儿童腹痛伴附件包块30例临床分析

目的 了解治疗腹痛伴附件包块患儿适当的处理方式.方法 回顾性分析1999年4月～至2006年7月因腹痛伴附件包块行腹腔镜手术或腹式手术的30例患儿(年龄≤14岁)的临床资料.结果 平均年龄11.36岁(7～14岁).腹腔镜手术组18例,腹式手术组12例.腹腔镜组患侧附件切除7例,患侧卵巢囊肿剥除5例,患侧输卵管切除4例,阑尾切除 单侧附件切除1例,卵巢肿瘤活检 阑尾切除1例 单侧附件1例;腹式组患侧附件切除7例,患侧卵巢囊肿剥除4例,患侧附件切除 大网膜切除 阑尾切除1例.腹腔镜组病理类型成熟性畸胎瘤10例(10/18,其中出血梗死5例);卵巢及输卵管出血性梗死性质不能确定,已彻底坏死7例;卵巢无性细胞瘤1例.腹式组成熟性畸胎瘤7例(7/12,其中出血梗死3例),卵巢浆液性囊腺瘤3例,卵巢未成熟性畸胎瘤和内胚窦瘤各1例.手术均顺利进行,无1例发生手术和麻醉并发症.术后随访无1例再次出现附件包块,不影响患儿月经.行卵巢囊肿剥除术的患儿入院到手术日时间短于行附件切除/输卵管切除的患儿,明显腹痛者卵巢囊肿剥除组小于切除组.结论 积极手术处理对保留患儿卵巢、输卵管是非常重要的,腹腔镜手术治疗儿童腹痛伴附件包块是安全和可行的.

Clinical analysis of abdominal pain with adnexal masses in 30 children

Objective To observe appropriate treatment in abdominal pain with adnexal masses inchildren. Methods Clinical data of 30 children (below 14 year of age ) with abdominal pain and adnexalmasses had been explorated by laparosopy or abdominally between April 1994 and 2006 were reviewed.Results The mean age was 11.36 years (range ,7-14 years). The laparosopy group was 18 cases ,thelaparotome group was 12 cases. Among the laparosopy group , 7 cases were unilateral adnexectomy , 5cases were ovarian cystectomy , 4 cases were unilateral salpingectomy, 1 cases was both unilateraladnexectomy and appendectomy, and 1 case was both unilateral adnexectomy and appendectomy after ovarychecked. Among the laparotome group , 7 cases were unilateral adnexectomy, 4 cases were ovariancystectomy and 1 case unilateral adnexectomy, appendectomy and epiploonectomy . Among the types ofpathology in the laparosopy group, 10 cases were mature teratoma (6 cases in hemorrhage and infaret),7 cases were hemorrhage and necrosis tissue and 1 case were ovarian dysgerminoma. Among the types ofpathology in the lapardenoma, 1 case unmature teratom and 1 case yolk sac tumor . All operations weresuccessful and had no complication of operation and anesthesia . The time from inhospital to operationin cases of ovarian cystectomy group was shorter than that in adnexectomy group . The number of caseof severe abdomen pain in ovarian cystectomy was smaller than that in adnexectomy group. Nodbodyrelapsed and the operation has no effect on children menstruation after follow-up . ConclusionActively operational treatment is very important to save ovary and oviduct in children . Laparosopymay be safely used in children with abdominal pain and adnexal masses.