Remorgida V, Magnasco A, Pizzorno V, Anserini P
Department of Obstetrics and Gynecology, University of Genoa, Italy.
J Am Coll Surg. 1998 Nov;187(5):519-21. doi: 10.1016/s1072-7515(98)00224-5.
Intraperitoneal spillage of dermoid cyst content, if not followed immediately by abundant peritoneal lavage, can cause a chemical peritonitis with subsequent adhesion formation.
We performed an open clinical study in a university hospital. Forty-four consecutive ovarian dermoid cysts were removed intact from 40 premenopausal women operated on between October 1993 and December 1997. The laparoscopic technique included: 1) creation of a cleavage plane between the cyst and the ovary; 2) dissection of the cyst by a combination of water, scissors, and gravity without direct traction on the cyst; and 3) extraction of the cyst after its placement inside a laparoscopic bag.
The mean cyst diameter was 6.5 cm (range 3 to 12 cm). Mean operating time was 125 minutes (range 50 to 180 minutes). All patients were discharged within 48 hours. The cysts were dissected completely intact and were extracted without spillage in the abdominal cavity in all cases. Operative followup was available in 15 of the 40 patients; mild adhesions were found on the treated ovary in 3 (20%).
It is always possible to prevent rupture and spillage of dermoid cysts during laparoscopic operations, but this approach is time consuming and needs expert surgical technique.
皮样囊肿内容物腹腔内溢出，若不立即进行充分的腹腔灌洗，可导致化学性腹膜炎并随后形成粘连。
我们在一家大学医院进行了一项开放性临床研究。1993年10月至1997年12月期间，对40名绝经前女性连续切除了44个完整的卵巢皮样囊肿。腹腔镜技术包括：1）在囊肿与卵巢之间创建一个分离平面；2）通过水、剪刀和重力相结合的方式解剖囊肿，而不直接牵拉囊肿；3）将囊肿放入腹腔镜袋后取出。
囊肿平均直径为6.5厘米（范围3至12厘米）。平均手术时间为125分钟（范围50至180分钟）。所有患者均在48小时内出院。所有病例中囊肿均被完整解剖并在腹腔内无溢出地取出。40名患者中有15名进行了手术随访；3例（20%）在治疗的卵巢上发现轻度粘连。
在腹腔镜手术期间始终有可能防止皮样囊肿破裂和溢出，但这种方法耗时且需要专业的手术技术。
