Crombleholme T M, Craigo S D, Garmel S, D'Alton M E
Center for Fetal Diagnosis and Treatment at The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, 19104-4318, USA.
J Pediatr Surg. 1997 Oct;32(10):1447-9. doi: 10.1016/s0022-3468(97)90558-3.
BACKGROUND/PURPOSE: Neonates who have ovarian torsion caused by an ovarian cyst often lose their ovary because the torsion and infarction occurred antenatally. Because ultrasound scan has been so effective in diagnosing ovarian cysts in utero, we have a better understanding of their natural history and can select appropriate cases for cyst decompression in utero to prevent torsion. The authors reviewed experience with seven fetuses who had fetal ovarian cyst.
During a 26-month period, seven patients were referred for the evaluation of fetal ovarian cyst. The mean gestational age at presentation was 31.9 +/- 3.6 weeks (+/-SD; range, 27 to 37 weeks). There was no history of maternal risk factors such as diabetes mellitus or fetal risk factors such as hyperthyroidism or placentomegally. All seven cases involved isolated unilateral cysts without associated anomalies or chromosomal abnormalities. Mean initial cyst diameter was 3.4 +/- 1.7 cm (+/-SD; range, 1 to 6.1). Indications used for ovarian cyst decompression included anechoic cysts with a diameter > or =4 cm, a cyst "wandering" about the abdomen on serial sonograms, or demonstrating rapid enlargement (>1 cm/wk).
All but one cyst progressed in size during observation. One fetal ovarian cyst (diameter, 2 cm) subsequently regressed spontaneously and another (diameter, 2.1 cm) stabilized during prenatal ultrasound surveillance. One "cyst" observed with a diameter of 3.5 cm proved to be a persistent cloaca. Four fetal ovarian cysts met criteria for decompression. Because of fetal position, decompression could not be performed in one. One cyst (seen before defining criteria for decompression) with a diameter of 5 cm was observed only and underwent torsion. Two cysts (diameters, 6.1 cm and 4 cm) were decompressed in utero under local anesthesia with ultrasound guidance, of 95 mL and 35 mL, respectively. High cyst fluid progesterone (12,041 and 1,990 ng/dL, respectively) and testosterone (1,298 and 2,900 ng/dL, respectively) confirmed the etiology of the cyst as ovarian. Neither cyst recurred, and postnatal ultrasound scan confirmed resolution. There was no maternal or fetal morbidity or mortality and only the patient observed before development of criteria for decompression lost her ovary because of torsion.
Fetal ovarian cysts tend to present as isolated unilateral lesions in normal fetuses in the third trimester. Spontaneous regression of fetal ovarian cysts may occur. Fetal ovarian cyst decompression, in select cases, may preserve ovaries at risk for torsion.
背景/目的：因卵巢囊肿导致卵巢扭转的新生儿常因产前发生扭转和梗死而失去卵巢。由于超声扫描在诊断子宫内卵巢囊肿方面非常有效，我们对其自然病史有了更好的了解，并且可以选择合适的病例在子宫内进行囊肿减压以预防扭转。作者回顾了7例患有胎儿卵巢囊肿的病例。
在26个月的时间里，7例患者因胎儿卵巢囊肿前来评估。就诊时的平均孕周为31.9±3.6周（±标准差；范围为27至37周）。没有糖尿病等母亲危险因素或甲状腺功能亢进或胎盘肿大等胎儿危险因素的病史。所有7例均为孤立性单侧囊肿，无相关畸形或染色体异常。初始囊肿平均直径为3.4±1.7 cm（±标准差；范围为1至6.1 cm）。用于卵巢囊肿减压的指征包括直径≥4 cm的无回声囊肿、在系列超声检查中囊肿在腹部“游走”或显示快速增大（>1 cm/周）。
除1个囊肿外，其余囊肿在观察期间均增大。1个胎儿卵巢囊肿（直径2 cm）随后自发消退，另1个（直径2.1 cm）在产前超声监测期间稳定。观察到的1个直径3.5 cm的“囊肿”被证明是持续性泄殖腔。4个胎儿卵巢囊肿符合减压标准。由于胎儿位置原因，1例无法进行减压。仅观察到1个直径5 cm的囊肿（在确定减压标准之前发现）发生扭转。2个囊肿（直径分别为6.1 cm和4 cm）在超声引导下于局部麻醉下在子宫内进行减压，分别抽出95 mL和35 mL囊液。囊液中高浓度的孕酮（分别为12,041和1,990 ng/dL）和睾酮（分别为1,298和2,900 ng/dL）证实囊肿的病因是卵巢性的。两个囊肿均未复发，产后超声扫描证实囊肿已消退。没有产妇或胎儿的发病或死亡情况，只有在确定减压标准之前观察的患者因扭转失去了卵巢。
胎儿卵巢囊肿在孕晚期正常胎儿中往往表现为孤立性单侧病变。胎儿卵巢囊肿可能会自发消退。在某些情况下，胎儿卵巢囊肿减压可能会保留有扭转风险的卵巢。
