卵巢粘液性囊腺瘤行腹腔镜及剖腹手术两种方式的治疗分析

发布时间：2018-05-04 21:56

本文选题：卵巢粘液性囊腺瘤 + 腹腔镜手术　；参考：《山东大学》2014年硕士论文

【摘要】：目的：对于非巨大卵巢良性肿瘤行腹腔镜治疗已成为卵巢肿瘤手术的首选术式,但术中肿瘤易破裂,内容物溢出后导致化学性腹膜炎及腹腔肉芽肿形成,尤其是卵巢粘液性囊腺瘤,囊瘤穿破后粘液溢出会在腹腔内播散种植形成腹膜假粘液瘤,从而限制了腹腔镜手术在治疗卵巢粘液性囊腺瘤中的应用。本研究对比采用不同手术途径对卵巢粘液性囊腺瘤的患者行囊瘤切除术治疗的效果及预后进行分析对比,以期比较腹腔镜手术与经典剖腹手术在治疗卵巢粘液性囊腺瘤时是否存在优势或不足。方法：回顾性分析临沂市人民医院妇产科2007年7月至2013年7月间收治住院的122例卵巢粘液性囊腺瘤患者手术治疗病例及手术治疗后的随访情况,分析比较采用腹腔镜行卵巢粘液性囊腺瘤切除(腹腔镜组)35例及剖腹行卵巢粘液性囊腺瘤切除术(剖腹组)87例的术中出血量、手术时间、瘤体大小、术后并发症、术后复发率及癌变率等指标。结果：122例患者均顺利完成手术,无术中副损伤发生,腹腔镜组手术时间为51.4±9.1min,术中出血量为30.1±10.2ml,剖腹手术组手术时间为60.1±9.5min,术中出血量45.8±15.6ml,差异有显著性(P0.05)。35例腹腔镜手术均无中转开腹及术后大出血、脏器损伤、化学性腹膜炎及皮下气肿等并发症；87例剖腹手术中2例出现术后发热并发症,其中1例为剖宫产术中行囊瘤切除术者。114例患者随访发现没有癌变者,14例复发(4例为腹腔镜组,10例为剖腹组),癌变率为0,总复发率12.3%,复发平均年龄34(20-39)岁,术后至复发的平均时间为31.2(6-55)个月,腹腔镜手术组复发率为11.4%,剖腹手术组复发率12.6%,差异无显著性(P0.05)。结论：腹腔镜手术与传统剖腹手术切除卵巢粘液性囊腺瘤后的复发率无显著差异,腹腔镜组手术时间、术中出血量均低于剖腹手术组,并有显著差异,腹腔镜手术治疗卵巢粘液性囊腺瘤是安全有效地,值得临床临床推广应用。
[Abstract]:Objective: laparoscopic treatment of non-giant benign ovarian tumors has become the first choice of surgery for ovarian tumors, but the tumor is prone to rupture during the operation, and the contents overflow will lead to the formation of chemical peritonitis and peritoneal granuloma. Especially in ovarian mucinous cystadenoma, mucus overflow after rupture will spread and implant into peritoneal pseudomyxoma, which limits the application of laparoscopic surgery in the treatment of ovarian mucinous cystadenoma. In this study, the effect and prognosis of cystectomy in patients with ovarian mucinous cystadenoma were analyzed and compared. To compare the advantages and disadvantages of laparoscopic surgery and classical laparotomy in the treatment of ovarian mucinous cystadenoma. Methods: 122 cases of ovarian mucinous cystadenoma admitted from July 2007 to July 2013 in Linyi people's Hospital were retrospectively analyzed. To compare and compare the intraoperative bleeding volume, operative time, tumor size and postoperative complications of ovarian mucinous cystadenoma resection by laparoscopy in 35 cases of ovarian mucinous cystadenoma and laparotomy in 87 cases of ovarian mucinous cystadenoma. Postoperative recurrence rate and canceration rate. Results the operation was successfully completed in 122 patients, and no side injury occurred during the operation. The operative time was 51.4 卤9.1 min, the intraoperative bleeding was 30.1 卤10.2 ml, the operative time was 60.1 卤9.5 min in the laparotomy group, and the intraoperative bleeding was 45.8 卤15.6 ml in the laparotomy group. Complications such as chemical peritonitis and subcutaneous emphysema were found in 2 of 87 patients undergoing laparotomy. One case was performed cystectomy in cesarean section. 114 cases were followed up. 14 cases with no canceration were found to have recurred and 4 cases were treated with laparoscopy, 10 cases were laparotomy, the canceration rate was 0, the total recurrence rate was 12.3 and the average age of recurrence was 3420 ~ 39 years old. The average time from operation to recurrence was 31.2 卤6-55 months, the recurrence rate of laparoscopy group was 11.4 and the recurrence rate of laparotomy group was 12.6. There was no significant difference between the two groups (P 0.05). Conclusion: the recurrence rate of ovarian mucinous cystadenoma after laparoscopic surgery and traditional laparotomy has no significant difference. The operative time and intraoperative bleeding in laparoscopic group are lower than those in laparotomy group, and there is significant difference in the recurrence rate of ovarian mucinous cystadenoma. Laparoscopic surgery for ovarian mucinous cystadenoma is safe and effective and worthy of clinical application.
【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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