对于儿童良性卵巢肿瘤(BOT)的治疗,尚无广泛认可的共识方案。这给次优管理带来了很大的风险。我们旨在制定多专业共识指导,以标准化手术管理,并为患有BOT的儿童提供明确的随访方案。
在多专业专家小组中分发的前瞻性两轮机密e-Delphi共识调查;通过两次半结构化视频会议结束。
就以下核心结果集达成共识:术前/术中管理;随访;青少年妇科转诊。(1)患有BOT的儿童应与其他具有潜在肿瘤性病变的患者接受相同的管理:术前讨论在儿科肿瘤多学科会议上对肿瘤进行风险分层,以及由具有保留卵巢手术和腹腔镜检查专业知识的卫生专业人员进行管理。(2)应尽可能进行BOT的保留卵巢手术,以最大程度地保留生育能力。(3)在紧急腹腔镜/开腹手术中发现的卵巢肿块应尽可能留在原位,并在切除前进行适当的检查(影像学/肿瘤标志物)。(4)BOT切除后所有患者均应进行随访。应向患者提供转诊至青春期妇科,以讨论对生育的影响。
本最佳实践德尔福共识声明强调了通过明确的肿瘤MDT策略管理患有BOT的儿童的重要性。为了优化风险分层,并尽可能通过保留卵巢手术保留生育力。
No widely agreed
consensus protocols exist for the management of benign ovarian tumors (BOT) in children. This presents a substantial risk for suboptimal management. We aimed to generate multispecialty
consensus guidance to standardize surgical management and provide a clear follow-up protocol for children with BOTs.
Prospective two-round confidential e-Delphi
consensus survey distributed among multispecialty expert panel; concluded by two semistructured videoconferences.
Consensus was generated on these core outcome sets: preoperative/intraoperative management; follow-up; adolescent gynecology referral. (1) Children with BOTs should receive the same management as other patients with potentially neoplastic lesions: Preoperative discussion at a pediatric oncology multidisciplinary meeting to risk stratify tumors, and management by health professionals with expertise in ovarian-sparing surgery and laparoscopy. (2) Ovarian-sparing surgery for BOTs should be performed wherever possible to maximize fertility preservation. (3) Ovarian masses detected during emergency laparoscopy/laparotomy should be left in situ wherever feasible and investigated appropriately (imaging/tumor markers) before resection. (4) Follow-up should be undertaken for all patients after BOT resection. Patients should be offered referral to adolescent gynecology to discuss fertility implications.
This best practice Delphi
consensus statement emphasizes the importance of managing children with BOTs through a well-defined oncological MDT strategy, in order to optimize risk stratification and allow fertility preservation by ovarian-sparing surgery wherever possible.