胎儿期卵巢囊肿的治疗策略

Treatments of prenatally diagnosed neonatal ovarian cysts

目的探讨产前诊断的新生儿卵巢囊肿的治疗策略。方法回顾性分析2017年1月至2019年6月产前诊断、出生后手术治疗的新生儿卵巢囊肿的临床资料,根据患儿手术治疗时年龄,分为新生儿组(出生10~28 d,18例)和小婴儿组(出生28 d至6个月,15例)。影像资料包括产前检查和术前B型超声结果、磁共振成像(MRI);术中所见卵巢病变情况、术后病理结果等。结果本研究共纳入33例新生儿卵巢囊肿,发生卵巢扭转坏死19例,扭转坏死比例高达57.6%(19/33)。其中28 d以下者8例(44.4%),28 d至6个月11例(73.3%),两者比较,差异无统计学意义(P>0.05);发生扭转坏死者均表现为复杂型卵巢囊肿,发生扭转坏死和未扭转坏死患儿卵巢囊肿的直径分别为(4.64±1.11)cm和(5.86±1.36)cm,二者差异有统计学意义(P<0.05)。结论产前检查即发现的新生儿卵巢囊肿扭转在6个月内坏死比例较高,应密切随访,随访过程中发现单纯向复杂转化的囊肿应积极手术探查,囊肿直径相对较小的卵巢更易发生扭转坏死。

Objective To explore the treatments of prenatally diagnosed neonatal ovarian cyst.Methods From January 2017 to June 2019,clinical data of prenatally diagnosed neonatal ovarian cysts were retrospectively analyzed.The imaging data of ultrasound and/or magnetic resonance imaging,intraoperative findings and pathological examination results were analyzed by t or chi-square tests respectively.Results A total of 33 cases of neonatal ovarian cysts were recruited.The age groups were 0-28 days(newborn,n=18)and 28 days to 6 months(infant,n=15).Ovarian torsion(n=19)occurred and accounted for 57.6%of all lesions,including newborn(n=8,rate of torsion:44.4%)and infant(n=11,rate of torsion:73.3%).No significant inter-group difference existed.All cysts of torsion showed signs of complex ovarian cysts with a diameter smaller than that in group without torsion.Conclusions The prenatal detection rate of neonatal ovarian cyst torsion remains high within 6 months.During close follow-ups,cysts with simple-to-complex transformation should be surgically explored.Those with a relatively smaller diameter are more prone to torsion.