腹腔镜辅助腹部小切口卵巢畸胎瘤手术66例

目的 探讨腹腔镜辅助腹部小切口卵巢成熟性囊性畸胎瘤手术的可行性。方法 66例卵巢成熟性囊性畸胎瘤行腹腔镜辅助腹部小切口畸胎瘤剔除或附件切除术。结果 63例经此方法完成手术，2例因极度肥胖和1例因卵巢固有韧带过短改行常规三孔腹腔镜手术。平均手术时间45min，平均术中出血量25ml，平均住院2．7d，无术中、术后并发症。全部病例术后随访3月～6年，均未见复发。结论 腹腔镜辅助腹部小切口卵巢成熟性囊性畸胎瘤手术具有安全、手术时间短、出血少、术后恢复快等优点。     

腹腔镜手术治疗婴儿卵巢成熟性囊性畸胎瘤的临床体会

目的:探讨腹腔镜手术治疗婴儿卵巢成熟性囊性畸胎瘤的手术技巧、临床疗效及安全性.方法:回顾分析为11例卵巢成熟性囊性畸胎瘤患儿行腹腔镜手术的临床资料.术中冲洗腹腔,以免术后发生腹腔感染、粘连.结果:所有腹腔镜手术均顺利完成,无一例中转开腹,无腹膜炎、切口感染、腹腔粘连等近期并发症发生,均治愈出院.随访10个月至7年,无复...     

2种腹腔镜下卵巢成熟性囊性畸胎瘤剥除术对残留卵巢体积影响的对比研究

目的探讨2种腹腔镜下卵巢成熟性囊性畸胎瘤剥除术对残留卵巢体积的影响。方法 47例（研究组）腹腔镜辅助下经腹壁小切口（二孔法）用手直接剥除卵巢成熟性囊性畸胎瘤,51例（对照组）传统三孔法腹腔镜下应用腹腔镜手术器械行卵巢成熟性囊性畸胎瘤剥除术,3个月后B超测量2组患者卵巢体积并进行比较。结果 3个月后研究组手术侧残留卵巢体积为（10.6±4.7）cm3,未手术侧卵巢体积为（12.1±5.1）cm3,无统计学差异（t=1.483,P=0.142）;对照组手术侧残留卵巢体积为（6.7±3.2）cm3,显著小于未手术侧卵巢体积（11.4±4.9）cm3（t=-5.735,P=0.000）。研究组两侧卵巢体积相比缩小（2.2±1.0）cm3,对照组两侧卵巢体积缩小（4.3±1.9）cm3,2组有显著性差异（t=6.761,P=0.000）。结论腹腔镜辅助下经腹壁小切口行卵巢成熟性囊性畸胎瘤剥除术能有效地避免正常卵巢组织的丢失。     

腹腔镜行卵巢囊性畸胎瘤切除术术式探讨

目的　探讨电视腹腔镜下卵巢囊性畸胎瘤治疗的手术方式。　方法　 6 7例卵巢囊性畸胎瘤行腹腔镜手术 ,其中囊肿直径 >8cm者 2 7例 ,2 3例行卵巢囊肿切除术或附件切除术 ,4 4例行囊肿剥除术。术中使用标本袋并以大量的温盐水冲洗腹腔 ,对较大的囊肿均行穿刺抽液 ,囊肿缩小后经腹壁戳口取出。　结果　卵巢囊肿剥除术中有 17例 (17/ 4 4 )囊肿破裂 ,卵巢囊肿切除或附件切除中无 1例囊液大量外溢。手术时间为 (34± 19)分钟 ,无 1例术中并发症及中转开腹手术。术后无化学性腹膜炎发生。结论　电视腹腔镜下卵巢囊性畸胎瘤手术是安全、可行的 ,较大的囊肿也能经腹腔镜手术切除。     

腹腔镜治疗卵巢良性肿瘤的疗效及安全性分析

目的:探讨腹腔镜治疗卵巢良性肿瘤的疗效和安全性。方法:回顾分析2002年1月至2008年12月因卵巢良性肿瘤行腹腔镜手术155例患者的临床资料。结果:所有患者均顺利完成腹腔镜手术,除1例为交界性粘液性囊腺瘤外,余均为良性卵巢肿瘤,其中卵巢巧克力囊肿42例,上皮性肿瘤23例,成熟性囊性畸胎瘤30例,黄体囊肿36例,卵巢冠囊肿13例,单纯性囊肿10例。平均手术时间65min,术中出血10～50ml,平均25ml,术后住院4d,无术后感染及复发病例。结论:腹腔镜治疗卵巢良性肿瘤安全有效,患者创伤小、康复快。     

