Retroauricular Transhairline Approach Robotic Surgery for Congenital Immature Teratoma-A 3-month-old Infant Case Report

耳後經髮際線切口機械手臂輔助先天性頸部未成熟畸胎瘤切除手術－3個月大嬰兒之病例報告

林韓杰(Han-Jie Lin) ； 蔡青劭(Stella Chin-Shaw Tsai)

《台灣耳鼻喉頭頸外科雜誌》 57卷2期 (2022/06) Pp. 129-135

https://doi.org/10.6286/jtohns.202206_57(2).129

摘要

Teratomas refer to germ cell tumors arising from all 3 germ cell layers: endoderm, mesoderm, and ectoderm with various degrees of differentiation respectively. Congenital teratomas are rare inborn diseases that commonly present early in infancy and rarely beyond 2 years of age. Clinical presenting sites were frequently seen in sacrococcyx, mediastinum, or retroperitoneum in the majority, whereas head and neck teratomas account for only 3% of all teratomas. We describe the first case report of a 3-month-old female infant with the presentation of left cervical mass since birth with a postoperative final diagnosis of immature teratoma WHO grade II after a robot-assisted resection via a retroauricular transhairline incision. Postoperative care was uneventful and there were no noticeable adverse events, such as prolonged intubation, nasogastric feeding, signs of neural damage or significant respiratory complications. A surgical scar was concealed behind the hairline and the patient's family was grateful for the cosmetic results. Follow-up magnetic resonance imaging (MRI) image 1 year later showed no evidence or residual disease of recurrence. We herein consider a retroauricular transhairline approach robotic surgery feasible and practicable for pediatric cervical teratomas, but further studies are needed for verifying this notion.

關鍵字

congenital ； cervical immature teratoma ； retroauricular transhairline incision ； robotic surgery

並列摘要

畸胎瘤為生殖細胞腫瘤，由三種生殖細胞層構成：外胚層、中胚層、內胚層，並且各自分化程度相異。先天性畸胎瘤為罕見先天性疾病，常早發於1歲之前孩童，少見於2歲之後。臨床上大多發現於骶尾骨、縱膈腔、後腹腔，而頭頸部畸胎瘤只占3%。本院報告一首發病例之3個月大新生嬰兒，於左頸部發現先天性腫塊，接受耳後經髮際線切口機器人輔助切除手術後，診斷為WHO第二級未成熟畸胎瘤之案例。術後照護順利，無顯著不良事件如延長插管、鼻胃管灌食、神經損傷、或呼吸道併發症。術後疤痕藏匿於耳後與髮際線之後，並且家屬滿意外觀之預後。1年後MRI追蹤顯示無殘存腫瘤或復發。因此，吾人認為經髮際線切口機器人輔助於小兒頸部畸胎瘤切除為可施行手術，然而仍需要更多研究加以佐證。

並列關鍵字

congenital ； cervical immature teratoma ； retroauricular transhairline incision ； robotic surgery（先天性 ； 頸部未成熟畸胎瘤 ； 耳後經髮際線切口 ； 機械手臂手術）