电视腹腔镜下卵巢良性畸胎瘤手术21例报告

目的探讨电视腹腔镜行卵巢良性畸胎瘤手术的适应症,预防和减少肿瘤破裂发生.方法对21例卵巢良性畸胎瘤病人在电视腹腔镜下行囊肿剥出术18例,附件切除术3例.结果发生肿瘤破裂12例,占66.67%,平均手术时间90min,平均术中出血80ml,1例出现皮下气肿,无术后出血、脏器损伤及化学性腹膜炎或肉芽肿.结论电视腹腔镜下行卵巢良性畸胎瘤的手术是完全可行的.     

腹腔镜下标本袋内剥除卵巢成熟畸胎瘤32例临床分析

腹腔镜下卵巢囊肿剥除术已成为目前治疗良性卵巢囊肿的主要方式。但在剥除卵巢成熟畸胎瘤过程中一旦发生囊肿破裂，其内容物在腹腔内扩散可能造成腹膜刺激征和肉芽肿形成。对本院采用腹腔镜下卵巢畸胎瘤标本袋内剥除的32例患者进行回顾性分析，以探讨腹腔镜下防止术中卵巢畸胎瘤内容物扩散的有效方法。     

“冷处理”腹腔镜卵巢畸胎瘤剥除术(附63例报道)

目的:研究"冷处理"腹腔镜卵巢畸胎瘤剥除术对卵巢功能的影响。方法:对63例卵巢畸胎瘤行"冷处理"腹腔镜剥除术,并对卵巢功能进行跟踪随访。结果:63例患者手术共剥除肿瘤70个,其中11个肿瘤术中发生破裂;手术持续时间(65±8.7)min,术中出血量(36±9.6)ml。术后半年11例妊娠,其余52例月经正常或基本正常,妇科彩超无异常,26例行性腺六项检查,结果正常。结论:"冷处理"腹腔镜卵巢畸胎瘤剥除术简便、易行,能较好地保护卵巢功能。     

腹腔镜下卵巢良性畸胎瘤手术65例分析

目的 探讨腹腔镜下卵巢良性畸胎瘤手术的可行性及临床应用价值。方法 采用德国WOLF电视腹腔镜对65例卵巢良性畸胎瘤行腹腔镜手术，与同期剖腹卵巢良性畸胎瘤手术63例进行对比分析。结果 腹腔镜组除手术时间长于剖腹组（P〈0．05）外，术中出血、拔尿管时间、肛门排气时间、住院时间及下床活动时间均少于剖腹组（P〈0．05）。结论 腹腔镜下卵巢良性畸胎瘤手术具有肠道干扰少、术中出血少、术后疼痛轻、进食早、恢复快、住院日短等优点，在临床中应用安全可行。     

腹腔镜下剥除卵巢良性畸胎瘤46例

腹腔镜下剥除卵巢良性畸胎瘤４６例黄小洁，王克，邵淑芹卵巢良性畸胎瘤（下文简称畸胎瘤）是妇科常见肿瘤，传统的治疗方法为开腹手术，腹腔镜下手术因恐肿瘤破裂，内容物流入腹腔而较少进行。我院自１９９３年２月起开展腹腔镜下剥除畸胎瘤，收到良好效果，现报告如下．...     

不孕症患者合并卵巢肿瘤的临床特点分析

目的 探讨不孕症患者合并卵巢肿瘤的临床特点、诊断、手术处理及妊娠结局。方法 回顾性分析1999年1月1日—2004年12月31日在浙江大学医学院附属妇产科医院生殖内分泌科因不孕症住院手术后经病理检查证实的110例卵巢肿瘤患者的临床资料。按病理检查结果分为卵巢上皮性肿瘤组（上皮性肿瘤组）、畸胎瘤组和其他组,分别为49、42、19例。结果 上皮性肿瘤组、畸胎瘤组和其他组的术前确诊率分别为29％、81％和63％,前组明显低于后两组（P〈0．01）。110例患者中,97例为直径〈5cm的卵巢小肿瘤患者;97例完成腹腔镜下卵巢肿瘤剔除手术,11例行开腹手术,2例腹腔镜检查后转开腹手术;上皮性肿瘤组合并盆腔致密粘连的发生率为61％,明显高于畸胎瘤组的26％（P〈0．01）。有随访结果的102例患者中,共45例妊娠,妊娠率44％,其中18例自然受孕,21例体外受精妊娠,6例人工授精妊娠。结论 （1）不孕症合并卵巢肿瘤以直径〈5em的小肿瘤为主,术前诊断率低,腹腔镜检查可明确诊断。（2）卵巢上皮性肿瘤合并慢性盆腔炎发生率较高,术中应认清解剖关系,完整剔除肿瘤,同时尽量保护卵巢功能。（3）不孕症合并卵巢肿瘤患者在手术和辅助生育治疗后可获得良好的妊娠结局。     

