48例卵巢肿瘤蒂扭转的手术治疗分析

发布时间：2018-02-28 22:26

本文关键词： 卵巢囊肿附件扭转保守性手术雌孕激素　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景：卵巢肿瘤蒂扭转是妇产科最常见的急腹症之一,其发病率约占卵巢肿瘤的10%[1],临床表现主要以急性下腹部疼痛、腹部包块及腹膜炎征象为主。尽早的诊断和治疗可以预防很多相关的并发症。如果没有及时的诊断和处理,出现扭转附件坏死,则需要切除该侧的输卵管及卵巢,将影响女性的内分泌功能,尤其是年轻女性,会影响其生育功能。患者若没有得到及时诊断和治疗,严重者可因卵巢静脉血栓的形成而导致肺栓塞,甚至死亡。目前的处理原则是诊断明确后尽快手术治疗,传统的手术方法是为避免血栓性疾病而行附件切除术,但卵巢肿瘤蒂扭转患者多为育龄期妇女,切除一侧附件后将对其生殖内分泌功能造成影响,使其生活质量下降。近年来,如何对育龄期卵巢良性肿瘤扭转患者施行保守性手术从而保留其患侧附件越来越受到人们的重视。现收集整理阳谷县人民医院妇产科收治的卵巢囊肿蒂扭转的临床资料,并进行评价。研究目的：探讨不同卵巢囊肿蒂扭转手术方式治疗的安全性及有效性。研究方法：回顾性总结了2009年1月至2013年6月在确诊为卵巢囊肿蒂扭转患者48例。根据其手术方式的不同分为两组,保留附件的卵巢囊肿蒂扭转复位+卵巢囊肿剥除术组(A组,26例)和附件切除术组(B组,22例)。从两组患者发病时间、卵巢囊肿扭转周数、手术时间、术中平均出血量、术后住院时间、激素水平等方面进行评价,以期寻求更合理的治疗方式。结果：卵巢囊肿蒂扭转复位+卵巢囊肿剥除术组和附件切除术组的发病时间分别为10.2±5.2小时及15.9±5.6小时,两组比较差异有统计学意义(P0.05)。卵巢囊肿蒂扭转复位+卵巢囊肿剥除术组和附件切除术组的扭转周数分别为1.7±0.5周及2.1±0.5周,两组比较差异有统计学意义(P0.05)。卵巢囊肿蒂扭转复位+卵巢囊肿剥除术组和附件切除术组的出血量分别为30.5±5.0m1及29.83±6.85m1,两组比较差异无统计学意义(P0.05)。卵巢囊肿蒂扭转复位+卵巢囊肿剥除术组和附件切除术组的手术时间分别为91.3±21.4分钟及85.4±19.7分钟,两组比较差异有统计学意义(P0.05)。卵巢囊肿蒂扭转复位+卵巢囊肿剥除术组和附件切除术组的住院天数分别为6.7±0.9天及6.9±0.8天,两组比较差异无统计学意义(P0.05)。卵巢囊肿蒂扭转复位+卵巢囊肿剥除术组和附件切除术组术后2个月两组患者内分泌激素的比较中,两组比较差异有统计学意义(P0.05),卵巢囊肿蒂扭转复位+卵巢囊肿剥除术组激素水平恢复情况优于附件切除术组。病理结果：根据术中冰冻及术后常规病理证实,48例均为卵巢良性肿瘤。结论：①早期诊断并进行及时治疗可有效的减少附件切除的机率,卵巢肿瘤蒂扭转一经确诊应积极手术探查。②术中附件的去留取决于肿瘤性质及扭转的时间及程度。③卵巢肿瘤蒂扭转时间短,扭转周数少的患者行卵巢囊肿剥除术是安全可行的。④卵巢肿瘤蒂扭转保留卵巢的手术有助于保留卵巢的内分泌功能。
[Abstract]:Background: torsion of ovarian tumor is one of the most common gynecological acute abdomen, the incidence of ovarian cancer 10%[1], the main clinical manifestations of acute lower abdominal pain, abdominal mass and peritonitis. Signs of early diagnosis and treatment can prevent many complications. If not timely diagnosis and treatment, there you need to reverse the attachment necrosis, fallopian tube and ovary resection of the side, will affect the endocrine function of women, especially young women, will affect their reproductive function. If the patient did not receive timely diagnosis and treatment, severe cases can lead to pulmonary embolism, but due to the formation of ovarian vein thrombosis or death. The treatment principle is after diagnosis surgical treatment as soon as possible, the traditional surgical method is to prevent thrombotic diseases and adnexectomy, but the torsion of ovarian tumor patients for women of childbearing age, with a The side attachment on the reproductive endocrine function affect the quality of life decreased. In recent years, how to age of benign ovarian tumor torsion underwent conservative surgery to preserve the ipsilateral accessory has attracted more and more attention. We collected in Yanggu County People's Hospital of Obstetrics and Gynecology Hospital of ovarian cyst torsion, and evaluate it.
Objective: To explore the safety and effectiveness of different ovarian cysts pedicled in the treatment of torsional operation.
Research methods: a retrospective analysis from January 2009 to June 2013 in the diagnosis of ovarian cyst torsion in 48 cases. According to the different operation mode into two groups, retain the attachment of ovarian cyst torsion reduction and ovarian cystectomy group (A group, 26 cases) and oophorectomy group (B group, 22 cases). Two groups of patients from the time of onset, ovarian cyst torsion weeks, operation time, average bleeding volume, postoperative hospitalization time, evaluate the hormone level and so on, in order to seek more reasonable treatment.
Results: ovarian cyst torsion reduction and the onset time of enucleation of ovarian cyst surgery group and oophorectomy group were 10.2 + 5.2 and 15.9 + hours of 5.6 hours, there was significant difference between two groups (P0.05). Ovarian cyst torsion reduction and ovarian cystectomy group and appendix resection group torsion weeks were 1.7 + 2.1 + 0.5 weeks and 0.5 weeks, there was significant difference between two groups (P0.05). Ovarian cyst torsion reduction and ovarian cystectomy group and oophorectomy group bleeding were 30.5 + 5.0m1 and 29.83 + 6.85m1, two groups had no statistically significant difference (P0.05). Ovarian cyst torsion reduction and enucleation of ovarian cyst laparoscopic operation group and oophorectomy group were 91.3 + 21.4 and 85.4 + minutes 19.7 minutes, there was significant difference between two groups (P0.05). Ovarian cyst torsion reduction and ovarian cystectomy group and Oophorectomy group hospitalization days were 6.7 + 0.9 and 6.9 + 0.8 days, the two groups had no statistically significant difference (P0.05). Ovarian cyst torsion reduction and enucleation of ovarian cyst 2 months of two groups of patients with endocrine surgery group and adnexectomy group after operation in group two than compared with the difference was statistically significant (P0.05), ovarian cyst torsion reduction and ovarian cyst removal surgery group hormone level recovery was better than the oophorectomy group. The pathological results confirmed that: according to the frozen and routine postoperative pathology, 48 cases were benign ovarian tumors.
Conclusion: early diagnosis and timely treatment can effectively reduce the probability of oophorectomy, reverse confirmed positive surgical pedicle of ovarian tumor during operation. The attachment or depends on the tumor nature and torsion. The time and degree of torsion of ovarian tumor torsion cycle time is short, less number of patients with ovarian cystectomy is safe and feasible. The torsion of ovarian tumors retained ovarian surgery helps preserve ovarian endocrine function.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.31

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