单孔腹腔镜手术治疗儿童卵巢囊肿蒂扭转临床分析

Clinical analysis of single-port laparoscopic surgery in the treatment of ovarian cysts pedicle torsion in children

目的探讨单孔腹腔镜手术治疗儿童卵巢囊肿蒂扭转的临床价值。方法回顾性分析大连市儿童医院2016年1月至2018年10月采用单孔腹腔镜行卵巢囊肿蒂扭转复位腹腔外囊肿剥除术22例的临床资料,其中左侧10例,右侧12例;年龄4~14岁[(10.2±2.9)岁];体重指数13~23kg/m^2[(17.7±2.9)kg/m^2];患儿均接受3~36个月的随访。观察患者的手术和术后情况。结果22例患儿均顺利完成手术,无中转开腹及多孔腹腔镜手术。手术时间25~60min[(41.4±9.2)min],囊肿直径5~16cm[(8.4±2.7)cm],术中出血量5~20mL[(11.4±3.5)mL]。患儿术后肠蠕动恢复时间8~20h[(13.6±3.7)h],术后住院时间3~6d[(4.2±0.9)d],住院治疗期间无手术相关并发症。21例扭转的卵巢囊肿复位后剥除囊肿保留卵巢组织,1例因卵巢及输卵管已缺血坏死,切除病变附件。手术切除的组织病理诊断均为良性病变。患儿术后随访3~36个月,彩色多普勒超声检查无卵巢萎缩及囊肿复发病例。结论单孔腹腔镜手术治疗小儿卵巢囊肿蒂扭转操作简单,损伤小、恢复快、瘢痕不明显、手术确切可靠,该技术值得推广应用。

Objective To investigate the clinical value of single-port laparoscopic surgery in the treatment of ovarian cysts pedicle torsion in children. Methods The clinical data of 22 children with ovarian cysts pedicle torsion,who underwent single-port laparoscopic surgery from during January 2016 and October 2018,were retrospectively analyzed. The children of 4-14 years old [mean (10.2±2.9) years old] were included in the study,of whom 10 cases were on the left and 12 on the right. Body mass index (BMI) was 13-23 kg/m^2 with a mean value of (17.7±2.9) kg/m^2. All patients were followed up for 3-36 months. The clinical data including operative situations,postoperative situations and perioperative period were analyzed statistically. Results All procedures were successfully completed without conversion to open surgery or mult-port laparoscopic surgery in 22 patients. Operation time was 25-60 min with a mean value of (41.4±9.2) min;diameter of the ovarian cysts was 5-16 cm with a mean value of (8.4±2.7) cm;intraoperative blood loss was 5-20 mL with a mean value of (11.4±3.5) mL. The bowel movement was recovered at 8-20 h [(13.6±3.7)] h after surgery;postoperative hospital stay was 3-6 d with a mean value of (4.2±0.9) d. There were no complications during treatment. Twenty-one patients who received surgery had their ovaries preserved,1 patient underwent adnexectomy due to necrosis of oviduct and ovary. All children were confirmed to have benign ovarian cysts by pathological examination. The patients were followed up for 3-36 months,and the Color Doppler ultrasound showed no recurrence or atrophy of ovaries after surgery. Conclusions Single-port laparoscopic surgery in the treatment of children ovarian cysts pedicle torsion is easy,minimally invasive,quickly recovered,and reliable without obvious scar. It is worth further clinical application.