输液针管抽吸联合小切口切除卵巢良性囊肿68例临床分析

目的:探讨输液针管抽吸联合小切口切除卵巢良性囊肿术式的可行性及临床价值。方法:回顾性分析3种术式治疗卵巢良性囊肿患者的临床资料,其中68例选择输液针管小切口手术(小切口组),50例行腹腔镜下囊肿剥出术(腹腔镜组),36例行传统开腹手术(传统组),比较这3组术式术中和术后情况。结果:与传统术式比较,小切口组和腹腔镜组术后恢复快。小切口组的手术操作时间最短(P<0.05),术中出血量最少(P<0.01)。结论:输液针管抽吸联合小切口切除卵巢良性囊肿,具有手术时间短、对患者组织损伤少、恢复快等特点。     

卵巢巨大良性囊肿腹腔镜手术8例

卵巢巨大良性囊肿在临床上较为少见。近几年通过腹腔镜手术治疗卵巢巨大良性囊肿有诸多报道,对囊肿及输卵管的处理多行切除术[1,2]。本文回顾性分析我院自开展腹腔镜手术以来,行卵巢巨大良性囊肿腹腔镜手术8例,结合文献资料,探讨卵巢巨大良性囊肿腹腔镜手术的可行性和处理方式以及对生育的影响。1资料与方法1.1一般情况1999年10月至2004年2月,我院共收治卵巢良性囊肿168例,其中卵巢巨大良性囊肿8例,占4.8%。目前卵巢巨大良性囊肿的诊断标准尚不一致,临床上一般认为肿瘤上界达脐孔以上定为卵巢巨大肿瘤的诊断标准[3]。8例患者年龄15~60岁,未…     

腹腔镜下卵巢成熟畸胎瘤剔除手术体会

目的探讨卵巢成熟畸胎瘤腹腔镜下剔除术的手术技巧。方法2003年2月至2007年4月在中山市人民医院行卵巢成熟畸胎瘤腹腔镜下剔除术101例,术中将标本袋敞开于患侧卵巢下方,用单极电凝在卵巢表面稍薄处点切开长约1cm,用分离钳沿切口撕开包膜,轻轻分离包膜与瘤体。如发生瘤体破裂,立即吸除溢出囊外的脂肪。结果术中瘤体破裂16例;取出瘤体后盆腔冲洗液中,22例发现了少量油滴,无毛发和块状脂肪。结论术中轻柔操作,尽量避免瘤体破裂,切下的成熟畸胎瘤装入标本袋中,可减少肿瘤内容物对腹腔的污染。     

腹腔镜卵巢子宫内膜异位囊肿剥除术联合使用GnRH-a对卵巢储备功能的影响

目的:探讨腹腔镜下卵巢子宫内膜异位囊肿剥除术联合GnRH-a治疗对卵巢储备功能的影响。方法:选择有手术适应证的卵巢子宫内膜异位囊肿患者117例,将患者分成两组:A组56例预先GnRH-a治疗2个周期后行腹腔镜手术,其中单侧卵巢子宫内膜异位囊肿33例(A1),双侧23例(A2);B组61例直接行腹腔镜手术,其中单侧卵巢子宫内膜异位囊肿38例(B1),双侧23例(B2)。记录患者的术中情况,检测治疗前及术后6月其基础性激素水平(FSH、LH、E2),阴道超声探测窦卵泡数(AFC)、卵巢体积。结果:双侧卵巢子宫内膜异位囊肿患者中,术前先行GnRH-a(亮丙瑞林)治疗组与直接行腹腔镜手术组比较,手术时间短、术中出血量少(P0.05)。双侧卵巢内异囊肿剥除手术患者术后6月的FSH水平均较治疗前显著升高,E2显著下降(P0.05);直接行腹腔镜手术组的FSH的水平明显高于腹腔镜手术前先GnRH-a(亮丙瑞林)治疗组(P0.05),术后AFC、卵巢体积均明显小于腹腔镜手术前先GnRH-a(亮丙瑞林)治疗组(P0.05)。单侧卵巢内异囊肿剥除手术患者治疗前及术后6月FSH、E2比较,均无显著差异(P0.05),囊肿侧的AFC、卵巢体积较正常侧明显减少(P0.05)。结论:腹腔镜卵巢内异囊肿剥除术可影响卵巢储备功能,以双侧卵巢内异囊肿更明显,术前使用GnRH-a治疗,可减少对卵巢功能的影响。     

Intestinal obstruction due to bilateral ovarian cystic teratoma in a pregnant woman: report of a case

