新生儿卵巢囊肿蒂扭转的诊治

目的 通过总结本院收治的8例新生儿卵巢囊肿蒂扭转的临床资料,探讨新生儿卵巢囊肿蒂扭转的诊治经验.方法 回顾性分析2001年1月～2006年6月治疗的8例新生儿卵巢囊肿,年龄为出生后2 h～30 d,出生前经B超诊断胎儿腹部囊性病变7例;因出生后发现外阴分泌物增多就诊,B超检查有腹腔内囊性占位1例.结果 开腹手术6例,腹腔镜手术2例.8例卵巢囊肿蒂扭转360°～1800°,顺时针扭转5例,逆时针扭转3例.囊肿最小2.5 cm × 3.0 cm× 2.0 cm,最大6.0 cm×9.0 cm×10.0 cm.术后病理结果显示囊性畸胎瘤1例,卵泡囊肿4例,血肿及纤维囊壁组织伴灶性钙化3例.结论 新生儿卵巢囊肿蒂扭转罕见,但是通过对具有高危因素的胎儿进行产前B超可早期发现.根据患儿具体情况采取合适的手术方式,对可疑病例可行腹腔镜检查.     

经脐单孔腹腔镜手术治疗小婴儿卵巢囊肿的疗效分析

目的总结本院近4年来应用经脐单孔腹腔镜辅助下微创治疗28例新生儿以及小婴儿卵巢囊肿的诊疗经验。方法收集2012年6月至2016年6月4年间由本院新生儿外科收治的年龄6个月以下新生儿及小婴儿卵巢囊肿患儿28例,回顾性分析其临床症状、发现时间、住院时间、囊肿大小、包块性质、影像学检查特点、产前干预措施、外科处理方式、术后病理检查及随访结果。结果 28例患儿中单侧23例,双侧5例。年龄1个月以下者11例,1~3个月者11例,3~6个月者6例。27例表现为腹部肿块,1例表现为腹胀。产前发现20例,其中1例行产前超声引导下囊肿穿刺减压。住院时间4~20 d,平均7.5 d。彩超示囊肿大小为4~5 cm者11例,5~10 cm者15例,10 cm者2例。28例患儿均采取经脐单孔腔镜协助下微创手术治疗。行患侧附件切除术15例,行单纯囊肿切除术13例。病理回报卵巢单纯性囊肿21例,卵巢滤泡囊肿4例,卵巢浆液性囊肿3例。本组患儿均获治愈,随访无复发。结论经脐单孔腹腔镜辅助下微创治疗新生儿及小婴儿卵巢囊肿安全易行,疗效较好。对于腹腔囊性包块5 cm者或随访观察囊肿不能消退甚至增长者,需采取手术治疗;5 cm不能排除来源于卵巢或其他部位者应予探查性手术治疗。对于产前已发现的巨大囊肿,必要时可行胎儿期穿刺减压等微创手术治疗。     

产前诊断胎儿卵巢囊肿的系统管理与生后早期手术治疗

目的 探讨产前诊断胎儿卵巢囊肿的系统管理与生后早期手术治疗.方法 选择2002年9月至2012年9月北京市三级医院产前超声检查拟诊为卵巢囊肿,并在本院小儿外科接受产前咨询、新生儿或小婴儿期进行手术治疗的病例.小儿外科医生在咨询中对胎儿准父母提出病变监测、出生后检查及外科治疗计划.手术指征:囊肿体积巨大,复杂型囊肿,以及不排除卵巢畸胎瘤者.结果 接受产前咨询共45例,其中15例在出生后经手术证实并治疗.手术年龄:≤7天3例,8～30天9例,1～5个月3例.术中情况:5例巨大单纯性囊肿在未发生扭转与出血的情况下手术.10例超声检查为囊壁增厚、囊内混合强回声的复杂型囊肿,手术证实囊内充盈稠厚血性液体或坏死组织,部分伴囊壁坏死,未穿孔.手术以切除囊性病变而尽可能保留卵巢、输卵管等附件组织为基本原则.结论 对于产前诊断的胎儿卵巢囊肿实施系统化管理,有利于患儿安全度过围产期,及时接受必要的手术治疗,最大限度地避免或减少卵巢囊肿扭转、出血、囊壁坏死等严重并发症的发生,改善预后.     

