Surgical Management of Benign Adnexal Masses in the Pediatric/Adolescent Population: An 11-Year Review

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• 作者：Lauren M. Bergeron ; MD¹ ; ^{BergeronL@wudosis.wustl.edu} ; Katherine C. Bishop ; MD¹ ; Holly R. Hoefgen ; MD¹ ; Margaret S. Abraham ; MD¹ ; Nhial T. Tutlam ; MPH¹ ; Diane F. Merritt ; MD¹ ; Jeffrey F. Peipert ; MD ; PhD²
• 关键词：Pediatric ; Adolescent ; Adnexal mass ; Adnexal torsion ; Ovarian conservation ; Laparoscopy
• 刊名：Journal of Pediatric and Adolescent Gynecology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：30
• 期：1
• 页码：123-127
• 全文大小：205 K
• 卷排序：30

文摘

The purpose of this study was to compare ovarian conservation rates and surgical approach in benign adnexal surgeries performed by surgeons vs gynecologists at a tertiary care institution.DesignA retrospective cohort review.SettingChildren's and adult tertiary care university-based hospital.ParticipantsPatients 21 years of age and younger who underwent surgery for an adnexal mass from January 2003 through December 2013.InterventionsPatient age, demographic characteristics, menarchal status, clinical symptoms, radiologic imaging, timing of surgery, surgeon specialty, mode of surgery, rate of ovarian conservation, and pathology were recorded. Patients were excluded if they had a uterine anomaly or pathology-proven malignancy.Main Outcome MeasuresThe primary outcome was the rate of ovarian conservation relative to surgical specialty; secondary outcome was surgical approach relative to surgical specialty.ResultsOf 310 potential cases, 194 met inclusion criteria. Gynecologists were more likely than surgeons to conserve the ovary (80% vs 63%; odds ratio, 2.28; 95% confidence interval, 1.16-4.48). After adjusting for age, body mass index, mass size, and urgency of surgery, the difference was attenuated (adjusted odds ratio, 1.84; 95% confidence interval, 0.88-3.84). Surgeons and gynecologists performed minimally invasive surgery at similar rates (62% vs 50%; P = .11). A patient was more likely to receive surgery by a gynecologist if she was older (P < .001) and postmenarchal (P = .005).ConclusionResults of our study suggest that gynecologists are more likely to perform ovarian-conserving surgery. However, our sample size precluded precise estimates in our multivariable model. Educational efforts among all pediatric and gynecologic surgeons should emphasize ovarian conservation and fertility preservation whenever possible.