Teratoma is the most common ovarian tumour associated with pregnancy. The complications in pregnancy include torsion, rupture and malignant transformation mimicking ovarian carcinoma. Its association with intestinal obstruction is uncommon. Case: A 35 year old gravida 5 para 4 woman with 18 week gestation was referred to our hospital with a 2 week history of abdominal pain, abdominal distension and vomiting. Initial physical examination and ultrasound scan showed bilateral ovarian masses and intrauterine singleton viable pregnancy. At surgery the right mass was observed to be adherent to a part of the small intestine. The masses were excised and confirmed grossly and histologically as benign cystic teratoma. She was well and discharged nine days post operatively. The pregnancy was managed conservatively and she was delivered of a normal male baby at term by spontaneous vertex delivery. Although intestinal obstruction due to benign cystic teratoma in pregnancy is uncommon, abrupt surgical intervention and conservative management is important for favourable outcome.     

Immature ovarian teratoma in an adolescent: a case report and review of the literature

BACKGROUND: Benign cystic teratomas are relatively common tumors in reproductive age women, but can occur at any age. While the incidence of malignant elements in a teratoma is low (approximately 1-2%), the survival of patients with immature teratoma is poor. Definitive diagnosis is mandatory. CASE: We describe a case of a 13-year-old African American female, gravida 0, presenting with a large pelvic mass, determined to be a benign cystic teratoma by intra-operative frozen section. However, due to the size of the tumor and the preponderance of neural elements we performed a full surgical staging procedure (excluding hysterectomy and complete removal of adnexa). The final pathology report revealed foci of immature neural tissue, with a final diagnosis of an immature cystic teratoma Stage Ia. CONCLUSION: Foci of immature neural elements can be readily missed on frozen section, especially with a large tumor. Full surgical staging at the time of initial laparotomy is justified when encountering an apparently mature cystic teratoma with a preponderance of neural elements on frozen section.     

Spontaneous Rupture of Benign Ovarian Cystic Teratoma in a Premenarcheal Girl

BackgroundSpontaneous rupture of benign cystic ovarian teratoma is an unusual occurrence.CaseA 9-year-old girl presented with acute onset of abdominal pain. Under a radiological diagnosis of cystic ovarian teratoma, she underwent laparoscopic cystectomy, preserving as much ovarian tissue as possible. Direct observation of a defect on the tumor surface and the presence of keratinized squamous cells in the ascites were important clues for intraperitoneal rupture. Pathologically, the defect was surrounded by inflamed tissues adjacent to the gastric mucosa, suggesting that autolysis of the wall by proteolytic enzymes induced the spontaneous rupture.Summary and conclusionWe present the youngest and first premenarcheal case of spontaneous rupture of cystic ovarian teratoma. Early diagnosis and minimally invasive surgical procedure are essential to preserve future fertility.     

Evaluation of immediate laparoscopic surgery for gynecologic disorders

The purpose of this study was to obtain information to aid in deciding the timing of immediate laparoscopic surgery for gynecological disorders. We evaluated immediate laparoscopic surgery (within 12 h after admission) performed at our institution between January 2005 and March 2010. Of the total 287 laparoscopic surgeries performed for patients with gynecological disorders during this period, 70 (24.4%) were immediate laparoscopic surgeries, 33 (47.1%) of which were for ectopic pregnancy, and 24 (34.3%) for ovarian tumor. Among the 24 surgeries for ovarian tumor, there were almost equal proportions of surgeries for mature cystic teratoma (ten cases, 41.7%) and endometrioma (nine cases, 37.5%). As to the breakdown of immediate surgery by pathology, immediate surgeries were performed in 20.8% of mature cystic teratoma cases and in 12.9% of endometrioma cases during this study period. In the 24 immediate surgeries for ovarian tumor, 10 cases (41.7%) had neither torsion nor rupture, 7 cases (29.2%) had torsion with mature cystic teratoma, serous cystadenoma or follicular cyst, and 7 cases (29.2%) had rupture of the tumor, all of which were endometrioma. Preoperatively, there were no significant differences between torsion and non-torsion cases in serum white blood cell (WBC) count or C-reactive protein (CRP) levels in peripheral blood. However, serum WBC and CRP levels tended to be elevated in cases of rupture with endometrioma. Especially in patients with ovarian tumor, presumed pathology is important in deciding the timing of immediate laparoscopic surgery.     

A case of a mature cystic teratoma of the uterosacral ligament successfully treated by laparoscopic surgery

An asymptomatic tumor was found in the pelvic cavity of a 49-year-old woman during a routine examination. With a diagnosis of mature cystic teratoma of the right ovary, laparoscopic surgery was performed. The intraoperative finding showed the presence of a cystic tumor firmly attached to the uterosacral ligament in a position distant from the bilateral ovaries. Laparoscopic excision was performed, and the diagnosis of mature cystic teratoma of the uterosacral ligament was made histopathologically. This is the first report in the literature of successful laparoscopic treatment for a mature cystic teratoma of the uterosacral ligament.     