腹腔镜治疗新生儿膈疝的探讨

目的探讨腹腔镜手术治疗新生儿膈疝的可行性。方法新生儿膈疝5例（生后1h、2d、7d、12d和24d）行腹腔镜手术治疗，其中，产前B超确诊2例，产后X线确诊3例；女4例，男1例；左侧膈疝4例，右侧膈疝1例。手术采用3孔或4孔腹腔镜法，还纳疝内容物，丝线缝合膈肌修补缺损。结果5例患儿在腹腔镜下顺利完成手术，手术时间85～160min，平均115min，手术出血量〈5ml，均无术中并发症，其中1例行腹腔镜手术后2周复发，再经腹腔镜手术治愈；另外1例行腹腔镜手术后1d复发行开腹补片修补术成功。5例患儿已随访6个月～4年，术前症状完全消失，无术后并发症发生。结论腹腔镜技术治疗新生儿膈疝具有暴露清楚、损伤小、打击小、恢复快、切口美观等优点，是一种可行方法。但由于新生儿腹腔镜手术普遍存在腹腔空间狭小的问题，特别是膈疝手术，将疝内容物还纳入腹腔后空间将进一步缩小，修补缝合手术操作较困难，需要熟练的腹腔镜技术。     

新生儿十二指肠梗阻64例

目的探讨新生儿先天性十二指肠梗阻的诊断、病理类型及治疗方法。方法对64例新生儿十二指肠梗阻患儿的术前诊断、病理类型、治疗方法及预后进行回顾性分析。其中18例行产前B超筛查。64例均经手术探查,59例术前行上消化道造影。肠旋转不良34例(合并肠坏死6例),33例行Ladd手术,4例加做肠切除、肠吻合术;十二指肠闭锁与狭窄12例,7例行隔膜切除及肠壁纵切横缝术,2例行十二指肠端端吻合术;其余3例及环状胰腺5例行十二指肠前壁菱形侧侧吻合术;2种原因梗阻者13例,其中十二指肠闭锁并肠旋转不良6例,十二指肠闭锁并环状胰腺1例,十二指肠闭锁并多发隔膜3例,环状胰腺并肠旋转不良2例,肠旋转不良并幽门隔膜1例,根据患者情况行单一或联合术式。结果行产前B超筛查患儿中12例(12/18,66.7%)怀疑十二指肠梗阻。上消化道造影的临床符合率为98.3%。64例患儿中58例痊愈(治愈率为90.6%),4例医院内死亡,2例放弃治疗。术后并发症主要包括黏连性肠梗阻5例,肠扭转、吻合口狭窄、漏诊多发畸形各1例,其中需要二次手术4例。结论产前B超有助于胎儿高位肠梗阻的早期发现;上消化道造影和B超是诊断十二指肠梗阻的有效方法;早期诊断、合理选择手术方式、避免漏诊及加强围手术期处理是提高治愈率的关键;发生肠扭转并长段肠坏死者预后不佳。     

