儿童双侧卵巢肿瘤的诊断和治疗  

Diagnosis and treatment of bilateral ovarian neoplasms in children

作　　者：朱志云 秦红[1] 杨维[1] 韩炜[1] 成海燕[1] 常晓峰[1] 冯俊 韩建宇 黄一晋 王焕民[1] Zhu Zhiyun;Qin Hong;Yang Wei;Han Wei;Cheng Haiyan;Chang Xiaofeng;Feng Jun;Han Jianyu;Huang Yijin;Wang Huanmin(Department of Surgical Oncology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院肿瘤外科,100045

出　　处：《中华小儿外科杂志》2020年第5期407-411,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨儿童双侧卵巢肿瘤的临床病理特点和诊疗策略。方法收集首都医科大学附属北京儿童医院2006年1月至2019年12月收治的15例双侧卵巢肿瘤患儿的临床资料,进行回顾性分析。15例患儿,年龄1个月至15岁10个月(中位年龄13岁零7 d)。临床表现以腹痛为主,其他有腹部膨隆、代谢综合征、性早熟等。术前B型超声发现双侧卵巢肿瘤12例,其中伴卵巢扭转9例,术中均证实。1例幼年型颗粒细胞瘤患儿人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)升高,余良性肿瘤患儿及1例卵巢未成熟畸胎瘤患儿瘤标未见异常。双侧卵巢肿瘤同时发生14例,其中4例患儿行单侧附件切除术+对侧卵巢肿瘤剥除术,10例良性肿瘤患儿行双侧卵巢肿瘤剥除术;双侧卵巢异时性肿瘤1例,初次行右侧卵巢肿瘤剥除术,二次手术切除右侧剩余卵巢、输卵管并剥除左侧卵巢肿瘤。结果病理检查示双侧卵巢肿瘤性质一致者12例,双侧肿瘤性质不同者3例。术后1例幼年型颗粒细胞瘤患儿及1例未成熟畸胎瘤行化疗,余无特殊治疗。随访患儿14例,均无复发,除1例颗粒细胞瘤患儿性激素低,无月经,其余患儿性激素、月经均未见异常。结论儿童双侧卵巢肿瘤,患儿大部分为学龄期儿童和青少年,绝大多数是同时性双侧肿瘤,大部分为良性病变,应结合多项指标评估肿物的良恶性,进一步决定手术方式。保留生育功能的手术方式优先考虑。Objective To explore the clinicopathological characteristics,diagnosis and treatment strategies of pediatric bilateral ovarian neoplasms.Methods From January 2006 to December 2019,clinical data were analyzed retrospectively for 15 children with bilateral ovarian neoplasms.Their median age was 13 years and 7 days(range:1 month to 15 years 10 months).The most common presenting symptoms included abdominal pain,abdominal distention,metabolic syndrome and precocity.Ultrasound revealed bilateral ovarian neoplasms(n=12)and ovarian torsion(n=9).All diagnoses were confirmed by operation.The level of HCG(human chorionic gonadotropin)was elevated in 1 child with juvenile granulosa cell tumor.Tumor markers(AFP&β-HCG)were normal in all children with benign tumor and 1 case with immature teratomas.Among 14 cases of synchronous bilateral ovarian tumor,4 children underwent unilateral salpingo-oophorectomy and contralateral ovarian cystectomy and another 10 patients with benign tumors had bilateral ovarian cystectomy.One case of metachronous contralateral ovarian neoplasm underwent right ovarian cystectomy during primary operation and right salpingo-oophorectomy and left ovarian ovarian cystectomy during re-operation.Results Histopathological diagnoses revealed 12 cases with the same type of histopathology in each of the ovaries and 3 cases with two different types.One case of juvenile granulosa cell tumor and another with immature teratomas received postoperative chemotherapy.Follow-ups were conducted for 14 children and there was no recurrence.The level of gonadal hormone was lower than normal in 1 case of granulosa cell tumor with amenorrhe.Other cases had normal levels of gonadal hormone and menstrual cycle.Conclusions Most children with bilateral ovarian neoplasms are school-aged and adolescents.A large majority of tumors occurs synchronously and are benign in nature.The nature of tumors should be evaluated by multiple factors to further determine surgical procedures.Ovary-sparing surgery is preferred.

关 键 词：卵巢肿瘤 外科手术 生育力 儿童 

分 类 号：R737.31[医药卫生—肿瘤]