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目的探讨产前诊断胎儿卵巢囊肿的系统管理与生后早期手术治疗。方法选择2002年9月至2012年9月北京市三级医院产前超声检查拟诊为卵巢囊肿,并在本院小儿外科接受产前咨询、新生儿或小婴儿期进行手术治疗的病例。小儿外科医生在咨询中对胎儿准父母提出病变监测、出生后检查及外科治疗计划。手术指征:囊肿体积巨大,复杂型囊肿,以及不排除卵巢畸胎瘤者。结果接受产前咨询共45例,其中15例在出生后经手术证实并治疗。手术年龄:≤7天3例,8～30天9例,1～5个月3例。术中情况:5例巨大单纯性囊肿在未发生扭转与出血的情况下手术。10例超声检查为囊壁增厚、囊内混合强回声的复杂型囊肿,手术证实囊内充盈稠厚血性液体或坏死组织,部分伴囊壁坏死,未穿孔。手术以切除囊性病变而尽可能保留卵巢、输卵管等附件组织为基本原则。结论对于产前诊断的胎儿卵巢囊肿实施系统化管理,有利于患儿安全度过围产期,及时接受必要的手术治疗,最大限度地避免或减少卵巢囊肿扭转、出血、囊壁坏死等严重并发症的发生,改善预后。
Objective To investigate the systematic management of prenatal diagnosis of fetal ovarian cysts and early surgical treatment after birth. Methods Selected from September 2002 to September 2012 Beijing tertiary hospital prenatal ultrasound examination to be diagnosed as ovarian cysts and pediatric surgery in our hospital received prenatal counseling, neonatal or small infancy surgical treatment of cases. Pediatric surgeons in the consultation on fetal prospective parents proposed disease monitoring, postnatal examination and surgical treatment plan. Surgical indications: huge cysts, complex cysts, and do not rule out ovarian teratoma. Results A total of 45 prenatal consultations were received, of which 15 were confirmed and treated surgically after birth. Age of surgery: ≤7 days in 3 cases, 8 to 30 days in 9 cases, 1 to 5 months in 3 cases. Intraoperative conditions: 5 cases of simple simple cyst in the absence of torsion and bleeding surgery. 10 cases of ultrasound examination of the cyst wall thickening, cystic mixed echo strong complex cysts confirmed by intraoperative filling thick bloody fluid or necrotic tissue, some with cyst wall necrosis, not perforated. Surgical removal of cystic lesions and as much as possible to retain the ovaries, tubal and other annex organizations as the basic principle. Conclusion The systematic management of prenatal diagnosis of fetal ovarian cysts is conducive to the safety of children perinatal period, the timely receipt of the necessary surgical treatment to minimize or reduce ovarian cyst torsion, bleeding, necrosis and other serious cyst wall Occurrence of disease, improve the prognosis.