Diagnosis and surgical treatment of ovarian cysts and tumors in children and adolescents: Summary of Ph.D. thesis in medical sciences: 321.15 - Obstetrics and gynecology

Abstract

Recent studies show that ovarian cysts are a fairly common pathology in patients of different age groups. In children and adolescents, ovarian tumors are recorded in 2.6 cases per 100,000 [5]. In the vast majority of cases, ovarian tumors in children and adolescents are benign, the incidence rate of malignant neoplasms being about 10% [1, 22]. Description of the research situation and definition of research issues Currently, imaging studies (ultrasound, CT, MRI) are considered the methods of choice in the diagnosis and assessment of ovarian cystic and tumor formations, as well as in the risk stratification strategy of malignant neoplasms [13]. One of the priority areas should be considered the researches on the development of unique radiological schemes for describing and stratifying the ovarian masses [14, 15], the information content of which in children decreases due to their age-related characteristics. Assessment of the level of tumor markers (AFP, b-hCG, CA-125, CEA and CA19.9) in ovarian tumors among children is widely used to differentiate benign and malignant ovarian tumors. The acquired collective experience has confirmed the nonspecificity of the tumor marker values in the stratification of OT in children and adolescents, while their role remains quite controversial [22]. Adnexal torsion (AT) is considered among the most serious complications of ovarian cysts and tumors associated with the preservation of fertile function [3]. Currently, there are priority areas in the diagnosis of AT to be outlined, such as determining the clinical predictors of ATs [7], developing a scoring system [7, 16], assessing the specific ischemic and inflammatory serological markers for AT, as well as evaluating the role of the radiological methods (US imaging velocimetry Doppler, CT and MRI) in diagnosing AT [8]. In this regard, the prospects and actuality of the present research in the field of accuracy of various methods for the early diagnosis of AT are well defined. The fundamental method of AT treatment involves the ovarian surgery (detorsion + cystectomy), regardless of the degree of ischemia [6, 10]. At the same time, there are ongoing studies related to the technical aspects of detorsion and the prevention of ischemia/reperfusion syndrome. Of particular interest are the unique publications concerning the structural and functional state of the ovaries after detorsion [11]. Despite the foregoing, the frequency of the unreasonable ovariectomies in torsion of the appendages accounts for 40%, according to the specialized literature [13]. Surgery is the treatment of choice for OT and symptomatic cystic masses refractory to hormone therapy in children. More and more experience are being gained in the application of laparoscopic technologies to this patient group [1, 2]. The main limitation in performing laparoscopic ovarian surgery in some cases is the large mass size, which significantly reduces the surgical space in the abdominal cavity. In this regard, alternative methods are being developed, like laparoscopically-assisted extracorporeal resections. However, only unique cases of using this method in children have been published in foreign literature so far [23]. Therefore, the diagnosis and surgical treatment of cystic and tumor formations in children and adolescents is an urgent issue of modern surgical gynecology. The scientific, practical and social significance of the present problem is determined by the development of a medical diagnostic complex aimed at increasing the number of organ-preserving surgeries and maintaining the fertile function. [...]