3月龄以下婴儿卵巢囊肿34例诊疗分析

目的探讨年龄3个月以下婴儿卵巢囊肿的诊疗方法。方法2005年1月至2013年12月我们收治34例年龄3个月以下婴儿卵巢囊肿,回顾性分析其临床症状、住院时间、囊肿大小、包块性质、影像学检查特点、处理方式及术后病理检查结果。结果34例中,1例表现为黄染,1例为腹胀,32例表现为腹部肿块。住院时间7~23 d。囊肿5 cm者5例,5~10 cm者24例,10 cm者5例。2例术后病理检查结果为卵巢黄素化卵泡颗粒细胞,而术前B超检查提示1例为囊实性,1例为囊性;5例术后病理检查结果为卵巢浆液性囊肿,而术前B超检查提示2例为混合性,3例为囊性;20例术后病理检查结果为单纯囊肿,术前超声检查提示均为囊性;2例超声提示为囊肿病例未行病理检查。34例中,5例予临床观察,未予手术治疗,13例采取腹腔镜手术治疗,16例采取小切口手术治疗。29例手术病例获治愈,且随访无一例复发。结论3月龄以下婴儿卵巢囊肿无明显急腹症体征。腹腔囊性包块5 cm者应予手术治疗,5 cm不能排除来源于卵巢其他部位者应予探查性手术治疗。     

3月龄以下小婴儿卵巢囊肿的诊治经验

目的探讨3月龄以下小婴儿卵巢囊肿的诊治经验及方法。方法回顾性分析2010年7月至2016年1月经本院治疗的22例产前诊断的卵巢囊肿病例,诊断年龄为产前28~40周,观察发现侧别、胎龄、手术日龄及囊肿大小与患儿卵巢是否缺失情况,总结诊治过程中的经验和体会。结果22例产前诊断的卵巢囊肿分别于生后4~80 d经腹腔镜辅助下行卵巢囊肿切除或剔除手术,其中12例(占54.5%)因卵巢发育不良或扭转而切除。卵巢缺损组患儿囊肿直径大于卵巢正常组患儿,分别为(9.75±4.20)cm、(6.60±1.78)cm,差异有统计学意义(P0.05)。结论卵巢囊肿引起患儿卵巢萎缩及扭转坏死的几率较大,囊肿过大易造成卵巢缺损或发育不良。腹腔镜手术可以有效治疗该病,发现囊肿逐渐增大时应及时手术。     

腹腔镜诊治卵巢良性病变42例

目的 探讨腹腔镜治疗卵巢囊肿、卵巢扭转及卵巢良性畸胎瘤的手术指征及手术特点.方法 回顾性分析2001～2008年经腹腔镜治疗的42例卵巢良性疾病患儿临床资料,包括卵巢囊肿13例,卵巢扭转7例,卵巢良性畸胎瘤22例,其中畸胎瘤合并扭转4例、恶性疾病及中转开腹病例未列入分析.结果 腹腔镜下切除卵巢20例,余22例保留卵巢.保留卵巢患者中,17例行卵巢畸胎瘤或囊肿剥除术,随访均未见复发,13例卵巢功能良好,4例仅保留部分皮质进行缝合者卵巢缩小,但仍有新卵泡形成;4例单纯卵巢囊肿开窗术者中1例复发;1例无基础病变的卵巢扭转复位后固定,卵巢发育正常,未出现扭转复发及对侧扭转发作.术中采用取物袋无腹腔污染及腹膜炎发生.结论 腹腔镜手术是诊断和治疗小儿卵巢疾患的首选方法,良性畸胎瘤及囊肿以保留性腺的剥除手术较为合理;卵巢扭转目前多主张保留卵巢复位固定,即便是畸胎瘤合并部分扭转也可复位后小心剥离并加以固定.     

