In January 2012, we successfully performed a laparoscopic surgery for a 16-year-old girl with a large ovarian cyst debulking. Before January, the patient’s ultrasound examination suggested a cystic mass of 200×180×170mm3 with good internal translucency in the pelvis. Twelve tumor marker results were in the normal range. Anal examination: the pelvic mass was the size of a 7-month pregnant uterus, soft and without pressure pain; the body of the uterus was not palpable due to the huge mass. Previously, she had visited several hospitals, all of which recommended a caesarean section. On the recommendation of the patient, the patient and her family came to the First Affiliated Hospital of Zheng University for consultation. Based on the history, physical signs and ultrasound examination, it was estimated that the mass might have originated from the ovary, and because of the concern that the huge cyst might affect the child’s studies and the possibility of malignancy could not be completely ruled out, it was decided to operate on her as soon as possible. However, considering that the patient was only 16 years old and a sophomore in high school, the surgical method was a problem. If open surgery was performed, the tumor would have to be taken out and the incision might be large, and the size of the abdominal incision would directly affect the patient’s postoperative recovery. If laparoscopic surgery is performed, the trauma is small, the recovery is fast, and the incision in the abdominal wall is beautiful, but the patient’s cyst is huge and the surgery is difficult, and at the same time, it is necessary to ensure that the cyst fluid cannot leak into the abdominal cavity to prevent recurrence problems. After a long time of reflection, we decided to perform open laparoscopic surgery in order to achieve the best treatment effect with the least trauma and to enable the patient to return to school as soon as possible, after repeated communication with the family. On the fourth day after admission, the patient was successfully operated under general anesthesia with oral insertion. During the operation, about 5000 ml of cystic fluid was slowly aspirated, the cyst was investigated to be from the left ovary, and the cyst was completely removed. After careful postoperative care, she recovered well and was discharged safely five days after surgery. Zhao Qian, Department of Obstetrics and Gynecology, First Affiliated Hospital of Zhengzhou University
Ovarian cyst is a kind of ovarian tumor in the broad sense. It can be found in all ages, but is most common in the age of 20-50. Ovarian tumors, whether benign or malignant, have no special symptoms in the early stage, and once symptoms such as abdominal pain, lower abdominal mass, ascites, etc. appear, most of them are benign tumors with complications or malignant tumors in advanced stage. Generally, the clinical diagnosis of ovarian tumor can be made based on the patient’s age, medical history, local signs and gynecological examination, and the estimation of benign or malignant. If the diagnosis is difficult, further auxiliary examinations can be performed, such as ultrasound with a clinical diagnosis rate of >90%, pathological diagnosis is the main basis to confirm the diagnosis of ovarian tumor, and tumor marker examination has a suggestive effect on the diagnosis. Recent studies have found that the prevalence of ovarian cysts in adolescent females under 20 years of age is increasing, but ovarian cysts as large as this patient are rare. For the treatment of ovarian cysts, ovarian cysts larger than 4 months of gestation were previously classified as contraindications to laparoscopic surgery. In this case, according to the traditional treatment, the patient was mostly treated with open surgery. However, we made bold reforms and innovations from the patient’s perspective, and successfully performed laparoscopic giant ovarian cyst debulking for the patient, achieving good treatment results. For adolescent females, it is important not to neglect regular physical examinations, and once a pelvic or abdominal mass is found, early consultation should be made to avoid delaying the condition.