中孕期腹腔镜卵巢手术30例临床特点

目的　探讨中孕期腹腔镜卵巢手术的特点。方法　2002年4月至2013年12月在北京协和医院妇产科行中孕期腹腔镜下卵巢囊肿手术30例，回顾性分析其临床特点，并评估手术的可行性及适应证。结果　30例中孕期腹腔镜卵巢囊肿手术中，孕妇平均年龄（28.5±3.1）岁，平均孕周为（14.7±2.5）周，平均手术时间（50±20）min。平均住院日为（4.5±0.8）d。孕16周及以上患者11例（36.7%），孕16周以下患者19例（63.3%），两者手术时间比较差异无统计学意义（P＞0.05）。仅5例（16.7%）患者在孕前已知有附件包块。平均卵巢肿瘤直径（9.0±5.4） cm，包块大于9 cm及以上者12例（40%），包块小于9 cm者18例（60%），前者手术时间明显长于后者（P＜0.05）。5例（16.7%）患者因腹痛行急诊手术，其中2例因卵巢扭转坏死行患侧附件切除术；28例(93.3%)患者行卵巢囊肿剔除术。术后病理：畸胎瘤18例（60%），浆液性囊肿6例(20%)，黄体囊肿3例(10%)，黏液性囊腺瘤2例(6.7%)，泡沫纤维瘤1例(3.3%)。有1例（3.3%）患者术后出现宫缩，经镇痛保胎治疗好转，无严重术后并发症。26例（86.7%）孕妇足月分娩健康新生儿，4例（13.3%）失访。结论　中孕期腹腔镜下卵巢手术对孕妇和胎儿是安全可行的，手术适应证为持续性附件包块和附件扭转。术中和术后应加强母胎监测。

Clinical analyses of 30 cases of laparoscopic surgery for adnexal masses in second trimester

Objective　To investigate the characteristics of laparoscopic surgery for ovarian cysts in second trimester. Methods　Between April 2002 and December 2013, 30 patients were treated with laparoscopic surgery for clinically suspected ovarian cyst in second trimester at Department of Obstetrics and Gynecology, Peking Union Medical College Hospital. Clinical data of these patients were reviewed for identification of clinical characteristics, and assessment of feasibility and indications of the surgery. Results　Of the 30 patients, the mean age was (28.5±3.1) years, gestational age was (14.7±2.5) weeks, mean operation time was (50±20)minutes, and mean length of hospital stay was (4.5±0.8)days. Between the patients with gestational age ≥16 weeks (11/30, 36.7%) and those with gestational age<16 week (19/30, 63.3%), no difference was noted in operation time (P＞0.05). In the 30 patients, only 5 (16.7%) patients had known about the ovarian masses before pregnancy. The mean diameter of the masses was (9.0±5.4) cm. In the 12 patients (40%) who had masses with diameter ≥9 cm, the operation time was significantly longer than that in the 18 patients (60%) who had masses ＜9 cm (P＜0.05). Five patients (16.7%) received emergency surgery, including 2 cases (6.7%) receiving simple salpingo-oophorectomy for ovarian necrosis due to adnexal torsion. In the other 28 patients(93.3%), the ovary cysts were removed. Postoperative pathological examination showed teratoma in 18 cases (60%), serous cyst in 6 cases (20%), corpus luteum cyst in 3 cases (10%), mucinous cystadenoma in 2 cases (6.7%), and foam fibroma in 1 case (3.3%). One patient (3.3%) experienced postoperative contractions, which were cured by magnesium sulfate and progestin. No severe complications occurred. Twenty-six(86.7%) patients delivered healthy full-term infants, and the other 4 (13.3%) cases lost to follow-up. Conclusions　Laparoscopic surgery is a safe and feasible procedure for the treatment of ovarian cysts in second trimester of pregnancy. For adnexal masses persistent or suspicious for torsion, surgical management is warranted. Close maternal and fetal monitoring is essential during and after the operation.