目的:本研究调查了儿童和青少年患者附件包块伴腹痛的临床病理特征和手术方式。我们的目标是更好地定义附件扭转的临床表现,并区分具有扭转和具有替代诊断的特征。
方法:对2012年3月至2019年12月期间因腹痛入院并出现附件包块的212例儿童和青少年患者进行了回顾性队列研究。在手术时对医疗记录进行了年龄审查,包括症状和体征的表现;肿瘤标志物水平;影像学检查;病理发现;肿块大小;治疗和结果。使用SPSS26.0进行数据管理和描述性分析。
结果:手术时患者的中位年龄为14.5±3.6岁。126(59.4%,126/212)患者出现突然发作的腹痛。共有82.1%(174/212)的参与者接受了附件保守性手术。179(84.5%,179/212)患者接受腹腔镜手术,平均肿瘤大小为7.7±3.4cm,而33名患者(15.6%,33/212)接受剖腹手术。包块破裂和异位妊娠分别占7.5%(16/212)和0.9%(2/212),分别。所有患者的36.8%(78/212)是扭转的原因。在扭转的患者中,恶心和呕吐症状在无扭转的女孩中更为常见(P<0.0001)。88.5%的扭转女童出现急性腹痛,而92.3%的患者有不能缓解或反复出现的持续性疼痛,显著高于无扭转者(P<0.001)。69.2%的扭转患者有固定的疼痛部位,无扭转的患者为42.2%(P<0.001)。88.5%的扭转女孩有卵巢囊肿/肿块≥5cm,没有扭转的女孩为75.0%(P=0.038)。66.7%的女孩接受了保留卵巢手术,与无扭转患者的92.2%相比。最常见的病理类型是成熟畸胎瘤和单纯性囊肿,分别占29.4%和25.6%,分别。多变量分析证实质量大小大于5cm(OR4.134,95%CI:1.349-12.669,P=0.013),急性发作疼痛(OR24.150,95CI:8.398-69.444,P=0.000),持续性或复发性疼痛(OR15.911,95CI:6.164~41.075,P=0.000)与扭转风险增加显著相关.
结论:在儿科人群中,扭转是一种相对罕见的事件,并不罕见,占所有儿科和青少年患者的三分之一以上,出现附件肿块和腹痛。儿童和青少年的疼痛评估对于区分扭转者和其他诊断者的特征很重要。因此,儿科和青少年患者,特别是骨盆肿块大小大于5厘米,急性发作疼痛,持续性或复发性疼痛具有良性原因,并且不会错过需要紧急关注的破坏性疾病。因此,早期和广泛使用诊断性腹腔镜检查(DL)的策略可能会改善卵巢抢救.
OBJECTIVE: This study investigated the clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients. Our objective was to better define the clinical presentation of adnexal torsion and to distinguish characteristics of those with torsion and those with an alternate diagnosis.
METHODS: Retrospective cohort study of 212 pediatric and adolescent patients was performed who admitted for abdominal pain and presenting with an adnexal mass between March 2012 to December 2019.Medical records were reviewed for age at operation, including presentation of symptoms and signs; the levels of tumor markers; imaging examinations; pathologic findings; the size of masses; treatment; and outcome. Data management and descriptive analyses were performed using SPSS 26.0.
RESULTS: The median age of the patients was 14.5 ± 3.6 years at the operation. 126 (59.4%, 126/212) patients presented with an abrupt onset of abdominal pain. A total of 82.1% (174/212) of the participants underwent adnexal conservative surgery. 179 (84.5%, 179/212) patients underwent laparoscopic surgery with an average tumor size of 7.7 ± 3.4 cm, while 33 patients ( 15.6%, 33/212) underwent laparotomy. Rupture of mass and ectopic pregnancy accounted for 7.5% (16/212) and 0.9%(2/212), respectively. Torsion was responsible for 36.8% (78/212) of all patients. Among the patients with torsion, the symptom of nausea and vomiting was more common among girls without torsion (P < 0.0001). 88.5% of the girls with torsion had acute onset of abdominal pain, while 92.3% had persistent pain that could not be relieved or occurred repeatedly, which significantly higher than that in the patients without torsion (P < 0.001). 69.2% of patients with torsion had fixed pain sites, compared with 42.2% in patients without torsion (P < 0.001). 88.5% of girls with torsion had an ovarian cyst/mass ≥ 5 cm, compared with 75.0% in girls without torsion (P = 0.038). 66.7% of girls underwent ovary-preserving surgery, compared with 92.2% in patients without torsion. The most common pathologic types were mature teratoma and simple cyst, accounting for 29.4% and 25.6%, respectively. The multivariate analyses confirmed that mass size greater than 5 cm (OR 4.134, 95% CI: 1.349-12.669,P = 0.013), acute onset pain (OR 24.150,95%CI: 8.398-69.444,P = 0.000), persistent or recurrent pain (OR 15.911,95%CI: 6.164-41.075,P = 0.000) were significantly associated with increased risk of torsion.
CONCLUSIONS: Torsion which is a relatively rare event in the pediatric population was not an uncommon condition and responsible for more than one third of all pediatric and adolescent patients presented with adnexal masses and abdominal pain. Pain assessment in children and adolescents is important to distinguish characteristics of those with torsion and those with an alternate diagnosis.Thus, pediatric and adolescent patients particularly with a pelvic mass size greater than 5 cm, acute onset pain, persistent or recurrent pain have a benign cause and not missing the devastating condition that needs emergent attention. Thus, a strategy of earlier and liberal use of Diagnostic Laparoscopy (DL) may improve ovarian salvage.