Hayrünisa ESEN KAHRAMAN, Mustafa Alper AKAY

Çocuklarda Overyan Kitle Patolojileri ve Tedavi Yaklaşımımız; 42 Olguluk Seri

GİRİŞ ve AMAÇ: Çocukluk çağında over kitleleri, fonksiyonel over kistlerinden kötü huylu tümörlere kadar çeşitlilik gösterirler. Çalışmamızda overyan kitle nedeni ile kliniğimizde takip ve tedavi edilen olguları retrospektif olarak klinik bulgular, teşhis yöntemleri, cerrahi tedavi yöntemleri, patolojik tanıları ve tedavi sonuçları açısından değerlendirmeyi amaçladık. YÖNTEM ve GEREÇLER: Çalışmamıza 2014-2018 yılları arasında Kocaeli Üniversitesi Tıp Fakültesi Çocuk Cerrahisi Kliniğinde over kitlesi nedeniyle takip ve tedavisi yapılan 42 hasta çalışmaya dahil edildi. Hastaların klinik bilgileri ve bilgisayar kayıtları retrospektif olarak incelendi. İncelenmede hastaların demografik verileri, başvuru yakınmaları, kitlenin lokalizasyonu, laboratuvar hormon düzeyleri ve ameliyat bulguları, histopatolojik tanıları, tedavi yöntemleri ve tedavi sonuçları değerlendirildi. BULGULAR: Çalışmaya toplam 42 kız hasta alındı. Hastaların yaş ortalaması 13,3y ( 8y-17y) dı. Karın ağrısı ve karında şişlik en sık görülen başvuru yakınması idi. Cerrahi müdahale 11 hastada laparoskopi, 31’inde ise laparatomi ile yapıldı. 25 hastada tek taraflı ooferektomi veya salpingoooferektomi yapıldı, 16 hastada ise over korunup sadece kist eksizyonu yapıldı. Olguların 13’ü over kisti, 15’i matür kistik teratom, 2’si mikst malign tümör, 1’i paraoverian kist, 1’i seröz papiller kist adenom, 4 hastada ise kitle olmaksızın sadece over torsiyonu idi. TARTIŞMA ve SONUÇ: Over kaynaklı kitlelerde en sık görülen klinik bulgu karın ağrısı ve karında ele gelen hareketli kitledir. Çocuklarda over kitleleri sık görüldüğünden karın ağrısı şikâyetiyle başvuran kız çocuklarında ayırıcı tanıda göz önünde bulundurulmalıdır. Radyolojik tanı yöntemlerinin yaygın kullanılmasıyla erken tanı konularak olası over torsiyon riskini azaltmak ve maling tümörlü hastalarda prognozu iyileştirmek mümkündür. Ameliyat öncesi yapılacak ileri görüntüleme yöntemleriyle over kitlelerinde yapılacak cerrahi belirlenmeli ve mümkün olduğunca over koruyucu cerrahi tercih edilmelidir

Ovarian Mass Pathologies in Children and Our Treatment Approach; Series of 42 cases

INTRODUCTION: Ovarian masses in childhood range from functional ovarian cysts to malignant tumors. In our study, we aimed to evaluate the patients who were followed up and treated in our clinic due to the ovarian mass in terms of clinical findings, diagnostic methods, surgical treatment methods, pathological diagnoses and treatment results. METHODS: 42 patients who were followed-up and treated for ovarian mass in Kocaeli University Medical Faculty Pediatric Surgery Clinic between 2014-2018 were included in the study. Clinical information and computer records of the patients were analyzed retrospectively. In the examination, demographic data of the patients, complaints of application, localization of the mass, laboratory hormone levels and surgical findings, histopathological diagnosis, treatment methods and treatment results were evaluated. RESULTS: A total of 42 female patients were included in the study. The mean age of the patients was 13.3y (8y-17y). Abdominal pain and abdominal swelling were the most common complaint. Surgical intervention was performed in 11 patients by laparoscopy and 31 by laparotomy. In 25 patients unilateral oophorectomy or salpingooopherectomy was performed, in 16 patients ovaries were preserved and only cyst excision was performed. Thirteen of the cases were ovarian cyst, 15 were mature cystic teratoma, 2 were mixed malignant tumor, 1 was paraoverian cyst, 1 was serous papillary cyst adenoma, and 4 patients were ovarian torsion without mass. DISCUSSION AND CONCLUSION: The most common clinical finding in ovarian masses is abdominal pain and mobile mass in the abdomen. Since ovarian masses are common in children, it should be taken into consideration in the differential diagnosis of girls presenting with abdominal pain. It is possible to reduce the risk of possible ovarian torsion and improve prognosis in patients with maling tumors by making early diagnosis with the widespread use of radiological diagnostic methods. Surgery to be performed in ovarian masses should be determined with advanced imaging methods before surgery and ovarian sparing surgery should be preferred as much as possible.

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