保守性手术治疗儿童卵巢扭转的安全性和有效性前瞻性研究  

A prospective study on the safety and efficacy of conservative surgery for ovarian torsion in children

作　　者：章均[1] 杜逸飞[1] 董波 赵珍珍[1] 孔祥如[1] 杨超[1] 李长春[1] 吕麟亚[1] 王珊[1] 魏光辉[1] Zhang Jun;Du Yifei;Dong Bo;Zhao Zhenzhen;Kong Xiangru;Yang Chao;Li Changchun;Lyu Linya;Wang Shan;Wei Guanghui(Department of Surgical Oncology,Ministry of Education Key Laboratory of Child Development&Disorders,National Clinical Research Center for Children's Health&Disorders,China International Science&Technology Cooperation Base of Children's Development&Critical Disorders,Affiliated Children's Hospital,Chongqing Medical University,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China;Rongchang District People's Hospital,Chongqing 402460,China)

机构地区：[1]重庆医科大学附属儿童医院肿瘤外科,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,400014 [2]重庆市荣昌区人民医院,402460

出　　处：《中华小儿外科杂志》2020年第5期401-406,共6页Chinese Journal of Pediatric Surgery

基　　金：重庆市自然科学基金(cstc2017shmsA130112);重庆市应用基础研究基金(cstc2017jcyjAX0139)。

摘　　要：目的探讨儿童卵巢扭转"坏死"行腹腔镜下保守性手术挽救卵巢策略的可行性。方法对2017年10月至2019年10月在重庆医科大学附属儿童医院诊断为卵巢扭转患儿,立即走急诊手术绿色通道,采用腹腔镜探查手术。如果手术证实为卵巢扭转,经过家长知情同意后,立即走小儿卵巢附件扭转保守性手术处理流程。卵巢扭转复位的患儿术后定期行小儿妇科彩色多普勒超声检查,随访双侧卵巢的体积、血供和卵泡情况。计算复位后各时间段卵巢体积与正常卵巢体积的比值、卵巢复位后各时间段卵巢体积与复位前体积的比值。统计保守手术后患儿卵巢保留成功率、血栓发生率、再扭转发生率、腹疼发生率、发热发生率、肿瘤恶变率。结果71例卵巢扭转患儿接受了保守性手术治疗,年龄为(6.51±3.98)岁,术后随访时间超过3个月。从发病开始到接受手术的时间为(43.91±17.37)h。本组患儿腹疼的发病时间和缺血程度之间有明显相关性(r=0.85,P<0.01)。所有病例均行腹腔镜下扭转卵巢复位术。所有复位卵巢患儿术后均未出现血栓发生的症状和体征。2例患儿出现一过性发热,所有患儿腹疼的症状和体征术后均逐渐消失。所有复位的扭转卵巢随访过程中未发生再扭转。69例非恶性肿瘤性卵巢扭转复位后,随访观察未发现恶变情况。所有患儿术后均未发生卵巢再扭转或者因保守手术引起的其他并发症而需要的非计划二次手术。3个月后彩色多普勒超声随访结果提示卵巢保留的成功率达98.60%。结论儿童卵巢扭转"坏死"行保守手术挽救卵巢策略具有可行性,但目前国内尚无相关的指南规范,术前需与家属充分沟通、解释病情,争取家属的理解与配合。Objective To explore the feasibility of laparoscopic conservative surgery for ovarian torsion necrosis in children.Methods All children with suspected ovarian volvulus underwent laparoscopy immediately.If ovarian torsion was confirmed,the process of conservative surgery for ovarian accessory torsion in children should be followed immediately after obtaining the informed parental consent.The volume,blood supply and follicle of bilateral ovaries were followed up.The ratios of volumes of torsion ovaries to normal ovaries and the ratios of ovarian volumes during each period after de-torsion to the volumes at the time of torsion were calculated.The successful rate of ovarian preservation,incidence of thrombus,incidence of recurrent ovarian torsion,incidence of abdominal pain,incidence of fever and the rate of malignancy were analyzed.Results From October 2017 to October 2019,71 children with ovarian torsion underwent conservative surgery.The average age was(6.51±3.98)years and the follow-up period over 3 months.The mean time from onset to operation was(43.91±17.37)hours.A significant correlation existed between onset time of abdominal pain and extent of ischemia in torsion ovaries(r=0.85,P<0.01).All children underwent laparoscopic ovarian de-torsion.There were no postoperative signs or symptoms of thrombus.Transient fever persisted in 2 cases and all symptoms and signs of abdominal pain disappeared gradually.No malignant change was found in 69 cases of non-malignant ovarian after de-torsion.No unplanned re-operation was performed for complications of conservative surgery,such as ovarian retorsion.Conclusions It is feasible to preserve ovary by conservative surgery for pediatric ovarian torsion.However,there is no relevant domestic guideline at present.Prior to operation,it is necessary to fully communicate and explain the condition with family members for their understanding and cooperation.

关 键 词：卵巢扭转 保守性手术 腹腔镜手术 卵巢扭转复位术 卵巢肿瘤剥除术 

分 类 号：R713.6[医药卫生—妇产科学]