Royal Manchester Children's Hospital, Manchester, UK.
Pediatr Surg Int. 2022 Apr;38(4):617-621. doi: 10.1007/s00383-021-05055-1. Epub 2022 Feb 17.
Several studies have addressed the long-term functional, psychosexual and psychosocial outcomes following sacrococcygeal teratoma (SCT) excision. It is well reported that the classical chevron incision and reconstruction can leave a cosmetically unsatisfactory result; however, there is little in the literature focussed on improving this outcome. In our institution the preference is to perform a midline reconstruction, where possible, this is felt to improve appearance without compromising the oncological or functional outcome. The aim of this study was to evaluate patient-perceived cosmetic outcomes of the midline reconstruction.
All patients undergoing surgery for SCT between 2007 and 2020 were included in the study. Patient demographics, operation type, functional outcome and recurrence were all recorded. The primary outcome measure was patient/parent satisfaction with the cosmetic appearance. This was assessed using both qualitative and quantitative methodologies. Following ethical approval parents were asked questions from two existing validated patient outcome questionnaires: "Patient and Observer Scar Assessment Scale" (POSAS) v2.0 and the "Patient Scar Assessment Questionnaire".
Thirty-two patients underwent surgery at our institution for SCT during the study period. Twenty-four had a posterior approach with midline reconstruction, two laparotomy and excision (excluded from this study) and six had a combined approach. Median follow-up was 35 months (8.5-96 months). There were no recurrences. 4/30 (13%) have persistent urological symptoms, and 1/30 (3%) has constipation requiring bowel management. Questionnaires were sent to 26/30 families with a 77% return rate. Median total score was 11 (7.4-17.5) on a 60-point scale (6, as normal skin, 60, worst imaginable scar). Twenty (95%) reported that the scar never affects the child's activities and 15 (71%) said they are "not at all" conscious of the scar.
Scars can lead to an array of cosmetic, functional, and psychological consequences and as such consideration needs to be given to scarring following surgery for sacrococcygeal teratomas. This study demonstrates that a midline reconstruction produces a cosmetically favourable outcome. We, therefore, recommend where appropriate a midline reconstruction should be considered for SCT.
已有多项研究探讨了骶尾部畸胎瘤（SCT）切除术后的长期功能、性心理和社会心理结局。已有大量报道称，经典的人字形切口和重建可能会导致美容效果不理想；然而，文献中很少有研究关注改善这一结果。在我们医院，首选尽可能进行中线重建，因为这种方法可以改善外观，同时不会影响肿瘤学或功能结果。本研究旨在评估中线重建的患者对美容结果的满意度。
本研究纳入了 2007 年至 2020 年间因 SCT 接受手术的所有患者。记录患者人口统计学资料、手术类型、功能结果和复发情况。主要观察指标为患者/家长对美容效果的满意度。采用定性和定量方法进行评估。在获得伦理批准后，家长回答了来自两个现有的经过验证的患者结局问卷的问题：“患者和观察者疤痕评估量表”（POSAS）v2.0 和“患者疤痕评估问卷”。
研究期间，本院共有 32 例患者因 SCT 接受手术治疗。其中 24 例采用后路入路联合中线重建，2 例行剖腹探查和切除（排除在本研究之外），6 例采用联合入路。中位随访时间为 35 个月（8.5-96 个月）。无复发。4/30（13%）例仍存在泌尿系统症状，1/30（3%）例存在便秘需要肠道管理。向 30 个家庭中的 26 个发送了问卷，回收率为 77%。中位总分为 60 分制的 11 分（7.4-17.5）分。20（95%）例报告说疤痕从不影响孩子的活动，15（71%）例表示他们“一点也不”在意疤痕。
疤痕会导致一系列美容、功能和心理后果，因此，在考虑骶尾部畸胎瘤手术后的疤痕问题时需要慎重。本研究表明，中线重建可产生美容效果良好的结果。因此，我们建议在适当的情况下，骶尾部畸胎瘤应考虑行中线重建。
