Childress Krista J, Santos Xiomara M, Perez-Milicua Gisselle, Hakim Julie, Adeyemi-Fowode Oluyemisi, Bercaw-Pratt Jennifer L, Dietrich Jennifer E
Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Division of Pediatric and Adolescent Gynecology, Winnie Palmer Physicians Center for Obstetrics and Gynecology, Orlando Health Physician Group, Orlando, Florida.
J Pediatr Adolesc Gynecol. 2017 Dec;30(6):636-640. doi: 10.1016/j.jpag.2017.03.139. Epub 2017 Mar 21.
(1) To determine the incidence of chemical peritonitis after cystectomy for ovarian dermoid cysts with intraoperative cyst rupture in the pediatric and adolescent population; and (2) to examine the intraoperative and postoperative outcomes of cystectomies performed for ovarian dermoid cysts using laparoscopy and laparotomy, especially those with intraoperative cyst rupture.
A retrospective cohort study of female patients who underwent ovarian cystectomy with proven ovarian dermoid pathology between July 2007 and July 2015.
Texas Children's Hospital, Houston, Texas.
One hundred forty-four patients between the ages of 1 and 21 years who underwent an ovarian cystectomy with proven benign ovarian dermoid histology on the basis of pathology reports.
Occurrence of spill of cyst contents, chemical peritonitis, postoperative complications, and hospital readmissions.
One hundred forty-four female patients underwent cystectomy (38 laparotomy and 106 laparoscopy) resulting in benign ovarian dermoid histology. Their mean age was 12.4 ± 4.1 years (range, 1-21), mean cyst size was 9.2 ± 6.4 cm (range, 1-30 cm), no patients had elevated tumor markers, 42 (29.1%) presented with torsion, 73 (50.7%) had cyst fluid spill, and there were no cases of chemical peritonitis. Few significant differences were found between cases performed via laparoscopy and laparotomy and those with and without intraoperative cyst rupture resulting in spill of contents. Laparotomy cases were found to have larger mean cyst size (P < .001), estimated blood loss (P = .003), and presence of bilateral cysts (P = .017) compared with laparoscopic cases. Cyst fluid spill occurred in more laparoscopic cases ([67/106] 63.2% vs [6/38] 15.8%; P < .001), and risk increased with cyst size greater than 5 cm (P < .001). In the laparoscopy group, cyst size greater than 5 cm was more likely to present with torsion (P < .001). There was no significant difference in the repeat cystectomy rate between the laparoscopy and laparotomy groups even with cyst rupture (P = .394). Only 5 cases presented to the emergency room postoperatively and 2 were admitted postoperatively for umbilical port site dehiscence and pyelonephritis.
Laparoscopic cystectomy of ovarian dermoid cysts is associated with greater intraoperative cyst rupture. However, cyst rupture is rarely associated with complications, therefore minimally invasive surgical management of ovarian dermoid cysts is a reasonable surgical approach.
（1）确定小儿及青少年人群中因卵巢皮样囊肿行囊肿切除术且术中囊肿破裂后化学性腹膜炎的发生率；（2）检查采用腹腔镜和开腹手术切除卵巢皮样囊肿的术中及术后结果，尤其是术中囊肿破裂的情况。
对2007年7月至2015年7月间经证实患有卵巢皮样囊肿病理的女性患者进行回顾性队列研究。
德克萨斯州休斯顿市德克萨斯儿童医院。
144例年龄在1至21岁之间的患者，根据病理报告接受了经证实为良性卵巢皮样组织学的卵巢囊肿切除术。
囊肿内容物溢出、化学性腹膜炎、术后并发症及再次入院情况。
144例女性患者接受了囊肿切除术（38例开腹手术和106例腹腔镜手术），术后病理显示为良性卵巢皮样组织学。她们的平均年龄为12.4±4.1岁（范围1至21岁），平均囊肿大小为9.2±6.4厘米（范围1至30厘米），无患者肿瘤标志物升高，42例（29.1%）出现扭转，73例（50.7%）有囊肿液溢出，且无化学性腹膜炎病例。在通过腹腔镜和开腹手术进行的病例之间，以及有和没有术中囊肿破裂导致内容物溢出的病例之间，未发现明显差异。与腹腔镜手术病例相比，开腹手术病例的平均囊肿尺寸更大（P<.001）、估计失血量更多（P=.003）且双侧囊肿的发生率更高（P=.017）。腹腔镜手术病例中囊肿液溢出的情况更多（[67/106]63.2%对[6/38]15.8%；P<.001），且囊肿尺寸大于5厘米时风险增加（P<.001）。在腹腔镜手术组中，囊肿尺寸大于5厘米时更易出现扭转（P<.001）。即使囊肿破裂，腹腔镜手术组和开腹手术组的再次囊肿切除率也无显著差异（P=.394）。术后仅有5例患者前往急诊室，2例因脐部端口部位裂开和肾盂肾炎术后入院。
卵巢皮样囊肿的腹腔镜囊肿切除术与术中更高的囊肿破裂率相关。然而，囊肿破裂很少与并发症相关，因此卵巢皮样囊肿的微创外科治疗是一种合理的手术方法。