107例儿童卵巢囊性肿块的临床特征和治疗分析

目的 分析儿童卵巢囊肿的疾病特征和治疗方案.方法 采集和分析2001年1月至2010年12月间,以卵巢囊肿为首要诊断的,并在复旦大学附属儿科医院外科治疗的107例14岁以下患儿的医疗记录.结果 卵巢囊肿107例,其中左侧34例,右侧67例,双侧6例.新生儿(≤28 d)22例,婴幼儿(29 d至3岁)8例,学龄期(4～8岁)24例,青春前期(9～12岁)28例,青春期(13～14岁)25例.肿瘤发病具有与年龄相关的特征.仅1例发现影像学上垂体的轻度异常.63.8％的患儿E2激素水平高于其所在的年龄段水平.73例手术,34例保守治疗,13例术后诊断为卵巢的真性肿瘤(囊性畸胎瘤、粘液性囊腺瘤和浆液性囊腺瘤).手术保留卵巢52例(71.2％),腹腔镜手术36例,开腹手术37例.术后复发3例,均为卵巢真性肿瘤患儿.未手术患儿34例,66％由于肿块在短期随访中缩小,20％由于肿块体积小(直径1 cm)不处理,余14％为家属主观原因和发现内分泌显著异常未加干预.结论 卵巢囊肿发生率高,在各个年龄阶段均可发生,症状各异.需要与卵巢真性肿瘤鉴别.治疗多提倡保守治疗,肿块增大或扭转是干预的指征.腹腔镜手术微创、可行,建议尽可能的保留卵巢组织,剜除囊肿.功能性的卵巢囊肿复发少见.     

先天性弓形虫病卵巢感染一例

患者 :女 ,6 0ｄ。孕母 38周Ｂ超检查时 ,发现胎儿腹腔有肿物。患儿Ｂ超检查示 :双侧卵巢囊肿 ,部分区域伴钙化。遂以“先天性卵巢囊肿”入院。检查 :在左下腹可触及一肿块 ,余未见明显异常。于 1年半前 ,患儿母亲第一次妊娠时 ,孕 4个月即胎死宫内 ,引产后证实为畸形儿。母亲弓形虫抗体ＩＨＡ检查阳性 ,用螺旋霉素治疗 4个月后阴转并停药。家中有长期养猫狗的习惯。患儿采用腹腔镜手术 ,术中发现双侧卵巢均见有体积为 3.5ｃｍ× 3.0ｃｍ×3.0ｃｍ的囊性肿物 ,左侧卵巢呈 2 80°扭转。继而行左卵巢切除及右卵巢囊肿剥离术。病理检查 :囊性肿…     

Neonatal ovarian cysts: management and follow-up

Twenty-seven neonatal ovarian cysts were diagnosed in utero during a 13-year period; 9 were complicated and 18 were initially simple, but 8/18 showed evidence of complications in utero or soon after birth, leaving only 10 simple cysts. One simple and 4 complicated cysts were surgically excised early in the study period; 2 simple cysts were treated by needle aspiration at birth because of their large size. The remaining 20 cases were initially managed conservatively. All simple cysts and 10/13 complicated cysts regressed completely within 12 months; 3 that failed to regress were surgically excised. Nineteen patients who did not undergo a laparotomy had ultrasonographic (US) examinations from 3 months to 9 years after birth. Echography showed both ovaries in all 9 girls who had simple cysts at birth and in 2 of the 10 with complications. In the other 8 complicated cases only one ovary was detected at follow-up. Pre- or post-natal aspiration of simple cysts 4 cm or more in diameter is recommended, while conservative management seems appropriate in the absence of symptoms for simple cysts of less than 4 cm and complicated cysts of any size tending to involute after birth. Accepted: 7 July 1999     

Antenatally detected ovarian cysts--a therapeutic dilemma.

Twenty-four instances of ovarian cysts detected antenatally are reported. Most cysts were functional in origin, histologically benign simple cysts. Pregnancy was clinically uncomplicated in all, followed by a spontaneous vaginal delivery in 20 cases between the 33rd and 41st week, four neonates were delivered by a cesarean section for obstetrical reasons. Nine cysts more than 5 cm in diameter at birth were treated surgically. The operative indications were as follows; 5 neonates had clinical symptoms caused by abdominal distention or vomiting. The remaining four showed a sign of hemorrhage following torsion. Thirteen cysts less than 5 cm in diameter, and two cysts more than 5 cm in diameter began to regress spontaneously within 6 months after birth and finally 10 of them disappeared between 2 weeks and 2 years.     

