative characteristics of complexity and ≥8 cm reduces the number of benign masses treated with laparotomy while ensuring malignant masses are managed with an open approach.
通过对小儿良性和恶性附件肿块确定准确的手术方法，来描述术前风险分层。
对2001年1月至2006年12月间所有接受手术治疗的附件肿块病例进行回顾性图表分析。
加拿大多伦多病童医院。
126例小儿和青少年患者的129例附件肿块接受了手术治疗。
超声特征（囊肿大小和性质）、手术方式（腹腔镜手术与开腹手术）以及囊肿切除方法（囊肿切除术与卵巢切除术）。数据在适当情况下采用Fisher精确检验进行评估（P < 0.05）。
恶性肿瘤更常采用开腹手术治疗（n = 14，98.6%，P < 0.001），而良性病例则更常采用腹腔镜手术（n = 78，97%，P < 0.001）。在超声检查中，恶性肿块比良性肿块更常表现为复杂型（n = 16，100%，P = 0.006）且≥8 cm（n = 16，100%，P < 0.001）（≥8 cm的良性肿块n = 60，53%；复杂型良性肿块n = 76，67%）。将≥8 cm和复杂性的超声测量结果相结合，可识别出100%的恶性肿块（n = 16）和36%的良性肿块（n = 41，P < 0.001，阳性预测值 = 37.1，阴性预测值 = 100%）。小儿外科医生（n = 17，77%）比小儿妇科医生（n = 44，41%，P = 0.002）更常要求进行包括CT/MRI在内的额外影像学检查。此外，与小儿妇科医生（n = 19，18%，P < 0.001）相比，小儿外科医生更常通过卵巢切除术来处理附件肿块（n = 12，55%）。
利用复杂性和≥8 cm的术前特征可减少开腹手术治疗的良性肿块数量，同时确保对恶性肿块采用开放手术方式进行处理。
