新生儿卵巢囊肿44例临床分析

Clinical features and prognosis of 44 neonates with ovarian cysts

目的分析新生儿卵巢囊肿的临床及影像学检查特点,了解卵巢囊肿蒂扭转的治疗及结局。方法选择2011年1月至2021年12月郑州大学第三附属医院新生儿科及小儿外科收治的新生儿卵巢囊肿患儿进行回顾性研究,分析其临床表现、影像学检查、病理结果、治疗及随访情况,按是否发生卵巢囊肿蒂扭转分为扭转组和未扭转组,并比较两组差异。结果共纳入44例新生儿卵巢囊肿患儿,均无特异性临床表现。保守治疗10例,手术治疗34例,23例术中证实为卵巢囊肿蒂扭转。34例患儿术前均行腹部超声检查,卵巢囊肿诊断准确率为91.2%(31/34),卵巢囊肿侧别定位准确率85.3%(29/34),卵巢囊肿蒂扭转诊断准确率82.6%(19/23);30例患儿行腹部CT检查,卵巢囊肿诊断准确率76.7%(23/30),卵囊囊肿侧别定位准确率53.3%(16/30),囊肿蒂扭转诊断准确率47.8%(11/23)。34例手术治疗患儿中,11例患儿术中未发现卵巢囊肿蒂扭转行卵巢囊肿剥离术,23例术中发现囊肿蒂扭转行卵巢囊肿切除术;单纯型卵巢囊肿中62.5%(15/24)发生扭转坏死,复杂型卵巢囊肿中80.0%(8/10)发生扭转坏死。扭转组卵巢囊肿平均最大直径大于未扭转组[(8.4±1.6)cm比(4.7±1.2)cm],差异有统计学意义(P<0.05)。结论新生儿卵巢囊肿多为单侧,无特异性临床表现,囊肿较大、双侧及复杂型卵巢囊肿易发生扭转坏死。腹部超声对卵巢囊肿侧别的定位及囊肿蒂扭转的诊断有优势,必要时手术治疗。

Objective To study the clinical characteristics and imaging features of neonatal ovarian cysts and to analyze treatment and prognosis of ovarian torsion.Methods From January 2011 to December 2021,neonates with ovarian cysts admitted to the department of neonatology and pediatric surgery of our hospital were retrospectively studied.They were assigned into ovarian torsion group and non-torsion group.Their clinical manifestations,imaging features,pathological results,treatment and prognosis were reviewed and compared.Results A total of 44 neonates with ovarian cysts were included,all without specific clinical manifestations.10 neonates were treated with conservative therapy and 34 received surgery.Ovarian torsion were confirmed during surgery in 23 patients.All 34 patients received abdominal ultrasound preoperatively and 31(91.2%,31/34)were diagnosed with ovarian cysts.The accuracy rates of ultrasound for cyst location and ovarian torsion were 85.3%(29/34)and 82.6%(19/23),respectively.30 patients received abdominal CT scan and 23(76.7%,23/30)were diagnosed with ovarian cysts.The accuracy rates of CT scan for cyst location and ovarian torsion were 53.3%(16/30)and 47.8%(11/23),respectively.Among the 34 patients treated with surgery,ovarian cyst dissection was performed in 11 patients and cyst resection in 23 patients with torsion necrosis.24 patients had simple cysts including 15 torsion necrosis(62.5%,15/24)and 10 had complicated cysts including 8 torsion necrosis(80.0%,8/10).The average diameter of ovarian cysts was significantly larger in the torsion group[(8.4±1.6)cm]than the non-torsion group[(4.7±1.2)cm](P<0.05).Conclusions Neonatal ovarian cysts are mostly unilateral without specific clinical manifestations.Large,bilateral and complex cysts are prone to torsion necrosis.Abdomen ultrasound has advantages than CT scan for the localization of the ovarian cyst and diagnosis of ovarian torsion.Surgical treatment is necessary after diagnosis.