单孔腹腔镜骶前囊性畸胎瘤切除1例

本文报道2016年6月应用单孔腹腔镜技术完整切除骶前囊性畸胎瘤1例,患者为53岁男性,体检超声发现骶前肿物,在完善术前检查及完善术前讨论后,决定应用单孔腹腔镜切除骶前肿物,术中在骶尾部建立单孔腹腔镜操作平台,超声刀及无创伤抓钳配合游离骶前肿物,完整切除肿瘤。术后病理提示成熟性囊性畸胎瘤。术后患者恢复良好,术后2个月随访无异常不适,二便正常,无盆腔神经损伤症状。     

电视腹腔镜手术治疗卵巢成熟畸胎瘤22例报告

回顾总结应用腹腔镜手术治疗的22例卵巢成熟性畸胎瘤,对其镜下诊断、手术适应证、手术方法及近远期并发症进行评价。本组镜下诊断畸胎瘤14例(63．64％),平均手术时间72分钟,无1例并发症发生,术中出血少。通过直视下抽吸肿瘤内容物无1例漏入腹腔。认为腹腔镜肿瘤剔除术治疗卵巢成熟性畸胎瘤是一种安全简便易行的手术方式,直视下抽吸肿瘤内容物能避免溢漏腹腔内,术后恢复快,预后好。     

单孔悬吊腹腔镜辅助手术治疗卵巢良性肿物30例

目的探讨单孔悬吊腹腔镜辅助手术治疗卵巢良性肿物的疗效。方法 2007年12月～2011年4月采用腹壁皮下单点悬吊术,选取腹壁麦氏点或反麦氏点单切口,应用无气腹腹腔镜辅助技术治疗30例育龄期卵巢良性肿物,其中行卵巢肿物剥除术24例(畸胎瘤10例,巧克力囊肿6例,囊腺瘤2例,卵巢囊肿6例),单侧附件切除术6例(巧克力囊肿2例,囊腺瘤4例)。结果 30例手术均获成功,病理诊断:囊性成熟畸胎瘤10例,卵巢巧克力囊肿8例,浆液性囊腺瘤6例,卵巢囊肿6例。手术时间30～80 min,平均46.8 min;术中出血量30～100 ml,平均56.5 ml。术后住院4～7 d,平均5.2 d。28例术后随访3～6个月,平均4.5月,无复发和并发症发生。结论 单孔悬吊式腹腔镜辅助手术损伤小、并发症少、安全省时、简单经济。     

腹膜后成熟性囊性畸胎瘤1例报告

正畸胎瘤是一种生殖细胞来源肿瘤,好发于男性睾丸和女性卵巢,发生于性腺外畸胎瘤约占总畸胎瘤的15%。发生于腹膜后腔的畸胎瘤十分罕见~([1]),相关诊疗经验较少,而经后腹膜途径全腹腔镜下行成熟性囊性畸胎瘤切除术国内少有报道。我院收治1例,报告如下。1病例报告患者男性,36岁,因"体检发现左肾上腺区肿物"     

腹腔镜腹膜后畸胎瘤切除术1例

本文报道我院2016年1月收治1例腹膜后畸胎瘤,女,25岁,术前误诊为左侧卵巢囊肿,行腹腔镜手术,术中发现肿块位于腹膜后,约9 cm×8 cm,考虑为腹膜后畸胎瘤,顺利完成腹腔镜腹膜后畸胎瘤切除术,术后病理示囊性成熟性畸胎瘤。术后1个月随访,无不适。     

Endoscopic surgery for mature teratoma of the ovary

Background: This study was undertaken to assess the value of laparoscopic surgery as treatment for benign mature teratomas of the ovary. Methods: A total of 70 patients treated exclusively with laparoscopic surgery for ovarian mature teratoma were studied. The tumors were either enucleated with preservation of the ovary or removed by salpingo-oophorectomy. Results: Ovary-preserving surgery was performed in 60 cases; salpingo-oophorectomy was accomplished in 10 cases. All tumors removed were histologically benign. No surgical complications were encountered throughout the series. In eight patients who underwent primary ovary-preserving surgery, a second-look laparoscopy was undertaken with virtually no pathological findings noted. Conclusions: Our findings confirm those of other authors—when performed by experienced surgeons, laparoscopic removal of ovarian mature teratomas is a safe and recommendable alternative to laparotomy. Preoperative diagnosis and intraoperative inspection of the tumor must be as thorough as possible.     

