经脐部单孔腹腔镜术结合卵巢托底缝合重建术治疗小儿卵巢成熟性畸胎瘤的效果

Effect of Transumbilical Single-Port Laparoscopic Surgery Combined with Ovarian Buttress Suture Reconstruction in the Treatment of Ovarian Mature Teratoma in Children

目的探讨经脐部单孔腹腔镜术结合卵巢托底缝合重建术治疗小儿卵巢成熟性畸胎瘤的效果。方法回顾性分析2017年1月至2022年6月在郑州大学第一附属医院小儿外科接受微创手术治疗的41例小儿卵巢成熟性畸胎瘤患儿的临床资料,其中2017年1月至2019年5月的19例接受传统腹腔镜术治疗(三孔组),2019年6月至2022年6月的22例接受经脐部单孔腹腔镜手术治疗,并结合卵巢托底缝合重建术(经脐单孔组)。比较两组围手术期相关指标。结果41例患儿均顺利完成传统腹腔镜手术或者经脐部单孔腹腔镜手术,无中转开腹手术,术后病理均证实为卵巢成熟性畸胎瘤。41例均未接受卵巢及输卵管切除术,其中2例卵巢成熟性畸胎瘤合并蒂扭转,术中扭转复位后,观察卵巢血运恢复,行卵巢肿瘤剥除术及卵巢托底缝合重建术。两组手术时间、术后出血发生率以及住院时间比较差异无统计学意义(P>0.05),但经脐单孔组的手术时间较短,无术后出血病例。经脐单孔组的术中出血量少于三孔组(P<0.001),切口长度小于三孔组(P<0.001)。术后随访6~66个月,两组均未见瘤体复发。结论与传统腹腔镜术相比,经脐部单孔腹腔镜结合卵巢托底缝合重建术治疗小儿卵巢成熟性畸胎瘤的手术时间短,切口长度小,术中出血量少,术后出血发生率低,抽吸瘤体囊液后,将卵巢肿瘤自脐部切口提出腹腔外,直视下剥除瘤体并重建卵巢,降低了手术难度,有利于彻底切除瘤体和止血。对于卵巢成熟畸胎瘤,应仅切除肿瘤,最大程度保留卵巢实质和卵巢功能。

Objective To explore the effect of transumbilical single-port laparoscopic surgery combined with ovarian buttress suture reconstruction in the treatment of ovarian mature teratoma in children.Methods The clinical data of 41 children with ovarian mature teratoma who received minimally invasive procedure in Department of Pediatric Surgery of the First Affiliated Hospital of Zhengzhou University from January 2017 to June 2022 were retrospectively analyzed.Among them,nineteen children from January 2017 to May 2019 accepted traditional laparoscopic treatment(three-port group),and twenty-one children from June 2019 to June 2022 accepted transumbilical single-port laparoscopic surgery,and combined with ovarian buttress suture reconstruction(transumbilical single-port group).The perioperative related indicators of two groups were Compared.Results All the 41 cases were successfully completed traditional laparoscopic surgery or transumbilical single-port laparoscopic surgery without conversion to open surgery.Postoperative pathology confirmed ovarian mature teratoma.The adnexectomy was not performed in all the 41 cases.Among them,two cases of ovarian mature teratoma complicated with pedicle torsion,after torsion reduction during the operation,observed the recovery of ovarian blood supply,and performed ovarian tumor removal and ovarian buttress suture reconstruction.There was no statistically significant difference in surgical time,postoperative bleeding incidence,and hospital stay between the two groups(P>0.05),but the operation time was shorter in the transumbilical single-port group,and there was no case of postoperative bleeding.The intraoperative bleeding volume in the transumbilical single-port group was less than that in the three-port group(P<0.001),and the incision length was shorter than that in the three-port group(P<0.001).After follow-up of 6-66 months,no tumor recurrence was observed in both groups.Conclusion Compared with the traditional laparoscopic surgery,the combination of transumbilical single-port laparoscopic surgery combined with ovarian buttress suture reconstruction for the treatment of ovarian mature teratoma in children has shorter operation time,smaller incision length,less intraoperative bleeding,lower postoperative bleeding complications.After aspiration of tumor cyst fluid,the ovarian tumor is lifted out of the abdominal cavity from the umbilical incision,and the tumor is peeled off and ovary is rebuild,which reduces the difficulty of operation and is beneficial to complete resection of the tumor and hemostasis.For ovarian mature teratomas,only the tumor should be excised to maximize the preservation of ovarian parenchyma and ovarian function.