妊娠合并卵巢肿瘤蒂扭转31例临床分析

发布时间：2018-04-14 04:31

本文选题：妊娠 + 卵巢肿瘤　；参考：《大连医科大学》2014年硕士论文

【摘要】：妊娠合并卵巢肿瘤是常见的妊娠期合并症，卵巢肿瘤一旦在妊娠期间发生蒂扭转可直接威胁母婴安全，具有起病急，进展快、临床表现复杂多样、易导致误诊、漏诊的特点，危险性、严重性均较非妊娠期大，治疗时要兼顾母婴两个因素，因此，总结妊娠合并卵巢肿瘤蒂扭转的临床表现、诊断方式、处理方法显得尤为重要。本文收集2006年1月-2013年2月中国人民解放军第202医院收治的妊娠合并卵巢肿瘤蒂扭转病人共31例，对其临床资料进行分析。并结合相关文献，从而探讨妊娠合并卵巢肿瘤蒂扭转的临床特征、诊断方式、处理方法及其对妊娠结局的影响，同时探讨采用先高位结扎卵巢动、静脉后复位扭转的附件并将卵巢肿物核除术式的疗效，以及腹腔镜手术对孕期卵巢肿瘤蒂扭转治疗的安全性。目的：探讨妊娠合并卵巢肿瘤蒂扭转的临床特征、诊断方式、处理方法及其对妊娠结局的影响，提高妊娠期卵巢肿瘤蒂扭转的诊断与治疗水平。方法：收集2006年1月-2013年2月中国人民解放军第202医院收治的31例妊娠合并卵巢肿瘤蒂扭转患者的临床资料，结合相关文献进行回顾性分析。结果：保守治疗2例，手术治疗明确妊娠合并卵巢肿瘤蒂扭转29例，其中1例术前误诊为阑尾炎。手术治疗中开腹手术19例（9例采取高位结扎卵巢动、静脉，保留患侧卵巢术式，10例采取常规切除患侧附件术式），腹腔镜手术10例（5例采取高位结扎卵巢动、静脉的新术式，5例采取常规切除患侧附件术式）。所有病例发生于孕早期（14w）4例，占12.9％；孕中期（14w~28w）25例，占80.6％；孕晚期（28w）2例，占6.5％。29例手术患者中良性肿瘤29例，无恶性肿瘤，术中见卵巢肿瘤大小在4~14cm之间，平均7.31±2.66cm。最常见的病理类型为畸胎瘤14例（48.3％），其次为浆液性囊腺瘤6例（20.7％），黄体或黄素化囊肿4例（13.8％），粘液性囊腺瘤3例（10.3％），子宫内膜异位囊肿2例（6.9％）。29例手术患者中足月分娩24例，早产3例，流产2例。保守治疗的2例患者足月分娩1例，，流产1例。结论：妊娠合并卵巢肿瘤蒂扭转因其特殊的生理、解剖变化，容易出现误诊，需要与多科室紧密参与诊断治疗。病理类型最常见的为成熟型囊性畸胎瘤，其次为浆液性囊腺瘤、黄体或黄素化囊肿、粘液性囊腺瘤、子宫内膜异位囊肿。妊娠合并卵巢肿瘤蒂扭转易发生于孕中期，一旦发生应立即手术治疗，合理的术式选择不增加早产及流产发生率。术中探查对于无明显感染的良性卵巢肿瘤蒂扭转患者，可采用高位结扎卵巢动、静脉后将扭转的卵巢复位，再核除肿瘤的术式，既解决了卵巢病变，又保留了卵巢组织及功能。腹腔镜手术可应用于妊娠中期治疗卵巢肿瘤蒂扭转。
[Abstract]:Pregnancy with ovarian tumor is a common complication of pregnancy. Once ovarian tumor occurs during pregnancy, it can directly threaten the safety of mother and child. It has the characteristics of acute onset, rapid progress, complicated clinical manifestations, easy misdiagnosis and missed diagnosis.The risk and severity are greater than that of non-pregnancy, so it is very important to summarize the clinical manifestation, diagnosis and treatment of pregnancy complicated with ovarian tumor pedicle torsion.31 cases of pregnancy complicated with ovarian tumor pedicle torsion were collected from January 2006 to February 2013 in the 202 Hospital of the Chinese people's Liberation Army and their clinical data were analyzed.In addition, the clinical features, diagnostic methods, management methods and their effects on pregnancy outcome of ovarian tumor pedicle torsion were discussed. At the same time, high ligation of ovary was used as the first ligation of ovary.The efficacy of retrovenous reduction of torsional appendages and removal of ovarian tumor nucleus, and the safety of laparoscopic surgery in the treatment of ovarian tumor pedicle torsion during pregnancy.Objective: to investigate the clinical features, diagnostic methods, management methods and their effects on pregnancy outcome of ovarian tumor pedicle torsion in pregnancy, and to improve the diagnosis and treatment level of ovarian tumor pedicle torsion during pregnancy.Methods: from January 2006 to February 2013, 31 cases of pregnancy complicated with ovarian tumor pedicle torsion were collected and analyzed retrospectively.Results: there were 2 cases of conservative treatment and 29 cases of pregnancy complicated with ovarian tumor pedicle torsion. One case was misdiagnosed as appendicitis before operation.Of the 19 patients undergoing laparotomy, 9 were treated with high ligation of the ovarian artery and vein, 10 with conventional excision of the affected side of the ovary and 5 with high ligation of the ovary.The new operation of vein was performed in 5 cases by routine excision of the accessory of the affected side.All the cases occurred in the first trimester of pregnancy in 4 cases (12.9%), in the second trimester of pregnancy, 25 cases (80.6%) in the second trimester of pregnancy, and in the third trimester of 28 weeks (29 cases), there were 29 cases of benign tumor, no malignant tumor, and the size of ovarian tumor was between 7.31 卤2.66 cm during operation, and the mean size of ovarian tumor was 7.31 卤2.66 cm during the second trimester of pregnancy.The most common pathological types were teratoma (14 cases), serous cystadenoma (6 cases), serous cystadenoma (6 cases), luteal or luteinized cyst (4 cases), mucinous cystadenoma (3 cases), endometrial cystoma (2 cases), endometrial cystoma (2 cases, n = 29), full-term delivery (n = 24), preterm delivery (n = 3).There were 2 cases of abortion.Conservative treatment of 2 cases of full-term delivery in 1 case, abortion in 1 case.Conclusion: because of its special physiological and anatomical changes, pregnancy complicated with ovarian tumor pedicle torsion is prone to misdiagnosis, so it is necessary to take part in diagnosis and treatment closely with multiple departments.The most common pathological types were mature cystic teratoma, serous cystadenoma, luteal or luteinized cyst, mucinous cystadenoma and endometriosis cyst.The pedicle torsion of ovarian tumor is easy to occur in the second trimester of pregnancy. If it occurs, it should be treated immediately, and the reasonable operation should not increase the incidence of premature delivery and abortion.Intraoperative exploration of benign ovarian tumor pedicle torsion without obvious infection can be performed by high ligation of ovarian artery, reduction of torsional ovary after vein, and removal of tumor by nucleus, which not only resolves ovarian disease, but also preserves ovarian tissue and function.Laparoscopic surgery can be used in the treatment of ovarian tumor pedicle torsion in the second trimester of pregnancy.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.2;R737.31

【参考文献】