改良腹腔镜下治疗卵巢成熟畸胎瘤的研究

目的:探讨腹腔镜下治疗卵巢良性畸胎瘤的效果和手术技巧,防止术中发生囊肿破裂等并发症的方法。方法:腹腔镜下采用囊肿先减压后腹腔外剥除的方法治疗较大卵巢良性畸胎瘤42例。结果:42例卵巢良性畸胎瘤患者腹腔镜手术均获成功,平均手术时间仅30m in。结论:腹腔镜手术治疗卵巢良性畸胎瘤具有患者创伤小,康复快等优点,囊肿先减压后腹腔外剥除的手术方法可有效地防止术中囊肿破裂等并发症的发生。     

Growing teratoma syndrome of the ovary: review of literature and first report of a carcinoid tumor arising in a growing teratoma of the ovary

We report the first case of a secondary tumor arising from a peritoneal nodule of mature teratoma in a patient with growing teratoma syndrome (GTS) of the ovary. The patient originally presented 19 years ago with an immature teratoma of the ovary and positive retroperitoneal lymph nodes. After surgery and chemotherapy, mature teratomas recurred as abdominal and pelvic masses after 1, 6, and 19 years. Upon the last recurrence, a trabecular carcinoid tumor developed in a mature teratoma associated with the liver. This case illustrates the importance of long-term follow-up for patients with GTS of the ovary, where the recurrent masses can appear many years after the primary tumor, compress the abdominal and pelvic structures and give rise to secondary neoplasms. In addition, we present a literature review of GTS of the ovary and some novel observations about this entity. On the basis of our review of ovarian GTS cases in the literature, we have found that ovarian GTS nodules tend to appear for the first time within 2 years of the initial primary. They remain confined almost exclusively to the pelvis, abdomen, and the retroperitoneum and do not venture to distant systemic sites. This new information may help identify and screen women with germ cell tumors of the ovary at risk for GTS.     

Metachronous Mature Cystic Teratomas in the Left Ovary and Bilateral Diaphragm: Report of a Case

Mature cystic teratomas are found often in gonadal sites, but rarely in extragonadal sites, such as the retroperitoneum, mediastinum, central nerve system, lung, and liver. To our knowledge, only seven cases of pathologically benign mature cystic teratoma originating in the diaphragm have been reported. We report the case of a 45-year-old woman found to have a mature cystic teratoma below the left side of her diaphragm. She had undergone oophorectomy for a huge mature cystic teratoma in the left ovary 34 years earlier, followed 1 year later by excision of a tumor in the right side of the diaphragm. All sections of the pathological specimen showed evidence of a mature cystic teratoma and pathologically resembled the specimens obtained in the previous two operations. Although this tumor might have been a recurrence of the mature cystic teratoma in the left ovary, it is more likely that multicentric teratomatous foci metachronously developed in the gonadal and extragonadal sites.     

垂体后叶素和子宫肌瘤旋切器在卵巢畸胎瘤剔除术中的应用

目的探讨垂体后叶素联合10mm自动子宫肌瘤旋切器在腹腔镜卵巢成熟性畸胎瘤剥除术中的应用价值。方法对我院2011年5月～2013年12月86例育龄期单侧卵巢成熟性畸胎瘤采用随机区组设计方案分成实验组和对照组。对照组采用常规剥除法，实验组将稀释的垂体后叶素（3u＋0．9％生理盐水20m1）注入卵巢囊肿壁与皮质间隙后再行剥除，剥离完全后将标本置入标本袋中用10mm自动子宫肌瘤旋切器将标本旋出。比较2组出血量、手术时间、囊肿破裂率和术后2个月术侧残留卵巢体积。结果2组均在腹腔镜下顺利完成手术。实验组手术时间（40±26）min，明显短于对照组（58±25）min（t=3．089，P=0．003）；实验组术中出血量（39±16）ml，明显少于对照组（68±35）ml（t=4．941，P=0．000）；实验组囊肿破裂率14．0％（6／43），明显低于对照组34．9％（15／43）（X2=5．103，P=0．024）。术后2个月实验组术侧残留卵巢体积（9．5±4．2）cm2，显著大于对照组手术侧残留卵巢体积（6．5±3．1）cm3（f=3．769，P=0．000）；实验组两侧卵巢体积缩小（2．4±1．1）cm3，显著小于对照组两侧卵巢体积的缩小值（4．2±1．8）em’（t=-5．595，P=0．000）。结论腹腔镜下改良卵巢成熟性畸胎瘤剔除术能减少术中出血，降低囊肿破裂率，降低手术难度，减少对卵巢的影响，优于常规腹腔镜卵巢成熟性畸胎瘤剥除术。     

Laparoscopic retroperitoneal lymph node dissection

Laparoscopic RPLND for clinical stage I testicular tumors is superior to open surgery in terms of efficiency, morbidity, and costs and has equal diagnostic accuracy. A quality of life study has shown that patients prefer surgery to chemotherapy and laparoscopy to open surgery. Laparoscopic RPLND is also feasible after chemotherapy, and the results are as good as those achieved in clinical stage I disease. Patients with stage IIb lesions can be spared the third and fourth cycle of chemotherapy if diagnostic laparoscopic RPLND is performed to exclude active tumor or remove mature teratoma. Laparoscopic removal of residual tumors following conventional chemotherapy for stage IIb lesions can be performed with minimal morbidity. The long and steep learning curve remains the biggest obstacle in laparoscopic RPLND. Most centers specializing in the treatment of testicular cancer are not trained in laparoscopic surgery and vice versa; however, the growing importance of laparoscopy for oncologic indications should help to overcome this problem in the near future.     