Pregnancy with bilateral ruptured benign cystic teratomas.

A case of intra-abdominal rupture of bilateral cystic teratomas in the first trimester of pregnancy is reported. Review of the literature revealed 22 cases of intraperitoneal rupture of benign cystic teratoma (1908 to 1971). In all of these cases only one ovary was involved, and the period of gestation was after the first trimester.     

Chemical peritonitis caused by an iatrogenic rupture of mature cystic teratoma of the ovary during labor: a report of a case didactic to all the maternity health care workers

A 37-year-old postpartum woman was presented with abdominal pain supposed to be caused by uterine involution or puerperal endometritis after vaginal delivery. During the pregnancy, she was suspected to have a subserosal myoma by ultrasound examination. The pain was finally revealed to be originated from the chemical peritonitis caused by the rupture of the mature cystic teratoma of the ovary by Kristeller's maneuver performed during vaginal delivery. When a pregnant or puerperal woman complains about abdominal pain, we need to consider the possibility of chemical peritonitis resulting from the rupture of mature cystic teratoma of the ovary.     

Conservative management of ovarian cystic teratoma during pregnancy and labor

OBJECTIVE: Our goal was to evaluate the adequacy of conservative management during pregnancy and labor in women with an ultrasonographically diagnosed ovarian cystic teratoma. STUDY DESIGN: Forty-nine women with ultrasonographically diagnosed ovarian cystic teratoma <6 cm were followed for detection of possible complications through pregnancy and labor. Serial ultrasonographic examinations before pregnancy, during pregnancy, and after delivery were performed to detect changes in the size of the cystic teratoma. RESULTS: In a group of 49 women with dermoid cysts (mean age, 30 years), 68 pregnancies resulted. Of the 68 pregnancies, 4 ended in miscarriages, 1 was electively terminated, and in the remaining 63 pregnancies, a total of 64 healthy infants were delivered. Five patients needed treatment with assisted reproductive techniques. Fifty-five pregnancies ended in normal vaginal deliveries and 8 were delivered by cesarean (cesarean delivery rate of 16%). None of the classical complications attributed to dermoid cysts such as torsion, dystocia, or rupture occurred in the study group. In a follow-up of 56 dermoid cysts throughout pregnancy, cyst size remained unchanged. CONCLUSIONS: Ovarian dermoid cysts <6 cm are not expected to grow during pregnancy or to cause complications in pregnancy and labor.     

Teratoma gigante asintomático en gestante. Anexectomía unilateral laparotómica en segundo trimestre de embarazo y parto eutócico a término. Revisión de la literatura

It is rare for pregnancies to occur simultaneously with an adnexal mass, and when they do, they are mostly asymptomatic. In almost 25%, it is identified as a mature cystic teratoma. Both the diagnosis, monitoring, and treatment of these diseases can be difficult at this stage, and the assessment of the pros and cons for surgical treatment during pregnancy, which can lead to controversy, is a major problem. Among the characteristics to be assessed is the size of the tumour. When these masses are larger than 10 cm, despite having benign ultrasound characteristics, they may be masking a neoplasm in 1 out of 10 cases. In which case, surgical treatment would be considered during the pregnancy and a laparoscopy approach is often carried out to avoid, as far as possible, the rupture of these giant tumour masses.The case is presented of an asymptomatic pregnant patient who is diagnosed with an adnexal giant cyst. After the work-up study, an exploratory laparotomy was performed in the 16th week of pregnancy, with a unilateral adnexectomy being performed, with the definitive diagnosis of a mature cystic teratoma. The subsequent recovery and the conclusion to full-term using standardised management was completed successfully. A review is presented on the diagnosis, follow-up and surgical approach of adnexal masses during pregnancy.     

Squamous cell carcinoma arising from mature cystic teratoma of the ovary with synchronous endometrial adenocarcinoma

Squamous cell carcinoma arising from a mature cystic teratoma of the ovary is a rare event representing only 1-2% of all mature cystic teratomas. Furthermore, the synchronous occurrence of a second malignancy in this setting is extremely rare. A 63-year-old woman presented with a pelvic mass which was diagnosed as a left ovarian mature cystic teratoma preoperatively by ultrasonography. The frozen section of the mass revealed a left ovarian mature cystic teratoma with a focus of squamous cell carcinoma. Subsequently surgical staging procedure for ovarian cancer was performed. The final pathologic diagnosis was squamous cell carcinoma in mature cystic teratoma of the ovary, and synchronous endometrial adenocarcinoma with a mixture of endometrioid and mucinous subtypes as an incidental finding. The combination of these two synchronous cancers is unique and to the best of our knowledge, this has not been previously reported in the English language literature.