Ovarian masses in the newborn

Prenatal sonography uncovers many fetal ovarian masses that previously would have gone unrecognized. This challenges clinicians to learn the natural history of these asymptomatic lesions so as to provide the best care postnatally. Spontaneous resolution of simple ovarian cysts is expected by about 6 months of age, which is attributed to predicted changes in the postnatal hormonal milieu. After birth, levels of human chorionic gonadotropin (HCG) and estrogen plummet. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) rise until about 3 months of age and then fall as the "gonadostat" matures. Although symptomatic cysts demand intervention, simple asymptomatic cysts less than 5 cm in diameter should be left alone but reassessed sonographically. If simple cysts are larger than 5 cm in diameter the risk of torsion may be significant, and intervention often is advocated. However, the risk of torsion versus the likelihood of resolution is not well established. The therapeutic goal for a clinician managing a newborn with a simple ovarian cyst is to maximize ovarian salvage. Aspiration alone may be a reasonable option. The laparascopic approach to the neonatal ovarian cyst provides a view of both ovaries and allows aspiration, unroofing, cystectomy, or ovariectomy. The sonographically complex cyst usually represents adnexal torsion but could be a neoplasm and warrants intervention because the morbidity from untreated neonatal adnexal torsion can be significant beyond loss of the ovary (eg, hemorrhage, peritonitis, intestinal obstruction, or a wandering tumor).     

Neonatal ovarian torsion: report of three cases and review of the literature

Ovarian cysts are common incidental findings in term infants and, if unusually large, may result in dystocia, torsion, or rupture. Torsion and infarction of a normal ovary tend to occur in older childhood. During a 4-month period, 3 cases of neonatal ovarian torsion were observed after antenatal ultrasonography had detected fetal pelvico-abdominal cystic lesions. The three infants were explored between 4 and 16 days of age. Ovarian torsion was right-sided in all 3, and 1 ovary had been autoamputated. The resected specimens were nontense, thin-walled cysts, filled with hemorrhagic fluid, that measured between 4.5 and 8 cm in diameter. Microscopically, focal calcification and widespread necrosis precluded recognition of underlying histologic landmarks. Neonatal ovarian cysts or cystic ovaries greater than 4 cm in diameter should be excised, even if asymptomatic, because they are prone to, or have undergone, torsion.     

Neonatal Ovarian Torsion: Report of Three Cases and Review of the Literature

Ovarian cysts are common incidental findings in term infants and, if unusually large, may result in dystocia, torsion, or rupture. Torsion and infarction of a normal ovary tend to occur in older childhood. During a 4-month period, 3 cases of neonatal ovarian torsion were observed after antenatal ultrasonography had detected fetal pelvico-abdominal cystic lesions. The three infants were explored between 4 and 16 days of age. Ovarian torsion was right-sided in all 3, and 1 ovary had been autoamputated. The resected specimens were nontense, thin-walled cysts, filled with hemorrhagic fluid, that measured between 4.5 and 8 cm in diameter. Microscopically, focal calcification and widespread necrosis precluded recognition of underlying histologic landmarks. Neonatal ovarian cysts or cystic ovaries greater than 4 cm in diameter should be excised, even if asymptomatic, because they are prone to, or have undergone, torsion.     

