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治疗儿科患者的良性卵巢病变:单中心腹腔镜与开放手术修复的回顾性研究。

Treating Benign Ovarian Lesions in the Pediatric Population: A Single Institution's Retrospective Investigation of Laparoscopy Versus Open Repair.

机构信息

Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Ascension St. Vincent General Surgery Residency, Indianapolis, Indiana, USA.

出版信息

J Laparoendosc Adv Surg Tech A. 2024 Oct;34(10):948-954. doi: 10.1089/lap.2023.0364. Epub 2024 Apr 30.

Abstract

Benign ovarian lesions in the pediatric population have variable risk of recurrence or development of metachronous lesions, leading to variations in operative approach. Our study compares outcomes with differing surgical approaches to better elucidate risk of recurrent or metachronous lesions, time to development of these lesions, and hospital length of stay to determine if one operative approach has superior outcomes. We retrospectively examined data from Indiana University Health facilities from 2002 to 2020. Patients ≤18 years old who underwent surgical management of a benign ovarian lesion were included. Patients were categorized as undergoing oophorectomy versus ovarian sparing surgery (OSS), with open and laparoscopic approaches. Significance was defined as < .05. We identified 127 patients who underwent an open ( = 65) versus laparoscopic ( = 55) surgical approach. Patients undergoing open surgery had a greater mean size of lesion ( = .05) and longer length of stay ( < .01). Complication rates ( = .1), rates of developing a metachronous or recurrent lesion postoperatively ( = .47), and time to formation of additional lesions were similar between groups ( = .25). The incidence of identifying an additional lesion after surgery was 14.2% ( = 18) in the mean time of 29.5 ± 31.6 months [SEM 7.5]. Risk of developing a metachronous lesion was similar regardless of the operative approach. Surgery for recurrent ovarian lesions was rare and occurred in only 1 case. Laparoscopic surgery was performed for smaller lesions and was associated with a shorter length of hospital stay. Laparoscopic and OSS was found to have no increased risk of developing metachronous lesions nor increased reoperative risk compared with traditional open and oophorectomy techniques.

摘要

儿科患者的良性卵巢病变具有不同的复发或发生异时性病变的风险,这导致手术方法的差异。我们的研究比较了不同手术方法的结果,以更好地阐明复发或异时性病变的风险、这些病变发生的时间以及住院时间,以确定一种手术方法是否具有更好的结果。我们回顾性地检查了 2002 年至 2020 年印第安纳大学健康设施的数据。纳入了接受手术治疗良性卵巢病变的≤18 岁患者。患者分为行卵巢切除术与卵巢保留手术(OSS),包括开放和腹腔镜方法。显著性定义为 <.05。我们确定了 127 名接受开放( = 65)与腹腔镜( = 55)手术方法的患者。行开放手术的患者病变的平均大小更大( =.05)且住院时间更长( <.01)。并发症发生率( =.1)、术后发生异时性或复发性病变的比率( =.47)以及形成额外病变的时间在组间相似( =.25)。术后识别额外病变的发生率为 14.2%( = 18),平均时间为 29.5 ± 31.6 个月[SEM 7.5]。发生异时性病变的风险与手术方法无关。复发性卵巢病变的手术治疗很少见,仅发生 1 例。腹腔镜手术适用于较小的病变,与较短的住院时间相关。与传统的开放和卵巢切除术技术相比,腹腔镜和 OSS 并未发现增加发生异时性病变或再次手术的风险。

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