Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
Department of Diagnostic Radiology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
J Int Med Res. 2023 May;51(5):3000605231171023. doi: 10.1177/03000605231171023.
To clarify the clinical characteristics and laparoscopic surgical outcomes of dermoid cysts complicated by spontaneous rupture.
This was a single-center retrospective observational study of patients with dermoid cysts treated between January 2005 and December 2021.
Among 1205 cases of dermoid cysts, spontaneous rupture occurred in nine and torsion occurred in 83 cases. No obvious triggers for rupture were identified, except for one postpartum case with fundal uterine pressure maneuver. Rupture was identified by computed tomography (CT) in six cases. Patients with ruptured cysts had significantly higher serum C-reactive protein (CRP), cancer antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), and squamous cell carcinoma antigen (SCC) levels compared with patients with uncomplicated dermoid cysts or cysts with torsion. Laparoscopic management was possible except for one case with severe adhesion, which required laparotomy. Two patients required prolonged postoperative administration of antibiotics due to refractory chemical peritonitis.
Combined use of CT imaging and elevated levels of CRP, CA125, CA19-9, and SCC may help to differentiate cyst rupture from torsion. Laparoscopic surgery may be a feasible option; however, prompt laparotomic conversion should be considered in cases with difficult adhesiolysis. Refractory chemical peritonitis may occur after successful surgical management.
阐明伴自发性破裂的皮样囊肿的临床特征和腹腔镜手术结果。
这是一项对 2005 年 1 月至 2021 年 12 月期间接受治疗的皮样囊肿患者进行的单中心回顾性观察性研究。
在 1205 例皮样囊肿中，有 9 例发生自发性破裂，83 例发生扭转。除 1 例产后子宫底压力操作外，未发现明显的破裂诱因。6 例通过计算机断层扫描（CT）发现破裂。与未破裂的皮样囊肿或扭转的囊肿患者相比，破裂囊肿患者的血清 C 反应蛋白（CRP）、癌抗原 125（CA125）、糖类抗原 19-9（CA19-9）和鳞状细胞癌抗原（SCC）水平显著升高。除 1 例严重粘连需剖腹手术外，腹腔镜处理是可行的。由于难治性化学性腹膜炎，有 2 例患者需要延长术后使用抗生素。
CT 成像和 CRP、CA125、CA19-9 和 SCC 水平升高的联合使用可能有助于区分囊肿破裂和扭转。腹腔镜手术可能是一种可行的选择；但是，在粘连难以松解的情况下，应考虑及时剖腹手术转换。在成功的手术治疗后可能会发生难治性化学性腹膜炎。
