背景:儿科人群中的卵巢肿块是年轻女孩中最常见的腹部肿块。在新生儿中,大多数肿块是良性的,而在儿童和青少年中存在恶性肿瘤的风险。这项研究的目的是对女孩卵巢肿瘤的临床和治疗方面进行25年的回顾性分析,为了说明微创技术的发展如何改变了这种病理的管理。
方法:18岁以下因卵巢包块而在3个儿科手术单元进行手术的患者的记录,在过去的25年里,进行了回顾性审查。该研究组包括1996年至2021年之间进行手术的147例患者,诊断为卵巢肿块。涉及的数据是人口统计,外科,随访和最终诊断。我们分析了手术技术的类型,术中数据(手术时间,使用不同的技术),并发症,住院时间和长期随访。基于这些数据,我们评估了在过去的25年中,新生儿和年轻女孩卵巢肿块的手术方法发生了怎样的变化。
结果:患者年龄介于7天至15岁之间(中位数,59天)。所有程序均在腹腔镜或机器人中完成,而在开放手术中没有转换。111例患者是新生儿;他们都有滤泡囊肿,并且都使用1或3个套管针在腹腔镜检查中进行了治疗。在80/111名患者中(72%),保留了一小部分卵巢实质;在31/111例患者(28%)中,其中卵巢实质是不可用的,进行了卵巢切除术.我们保存了一小部分卵巢的病人,长期随访(最少随访12年)(29/80,36%),在美国控制下发育为正常卵巢。36人是老年患者。他们的组织学诊断为良性(30)或恶性(6)肿瘤。所有术前怀疑卵巢恶性肿瘤的患者(8/36)均接受了卵巢切除术和使用密封装置的附件切除术。在过去的10年里,所有的孩子,除了新生儿,我们采用了密封装置,在过去的四年里,在20个案例中,我们一直采用ICG荧光技术在扭转时检查卵巢血管形成或在恶性肿瘤时检查淋巴结状况。
结论:在新生儿卵巢囊肿中,手术治疗保持不变,始终需要保留卵巢,长期随访证实了这一假设.这个年龄段的主要创新是在扭转的情况下使用ICG荧光技术检查卵巢血管形成。在青少年中,决策策略基于肿瘤标志物和肿块的形态学方面。机器人膀胱切除术或卵巢切除术现在代表了更安全和更快的方式来执行。密封装置是解剖和切除以避免出血的重要工具。所有年龄段的ICG荧光技术对于检查扭曲后的卵巢血管形成或在恶性肿瘤的情况下检查淋巴结状态至关重要。所有可疑病变必须用内袋清除。
BACKGROUND: Ovarian masses in pediatric populations are the most common abdominal masses in young girls. In neonates, the majority of masses are benign while in children and teen-agers the risk of malignancy exists. The aim of this study is to perform a 25-year experience retrospective analysis of clinical and therapeutic aspects of ovarian tumors in girls, in order to show how the development of minimally invasive technology has changed the management of this pathology.
METHODS: The records of patients under the age of 18 who were operated in three pediatric surgical units due to ovarian mass, in the last 25 years, were reviewed retrospectively. The study group comprised 147 patients operated between 1996 and 2021 with a diagnosis of ovarian masses. Data involved were demographical, surgical, follow-up and final diagnosis. We analyzed the type of surgical technique, intra-operative data (operative time, the use of different technologies), complications, length of stay and long-term follow-up. Based on these data, we assessed how the surgical approach to ovarian masses has changed in the last 25 years in newborns and young girls.
RESULTS: The patients ages ranged between 7 days and 15 years (median, 59 days). All the procedures were completed in laparoscopy or robotics without conversion in open surgery. One-hundred and eleven patients were neonates; they all had follicular cysts and they were all managed in laparoscopy using 1 or 3 trocars. In 80/111 patients (72%), a small part of ovarian parenchyma was saved; in 31/111 patients (28%), in which the ovarian parenchyma was not available, an ovariectomy was performed. Patients in which we saved a small part of ovary, at long term follow-up (minimum follow-up of 12 years) (29/80, 36%), developed a normal ovary at US control. Thirty-six were older patients. They had a histological diagnosis of benign (30) or malign (6) tumors. All the patients (8/36) with a pre-operative suspicion of ovarian malignancy received an ovariectomy and an adnexectomy using sealing devices. In the last 10 years in all the children, except neonates, we adopted sealing devices and, in the last 4 years, in 20 cases, we always adopted ICG fluorescence technology to check ovarian vascularization in case of torsion or to check lympho-nodes condition in case of malignancy.
CONCLUSIONS: In neonatal ovarian cysts, surgical management remained unchanged and an ovarian sparing procedure is always indicated and the long-term follow-ups confirm this hypothesis. The principal innovation in this age period is the use of ICG fluorescence technology to check ovarian vascularization in case of torsion. In teenagers, the decision-making strategy is based on the tumoral markers and on the morphological aspects of the mass. Robotics cystectomy or ovariectomy now-days represents the safer and faster way to perform this. Sealing devices are essential tools for dissection and resection to avoid bleeding. ICG fluorescence technology in all ages is fundamental to check ovary vascularization after detorsion or to check lympho-node status in case of malignancy. All the suspected lesions have to be removed with an endo-bag.