131例卵巢交界性肿瘤临床分析

发布时间：2018-03-25 02:09

本文选题：卵巢交界性肿瘤　切入点：诊断　出处：《青岛大学》2017年硕士论文

【摘要】：目的:本文将探讨卵巢交界性肿瘤临床特点、病理特征、治疗及复发影响因素。方法:回顾性分析2000年1月至2016年7月期间在青岛大学附属医院行初次手术治疗,术后石蜡病理诊断为卵巢交界性肿瘤的131例患者的病例资料,通过分析记录病历资料、电话随访患者术后复查及治疗情况,复发患者及复发后治疗情况,利用SPSS21.0进行数据分析。结果:1、纳入本研究的131例卵巢交界性肿瘤患者的年龄在13-81岁之间,平均发病年龄41.5±18.4岁,小于40岁者有52.67%(69例)。患者因“查体”发现者58.8%(77例),因“腹痛”就诊者16.0%(21例),因“扪及腹部包块”及“腹胀”原因就诊者均占9.9%(13例)。2、在BOTs的不同病理类型中,卵巢浆液性交界性肿瘤患者占68.7%(90例),卵巢粘液性交界性肿瘤患者26.7%(35例)。在不同的分期中,I期患者121例(92.4%),其中IA期患者有81例(61.8%),IB期1例(0.8%),IC期39例(29.8%),II期、III期患者均有5例(3.8%)。3、124例患者行血清CA125检测,血清CA125升高(35.0IU/ML)者占55.65%,血清CA125在I期患者中升高率占51.75%,II期及III期患者中升高率均为100%。4、在彩色多普勒超声检查下,浆液性肿瘤最大径线平均值为9.08±6.09cm,肿瘤位于双侧者占16.7%(15例);粘液性肿瘤最大经线平均值为17.28±9.90cm,肿瘤均位于单侧,粘液性肿瘤径线大于浆液性肿瘤(P0.05),浆液性肿瘤易发生在双侧卵巢(P0.05)。5、所有患者均行手术治疗,其中开腹手术及腹腔镜手术患者均占48.9%(64例),腹腔镜中转开腹手术患者有3例(2.1%),腹腔镜手术患者肿瘤平均直径约8.22±4.48cm,开腹手术患者肿瘤平均直径约14.87±9.47cm(P0.05)。腹腔镜组中造成医源性肿瘤破裂的患者占32.81%(21例),开腹手术中造成医源性肿瘤破裂的患者占32.15%(20例)(P0.05)。6、纳入研究的患者术后复发率为7.6%(10例),复发时间间隔3.5-47个月,平均约18.6个月。保留生育功能手术中复发患者占12.9%(9/70),非保留生育功能手术中复发患者占1.96%(1/51)(P0.05)。复发患者中术后病理90%(9/10)仍为卵巢交界性肿瘤,10%(1例)进展为恶性肿瘤。结论:1.卵巢交界性肿瘤患者发病年龄较年轻,其临床症状隐蔽,多数因查体发现。2.卵巢交界性肿瘤术前准确诊断率低,彩色多普勒超声检查及血清CA125检测有助于诊断。3.卵巢交界性肿瘤分期早,以浆液性及粘液性两种病理类型为主,两种病理类型有着不同的临床表现。4.卵巢交界性肿瘤术后具有复发倾向,初次手术手术方式是影响术后复发的主要因素,如复发可行再次手术治疗。复发多局限于盆腔,很少发生恶变。卵巢交界性肿瘤术后复发时间间隔长,应进行长期随访。
[Abstract]:Objective: to investigate the clinical features, pathological features, treatment and recurrence factors of borderline ovarian tumors. Methods: from January 2000 to July 2016, the primary surgical treatment was performed in the affiliated Hospital of Qingdao University. The data of 131 cases of ovarian borderline tumor diagnosed by paraffin wax after operation were analyzed and recorded. Results the age of 131 patients with borderline ovarian tumors was between 13 and 81 years old, and the mean age of onset was 41.5 卤18.4 years. There were 69 patients younger than 40 years old. 77 patients were found by "body check", 21 patients by "abdominal pain", 13 patients by "palpation of abdominal mass" and "abdominal distension". Among the different pathological types of BOTs, There were 90 cases of ovarian serous borderline tumor, 35 cases of ovarian mucinous borderline tumor, 121 cases of stage I of ovarian mucinous borderline tumor in different stages, 121 cases of stage I and 81 cases of stage IA, including 81 cases of stage IA, including 81 cases of stage Ib and 1 case of stage 0.8 of IC, 39 cases of stage II and III stage of ovarian mucinous borderline tumor. Serum CA125 was detected in 5 patients with 3. 8 and 3 124 patients. The increase rate of serum CA125 in patients with stage I and stage II and III stage was 55.65 and 55.65, respectively. The increase rate of serum CA125 in patients with stage I and stage III was 100 and 4, respectively. Under the examination of color Doppler ultrasound, the increase rate of serum CA125 in patients with stage I and stage III was 100. 4%, 55.65% and 55.65%, respectively. The mean maximum diameter of serous tumor was 9.08 卤6.09 cm, and that of bilateral tumor was 16.7cm, while that of mucinous tumor was 17.28 卤9.90 cm. The diameter of mucous tumor was larger than that of serous tumor (P0.05), serous tumor was prone to occur in bilateral ovarian tumor P0.05. 5. All patients were treated by operation. The mean diameter of tumor was about 8.22 卤4.48 cm in laparoscopic operation and 14.87 卤9.47 cm in laparotomy group. The patients with iatrogenic tumor rupture accounted for 32.81%, and the patients with iatrogenic tumor rupture caused by laparotomy accounted for 32.1515 cases, 20 cases with iatrogenic tumor rupture. The recurrence rate of the patients included in the study was 7.610 cases, the interval of recurrence was 3.5-47 months. The average of 18.6 months was about 18.6 months. The recurrence rate of 12.9% / 70% in fertility preserving operation and 1.96% / 51% P 0.05 in non-reserved reproductive function surgery. The postoperative pathology of 90% 10% of recurrent patients was still ovarian borderline tumor (10%) and 1 case of ovarian borderline tumor (n = 1). Conclusion: one case of ovarian borderline tumor is malignant tumor. The patients with borderline ovarian tumors develop at a younger age. The clinical symptoms were concealed, most of them were found by physical examination. The accurate diagnosis rate of ovarian borderline tumor before operation was low. Color Doppler ultrasonography and serum CA125 detection were helpful in diagnosis of ovarian borderline tumor. Serous and mucinous types were the main pathological types. The two pathological types had different clinical manifestations. 4. Ovarian borderline tumors had recurrent tendency after operation, and the primary operation mode was the main factor that affected the recurrence of ovarian borderline tumors. If recurrence is feasible, the recurrence is limited to pelvic cavity and rarely occurs malignant change. The interval between recurrence and recurrence of ovarian borderline tumor is long and should be followed up for a long time.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31

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