Güneş KARAKURT, Erdal KARAKAYA, Oğuz ATEŞ, Gülce HAKGÜDER, Mustafa OLGUNER, Feza M. AKGÜR

Prenatal tanılı over kistlerinin prenatal ve postnatal tedavisi

Amaç: Prenatal ultrasonografi izlemlerinin yaygınlaşması ile intrauterin dönemde saptanan over kisti sayısı giderek artmaktadır. Prenatal saptanan over kistlerinin prenatal ve postnatal tedavisi ile ilgili deneyimlerimizi sunmak istiyoruz. Gereç ve Yöntem: 2002-2009 yılları arasında prenatal US’de over kisti saptanan 12 hastanın kayıtları geriye dönük olarak incelendi. Kistlerin komplike olup olmadığı, prenatal ve postnatal boyutları, postnatal semptomları ve US izlemleri değerlendirildi. Bulgular: Serimizde 2 hastada basit over kisti, 9 hastada komplike over kisti ve 1 hastada bir tarafta basit over kisti, kontralateral tarafta komplike over kisti saptandı. Basit over kistlerin ortalama boyutu 3,3 ± 2,5 cm (1,0 - 6,0 cm) ve komplike over kistlerinin ortalama boyutu 4,5 ± 0,8 cm (3,2 - 5,5 cm) olarak ölçüldü. Basit over kistlerinden prenatal dönemde çapı 1 ve 3 cm ölçülen iki hastanın kisti doğum sonrası sırası ile 4 ve 6 hafta takip sonrası regrese oldular. Prenatal basit over kist çapı 6 cm olarak saptanan hastanın kisti postnatal US’de 8 cm olarak ölçülmesi üzerine laparoskopik kistotomi yapıldı. Prenatal 10 komplike over kistlerinin 6 tanesi postnatal izlem sırasında regrese oldu, 3 tanesi postnatal dönemde küçülmediği için laparoskopik kistotomi yapıldı, 1 tanesinde postnatal 8. haftada intestinal obstruksiyon geliştiği için laparotomi ile adezyolizis ve kistotomi yapıldı. Regrese olan komplike over kistli bir olgu postnatal 9. ayda intestinal obstrüksiyon ile başvurdu. Sonuç: Prenatal tanılı komplike over kistlerinde malignite kuşkusu yoksa ve asemptomatik seyrediyorsa yakından izlenmelidir. Komplike over kistlerinin regrese olmadığı ve intestinal obstrüksiyona neden olduğu durumlarda cerrahi girişim yapılmalıdır.

Prenatal and postnatal treatment of prenatally diagnosed ovarian cysts

Objective: Widespread use of prenatal ultrasonography leads to an increase prenatally detected ovarian cysts. We herein present our experience with prenatal and postnatal treatment of prenatally diagnosed ovarian cysts. Material and Method: Between 2002 - 2009 years, the records of 12 patients with to have ovarian cysts were reviewed retrospectively. US appearance of cyst (simple versus complicated cyst), prenatal and postnatal dimensions, postnatal symptoms and US follow up were recorded. Results: While two patients had simple cyst, 9 patients had complicated cyst and one patient had a simple cyst with a contralateral complicated cyst. Two patients with simple cysts, whom prenatal US measurements were 1 cm and 3 cm respectively, regressed during postnatal 4th and 6th weeks, follow up. One of the simple cysts that was prenatally measured as 6 cm was found to be 8 cm postnatally and it required laparoscopic cystotomy. All of 10 complicated cysts were followed up nonoperatively. Among them, seven cysts regressed during postnatal follow up however 3 cysts persisted that required laparoscopic cystotomy and 1 cyst led to intestinal obstruction at 8th postnatal week that required adheziolysis and cystotomy. One patient with a regressed complicated ovarian cyst presented with an intestinal obstruction at 9 months of age. Conclusion: Fetal complicated ovarian cysts which have no postnatal symptoms should be initially treated nonoperatively. Complicated ovarian cyst not regressing after postnatal 3 months and those causing intestinal obstruction should be treated operatively.

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