Recurrent mature ovarian teratomas: a retrospective analysis

Objective: To investigate the clinical characteristics and the regularity of recurrence in mature ovarian teratoma.Methods: The clinical data of 36 patients with recurrent mature ovarian teratoma (case group) was analyzed retrospectively and compared with the data of 72 patients without recurrence (control group) who underwent surgical treatment in the same period.Results: The overall incidence of recurrence after conservative operation is 2.5%. The mean recurrence interval was (7±7) years. The patients with recurrence was (24±7) years old on average at the onset of recurrence, significantly younger than those without recurrence (30±6) years old(P<0.05). There was no significant difference in gravidity, parity, tumor size, mode of surgery and spillage or not during operation between the two groups. The rates of bilateral or multilocular cysts in the patients with recurrence were significantly higher than those of the patients without recurrence(P<0.05 or P<0.01).Conclusion: Young patients and patients with bilateral or multilocular ovarian teratomas should be followed up closely. Laparoscopy is the best choice for the treatment of mature ovarian teratomas. Biopsy of the contralateral ovary is not recommended routinely in surgery.     

Metachronous benign ovarian tumors are not uncommon in children

Purpose

To evaluate the risk for metachronous ovarian tumor in pediatric patients with mature ovarian teratoma.

Methods

During 1981–2011, 22 children underwent oophorectomy for mature teratoma at the median age of 11.4 (range 1.5–15.3) years. The patients were followed-up in median 4.4 (range 0.5–25.5) years.

Results

None of the patients had synchronous bilateral tumor at the time of primary operation, but during follow-up five patients (23%) got metachronous contralateral ovarian tumor. The contralateral tumor was observed in median 3.6 (range 1–8.8) years after the primary operation. According to Kaplan–Meier analysis the risk for contralateral tumor was 14% ± 8% (SE) within five years and 66% ± 26% (SE) within 10 years. In this series, the contralateral tumor was operated by ovary preserving surgery. Three of the metachronous tumors were mature teratomas and two were seromucinous infantile cystadenomas. One patient had a second teratoma recurrence 14 years after the first recurrence.

Conclusions

More than one fifth of the children with ovarian mature teratoma get metachronous benign tumor to the contralateral ovary. Therefore a yearly ultrasound follow-up is needed for these patients up to potential pregnancy to enable early diagnosis, ovary preserving surgery and maintenance of fertility in the case of metachronous tumor.     

Gamma knife radiosurgery for intracranial mature teratoma--long-term results and review of literature

BACKGROUND: The purpose of this report is to present long-term outcomes of gamma knife radiosurgery for intracranial mature teratoma after debulking surgery. METHODS: Three patients with intracranial mature teratoma had initial target volumes of 5.4, 18.7, and 5.1 cm(3), respectively, and were treated by gamma knife radiosurgery between 1993 and 2004. Marginal doses of 17, 12.5, and 13.5 Gy, respectively, were delivered to the tumors at isodose levels of 50%, 50%, and 62%, respectively. The first patient received radiosurgery after surgical removal and conventional radiotherapy. The second patient received similar management, including surgery and radiotherapy, with tumor recurrence. Two additional operations and subsequent radiosurgery were performed on this patient. Based on the favorable results of the first 2 patients, we performed radiosurgery instead of conventional radiotherapy after subtotal surgical removal in the last patient. By reviewing literatures concerning the therapeutic modalities and the long-term results of our 3 patients, we discuss the role of radiosurgery in treating intracranial mature teratoma. RESULTS: A follow-up period of 121, 89, and 31 months, respectively, demonstrated tumor volume reduction rates of 70%, 89%, and 48%, respectively. No evidence of further tumor progression and no radiosurgery-related complication or morbidity was noted. The school performances of the affected children are all above average. CONCLUSIONS: Gamma knife radiosurgery provides a safe and effective alternative as the adjuvant treatment of intracranial mature teratoma after surgical debulking. Previous conventional radiotherapy does not alter final tumor control. Radiosurgery should be considered when residual tumor growth continues with no related symptoms or evaluations of tumor markers during follow-up.