Fetal ovarian cysts: postnatal evolution and indications for surgical treatment

Fetal ovarian cysts are an increasingly common finding during routine prenatal ultrasonography (US). These lesions were occasionally diagnosed in the past, but only on the basis of a palpable abdominal mass or, rarely, because a twisted ovarian cyst caused an acute abdomen. Surgery is currently recommended for neonates after prenatal diagnosis, even in asymptomatic cases, when the cyst has a diameter larger than 5 cm or echographic findings suggest torsion or intracystic hemorrhage. In our 12 cases of suspected fetal ovarian cysts, wide variations in diameter were seen in 6 during pre- and postnatal follow-up. Two of these were not confirmed at birth; 7 were treated conservatively and excluding 1 perinatal death from multiple associated anomalies and 1 case lost to follow-up, the remaining cases showed uneventful, spontaneous regression of the cyst. Postnatal US signs suggesting necrosis secondary to torsion in a previously uncomplicated cyst and requiring surgery were seen in only 3 cases. Conservative treatment must be recommended in most prenatally diagnosed cysts; indications for surgery cannot be based only on dimensions. The incidence of complications has been overemphasized and the risk of associated malignancy is negligible in newborns, while possible size reduction and resorption can be expected in most cases. Nonoperative management may also be recommended when signs of torsion are seen before birth and spontaneous asymptomatic involution of the cystic ovary is documented in early postnatal life. Accurate clinical and US follow-up is mandatory in all cases. Surgery must be reserved for symptomatic cases or when an alteration of the cystic structure is documented by US in a previously uncomplicated cyst.     

Management of prenatal ovarian cysts

OBJECTIVES: The aim of the present study was to analyze the antenatal and postnatal outcome of fetal ovarian cysts in relation to their ultrasonographic pattern and size. METHODS: Sixteen fetal ovarian cysts were diagnosed in 16 fetuses and followed with serial ultrasonograms in utero and after birth until spontaneous or surgical resolution. RESULTS: Eleven fetal ovarian cysts were simple cysts at first prenatal scan but 3 of the 11 became complex cysts at last prenatal scan and required postnatal laparoscopic surgery. Seven of the 11 simple cysts (63%) disappeared on follow-up imaging by ultrasonograms or MRI during pregnancy or within 2 months after birth. The rate of spontaneous resolution of simple cysts was higher than that of complex cysts (40.0%). The mean maximum diameter of the ovarian cysts before delivery that were subsequently excised surgically at postnatal period (50+/-13.4 mm) was not different from that of ovarian cysts that resolved spontaneously (42.8+/-12.8 mm, P=0.2918). CONCLUSION: In our study, cyst size did not predict the risk of ovarian loss. The opportunity of laparoscopic exploration versus conservative management needs to be investigated because some complex cysts resolved spontaneously in the postnatal period.     

Neonatal ovarian cysts

Twelve cases of ovarian cysts are reported. The diagnosis was made antenatally by ultrasound scan. The authors consider the ultrasonic images of these cysts and signs of in-utero torsion, the antenatal and postnatal evolution, the pathological findings at surgery, and the histological results for six children that were operated. A review of the literature enables us to describe the possible complications in the evolution of this tumor and to discuss the perinatal management of the ovarian cyst, which depends on the appearance and diameter of the cyst and on its evolution. Offprint requests to: J. Gaudin     

Ovarian cysts in newborns

Before the introduction of ultrasonography (US), ovarian cysts in newborns were thought to be rare. With the extended use of real-time US, prenatal detection has increased. There is still considerable controversy regarding the best treatment of these neonatal findings. A total of 27 instances in 24 consecutive newborns of antenatally-diagnosed ovarian cysts were reviewed for US data, management, and outcome to assess the ante- and postnatal evolution of the cyst and establish appropriate therapy. The cysts detected during pregnancy were studied by repeated postnatal US studies. In 10 children (2 with bilateral cysts) the cyst evolved spontaneously toward regression. Fourteen patients were operated upon; 10 had complex and 4 (in 1 bilateral) had simple cysts. Cystectomy was employed when possible to preserve the ovarian parenchyma (3 cases); in the remaining cases oophorectomy was performed. Histologically, the cysts were of follicular origin or necrosis made a diagnosis impossible. US was found to be a helpful diagnostic tool for simple ovarian cysts, but could not reliably distinguish between benign and malignant tumors if a sonographically complex lesion was present. Based on our experience, surgical management of ovarian cysts should be reserved to complex masses. Simple cysts can be monitored safely by close US follow-up; surgery is indicated if the cyst fails to regress after several months or becomes symptomatic. Accepted: 9 March 2000