妊娠合并卵巢肿瘤206例临床病例分析

发布时间：2018-02-24 11:10

本文关键词： 妊娠卵巢肿瘤病理类型妊娠结局　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨妊娠合并卵巢肿瘤的诊断、病理类型、处理方法、妊娠母儿结局。方法对山东大学齐鲁医院妇产科在2011年1月-2016年9月收治的经手术及病理确诊的206例妊娠合并卵巢肿瘤病例进行回顾性分析,统计并分析妊娠合并卵巢肿瘤患者的基本资料、初诊方式及时间、手术时机及术式、病理类型、母胎结局。结果206例病例中,孕前发现者16例(16/206 7.77%),其中3例通过妇科检查发现,13例经超声检查发现;妊娠14周前发现者68例(68/206 33.01%),其中,经妇科检查发现者6例,经超声检查发现者62例;妊娠14～28周发现者18例(18/206 8.74%),经妇科检查发现者1例,超声检查发现者17例;妊娠28周后发现者34例(34/206 16.50%),均经超声发现;剖宫产手术中首次发现者70例(70/206 33.98%)。其中,非剖宫产术中首次发现的136例患者中,共58例(42.65%,58/136)患者于孕期接受非剖宫产目的手术治疗:妊娠14周前手术20例(14.71%,20/136),其中10例同时人工流产,另10例中,其中1例(1/10 10%)失访,其他9例(9/9 100%)均足月分娩;孕14～28周手术37例(63.79%,37/58),其中33例(33/35 94.29%)于足月后分娩;2例(2/35 5.71%)因患者强烈要求行中期妊娠引产;1例(1/35 2.86%)因肿瘤复发于妊娠30周行治疗性剖宫产;1例失访(1/37 5.41%)。孕28周后手术1例(1.72%,1/58),因双侧卵巢krukenberg瘤同时行治疗性子宫下段剖宫产术,早产儿存活。经手术证实发生并发症者共9例(9/206 4.37%),其中蒂扭转7例(7/206 3.40%)、肿瘤破裂2例(2/206 0.97%)。各种病理类型中,妊娠合并卵巢良性肿瘤共193例,占93.69%;妊娠合并卵巢恶性肿瘤共7例,占3.40%;妊娠合并卵巢交界性肿瘤共6例,占2.91%。良性肿瘤中,较常见的病理类型按所占比例从高到依次为:成熟性畸胎瘤(93/206 45.15%),子宫内膜异位囊肿(34/206 16.50%),粘液性囊腺瘤(35/206 16.99%),浆液性囊腺瘤(13/206 6.31%)。卵巢交界性肿瘤中,交界性浆液性囊腺瘤3例(3/206 1.46%),交界性粘液性囊腺瘤1例(1/206 0.49%),交界性子宫内膜样肿瘤1例(1/206 0.49%)。卵巢恶性肿瘤中,粘液性腺癌5例(5/206 2.43%),浆液性癌1例(1/206 0.49%),未成熟性畸胎瘤 1 例(1/206 0.49%),Krukenberg 瘤 1 例(1/206 0.49%)。结论孕早期的妇科检查及孕早中期的超声检查有助于诊断,剖宫产术中仔细探查双附件并送快速病理至关重要。孕周、卵巢肿瘤的性质、年龄、生育要求是影响临床决策的主要因素,良性肿瘤多数可通过期待治疗至妊娠终止,可于剖宫产手术时一并切除肿瘤。通常,于妊娠14-28周行手术较安全,对于有症状、怀疑发生并发症、高度怀疑恶性肿瘤的患者及时进行手术干预。
[Abstract]:Objective to investigate the diagnosis, pathological types and management of ovarian tumors in pregnancy. Methods from January 2011 to September 2016, 206 cases of pregnancy complicated with ovarian tumor were treated in Qilu Hospital of Shandong University from January 2011 to September 2016. Statistics and analysis of the basic data of pregnancy complicated with ovarian tumor, the way and time of first visit, the time and method of operation, the pathological type, the maternal and fetal outcome. 16 cases were found before pregnancy, among which 13 cases were found by ultrasonography in 3 cases by gynecological examination, 68 cases by 68 / 206 33.01% before 14 weeks of pregnancy, 6 cases by gynecological examination and 62 cases by ultrasound examination. 18 cases were found at 14 / 28 weeks of pregnancy, 1 case was found by gynecological examination, 17 cases were found by ultrasound, 34 cases (34 / 206 16.50%) were found after 28 weeks of pregnancy, all were detected by ultrasound; 70 cases (70 / 206 33.98) were first found in cesarean section. Of the 136 patients who were first found in non-cesarean section, 58 patients received non-cesarean operation during pregnancy: 20 patients underwent surgery 14 weeks before gestation, 10 of them had simultaneous induced abortion, and one of the other 10 patients lost one of the 1 / 10 percent of the total. The other 9 cases (9 / 9 100) were born on term; Of the 37 patients who underwent surgery at 143.79 weeks, 33 were 33 / 35 94.29) after term, 2 / 2 / 35 / 35 / 5.71) because of the patient's urge to have induced labor in the second trimester of pregnancy, 1 case (1 / 35 2.86) underwent a therapeutic cesarean section at 30 weeks of pregnancy due to recurrence of the tumor. In one case, 1.72% of the uterus was treated with caesarean section due to bilateral ovarian krukenberg tumor, and all of them were treated with caesarean section of the lower uterine segment at the same time. There were 9 cases of complications confirmed by surgery, including 7 cases of pedicle torsion (7 / 206 3.40%), 2 cases of tumor rupture (2 / 206 0.97%), 193 cases of pregnancy complicated with ovarian benign tumor (93.69 990%) and 7 cases of pregnancy complicated with ovarian malignant tumor (7 cases). There were 6 cases of pregnancy complicated with borderline ovarian tumor, accounting for 2.91%. The more common pathological types were: mature teratoma 93 / 206 45.15J, endometrial cysts 34 / 206 16.50m, mucinous cystadenoma 35 / 206 16.99m, serous cystadenoma 13 / 206 6.31. In ovarian borderline tumors, 3 cases of borderline serous cystadenoma, 1 case of borderline mucinous cystadenoma, 1 case of borderline mucinous cystadenoma, 1 case of borderline endometrioid tumor, 1 case of borderline endometrioid tumor, 1 case of ovarian malignant tumor, 3 cases of borderline serous cystadenoma, 1 case of borderline mucinous cystadenoma, There were 5 cases of mucous adenocarcinomas, 1 case of serous carcinoma, 1 case of serous carcinoma, 1 case of immature teratoma, 1 case of immature teratoma, 1 case of Krukenberg tumor, 1 case of Krukenberg tumor, 1 case of Krukenberg tumor. Conclusion the gynecological examination in early pregnancy and ultrasound examination in middle and early pregnancy are helpful for diagnosis. Careful exploration of double appendages and rapid pathology during caesarean section is of great importance. The nature, age, and fertility requirements of ovarian tumors are the main factors influencing clinical decision-making during cesarean section. Most benign tumors can be treated until pregnancy terminates. Usually, it is safe to perform surgery at 14-28 weeks of gestation. For patients with symptoms, suspected complications, and highly suspected malignant tumors, surgical intervention is timely.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31;R714.2

【相似文献】