Review of a 25-Year Experience in the Management of Ovarian Masses in Neonates, Children and Adolescents: From Laparoscopy to Robotics and Indocyanine Green Fluorescence Technology.
Review of a 25-Year Experience in the Management of Ovarian Masses in Neonates, Children and Adolescents: From Laparoscopy to Robotics and Indocyanine Green Fluorescence Technology.
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DOI：
10.3390/children9081219
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发表时间：
2022-08-12
期刊：
影响因子：
--
通讯作者：
Escolino M
中科院分区：
文献类型：
--
作者：
Ciro E;Vincenzo C;Mariapina C;Fulvia DC;Vincenzo B;Giorgia E;Roberto C;Lepore B;Castagnetti M;Califano G;Escolino M
背景：儿童卵巢肿块是年轻女孩最常见的腹部肿块。在新生儿中，大多数肿块是良性的，而在儿童和青少年中存在恶性肿瘤的风险。本研究的目的是对25年来女孩卵巢肿瘤的临床和治疗方面进行回顾性分析，以显示微创技术的发展如何改变了这种病理的治疗。方法：回顾性分析近25年来3个儿科外科收治的18岁以下卵巢肿块患者的临床资料。该研究组包括147名在1996年至2021年间接受卵巢肿块手术的患者。涉及的数据包括人口统计、手术、随访和最终诊断。我们分析了手术技术的类型，术中数据（手术时间，不同技术的使用），并发症，住院时间和长期随访。基于这些数据，我们评估了过去25年来新生儿和年轻女孩卵巢肿块的手术方法是如何变化的。结果：患者年龄在7天到15岁之间（中位，59天）。所有手术均在腹腔镜或机器人下完成，无需在开放手术中转换。111例为新生儿；他们都有滤泡囊肿他们都在腹腔镜下用了1到3个套管针。111例患者中有80例（72%）卵巢实质部分保留；111例患者中有31例（28%）未见卵巢实质，行卵巢切除术。在长期随访（至少随访12年）中，我们保留了一小部分卵巢的患者（29/ 80,36 %）在US对照下发育为正常卵巢。36例为老年患者。他们的组织学诊断为良性或恶性肿瘤。所有术前怀疑卵巢恶性肿瘤的患者（8/36）均采用封闭装置行卵巢切除术和附件切除术。近10年来，除新生儿外，所有患儿均采用封闭装置，近4年来，20例患儿均采用ICG荧光技术检查卵巢扭转血管情况，恶性肿瘤检查淋巴结情况。结论：在新生儿卵巢囊肿中，手术治疗保持不变，卵巢保留手术总是指征，长期随访证实了这一假设。这一时期的主要创新是使用ICG荧光技术检查卵巢扭转情况下的血管化。在青少年中，决策策略是基于肿瘤标志物和肿块的形态学方面。如今，机器人膀胱切除术或卵巢切除术是更安全、更快捷的方法。密封装置是切除和切除以避免出血的必要工具。ICG荧光技术在所有年龄段都是检查卵巢变形后血管形成或恶性肿瘤时检查淋巴结状态的基础。所有可疑的病变都必须用内袋切除。
Background: Ovarian masses in pediatric populations are the most common abdominal masses in young girls. In neonates, the majority of masses are benign while in children and teen-agers the risk of malignancy exists. The aim of this study is to perform a 25-year experience retrospective analysis of clinical and therapeutic aspects of ovarian tumors in girls, in order to show how the development of minimally invasive technology has changed the management of this pathology. Methods: The records of patients under the age of 18 who were operated in three pediatric surgical units due to ovarian mass, in the last 25 years, were reviewed retrospectively. The study group comprised 147 patients operated between 1996 and 2021 with a diagnosis of ovarian masses. Data involved were demographical, surgical, follow-up and final diagnosis. We analyzed the type of surgical technique, intra-operative data (operative time, the use of different technologies), complications, length of stay and long-term follow-up. Based on these data, we assessed how the surgical approach to ovarian masses has changed in the last 25 years in newborns and young girls. Results: The patients ages ranged between 7 days and 15 years (median, 59 days). All the procedures were completed in laparoscopy or robotics without conversion in open surgery. One-hundred and eleven patients were neonates; they all had follicular cysts and they were all managed in laparoscopy using 1 or 3 trocars. In 80/111 patients (72%), a small part of ovarian parenchyma was saved; in 31/111 patients (28%), in which the ovarian parenchyma was not available, an ovariectomy was performed. Patients in which we saved a small part of ovary, at long term follow-up (minimum follow-up of 12 years) (29/80, 36%), developed a normal ovary at US control. Thirty-six were older patients. They had a histological diagnosis of benign (30) or malign (6) tumors. All the patients (8/36) with a pre-operative suspicion of ovarian malignancy received an ovariectomy and an adnexectomy using sealing devices. In the last 10 years in all the children, except neonates, we adopted sealing devices and, in the last 4 years, in 20 cases, we always adopted ICG fluorescence technology to check ovarian vascularization in case of torsion or to check lympho-nodes condition in case of malignancy. Conclusions: In neonatal ovarian cysts, surgical management remained unchanged and an ovarian sparing procedure is always indicated and the long-term follow-ups confirm this hypothesis. The principal innovation in this age period is the use of ICG fluorescence technology to check ovarian vascularization in case of torsion. In teenagers, the decision-making strategy is based on the tumoral markers and on the morphological aspects of the mass. Robotics cystectomy or ovariectomy now-days represents the safer and faster way to perform this. Sealing devices are essential tools for dissection and resection to avoid bleeding. ICG fluorescence technology in all ages is fundamental to check ovary vascularization after detorsion or to check lympho-node status in case of malignancy. All the suspected lesions have to be removed with an endo-bag.
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影响因子：
2
作者：
Esposito, Ciro;Coppola, Vincenzo;Escolino, Maria
通讯作者：
Escolino, Maria
影响因子：
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作者：
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影响因子：
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DOI：
10.1016/j.jogoh.2020.101901
发表时间：
2021-05-11
影响因子：
1.9
作者：
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通讯作者：
Ozcelik, Z.
影响因子：
1.7
作者：
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通讯作者：
Helmrath, Michael A