以急腹症为首发症状的非良性卵巢肿瘤28例临床分析

目的:探讨妇科急腹症附件手术中卵巢非良性肿瘤的临床特点。方法:选取2011年6月至2018年10月大连医科大学附属第一医院收治的以急腹症为首发症状的卵巢非良性肿瘤患者28例(观察组),以手术为初始治疗的卵巢恶性肿瘤患者50例(对照组A)以及以急腹症入院的卵巢良性肿瘤患者50例(对照组B)。回顾分析3组患者的临床资料。结果:观察组患者的年龄中位数、绝经例数、术前Fib中位数、术前超声血流信号阳性、超声评分阳性、肿瘤单双侧比例、肿瘤径线≥10cm例数明显高于对照组B,差异均有统计学意义(P<0.05)。结论:年龄较大或绝经后妇女出现卵巢肿瘤引起的急腹症，若Fib升高、肿瘤径线大于10cm或超声提示肿物有血流信号时应注意排除恶性肿瘤可能。术前Fib对于卵巢肿瘤的良恶性判断有指导意义，且Fib水平与卵巢恶性肿瘤分期存在正相关。     

卵巢腺肉瘤

子宫外苗勒氏腺肉瘤非常罕见,来源于卵巢、输卵管和腹膜间皮。文献中仅见13例卵巢和14例生殖道外的腺肉瘤的报道。本文报道1例卵巢腺肉瘤。患者32岁,日本妇女,G3P1,下腹疼痛7个月,无放射治疗史,盆腔检查发现右侧卵巢肿物并有子宫内膜异位囊肿,血清CA125 1 100 U/ml(正常为<35U/ml)。行右侧卵巢切除术。术中盆腹腔未见异常。术后10个月CT发现子宫直肠陷窝有肿瘤复发,血清CA125为950 U/ml。行全子宫、左侧附件、肿物、网膜及盆腔淋巴结切除术,术后4个月未发     

女性胃肠道间质瘤术前误诊为妇科肿瘤18例原因分析

目的探讨女性胃肠道间质瘤(GIST)术前误诊妇科肿瘤的原因。方法回顾性分析18例拟诊"妇科肿瘤"收住妇科手术且经术后病理证实为GIST患者的临床资料。结果 18例患者平均年龄(54.50±12.44)岁;体检发现腹、盆腔包块7例,腹痛5例,腹胀4例;伴大便性状改变5例,贫血5例,尿频尿急3例,头晕乏力、发热、阴道出血、闭经各1例;经阴道B超检查GIST包块接近盆腔、子宫、附件17例,位于腹腔1例。其中多次B超检查以腹部实性不均质低回声肿物为主,不随子宫移动或盆腔内可见卵巢组织,提示肿块可能来源于肠道6例。结论 GIST主要表现为腹部及盆腔包块,缺乏特异性,当出现较大盆腹腔肿物时应与肠道间质瘤鉴别。     

误诊为妇科肿瘤的58例临床病例分析

目的：探讨误诊为妇科肿瘤的临床病例特点,提高妇科医生对盆腔非生殖系统肿瘤的认知及诊断能力。方法：回顾性分析2009年8月—2022年3月首都医科大学附属北京妇产医院收治的58例误诊为妇科肿瘤收治入院患者的病例资料,经术中探查及病理学诊断证实腹膜后肿瘤24例,阑尾肿瘤15例,肠或肠系膜肿瘤19例,分别分析其临床特点、影像学表现、手术方式及术后病理诊断。结果：24例腹膜后肿瘤患者术前误诊为附件肿物18例（75.0%）,误诊为子宫肌瘤或阔韧带肌瘤5例（20.8%）,误诊为盆腔炎性包块1例（4.2%）。临床表现为腹痛或下腹部坠胀6例（25.0%）,尿频2例（8.3%）,大便不畅伴骶尾部不适1例（4.2%）,无明显症状15例（62.5%）。超声或盆腔磁共振成像（magnetic resonance imaging,MRI）检查均未提示腹膜后肿物可能,仅1例患者盆腹腔增强CT提示不除外腹膜后肿物可能。15例阑尾肿瘤患者术前均误诊为附件肿物;临床表现为腹痛或下腹部坠胀6例（40.0%）,无明显症状9例（60.0%）;超声均未提示阑尾肿物来源可能,3例盆腹腔CT或盆腔增强MRI提示不除外阑尾来源肿瘤可...     

腹腔镜手术治疗卵巢肿物512例临床分析

目的探讨腹腔镜手术在卵巢肿物治疗中的价值及安全性。方法回顾性分析郑州大学第二附属医院妇科2006年1月至2009年10月诊断为卵巢良性病变接受腹腔镜手术的512例患者的临床资料。结果 512例患者中,502例(98.05%)腹腔镜术后诊断为卵巢良性病变,除1例因盆腔粘连严重中转开腹外,其余均顺利完成手术,无术中副损伤及术后并发症;10例(1.95%)术前未预计卵巢非良性肿瘤,其中术中确诊7例,术后确诊3例。10例非良性肿瘤中,9例为卵巢恶性肿瘤,其中4例在腹腔镜下完成了手术,2例中转开腹,3例行二次手术;1例为双侧卵巢交界性肿瘤,中转开腹行双侧卵巢肿瘤剥除术。10例患者中,6例行保留生育功能手术,4例成功受孕,其中2例已分娩。10例非良性肿瘤患者术后平均随访(22.4±2.5)个月,均无复发。结论腹腔镜手术可作为术前诊断为良性卵巢肿物的首选安全的手术方式,对术前未预计的卵巢非良性肿瘤患者预后无明显影响。     

绝经后的可触卵巢综合征(PMPO)

在妇科肿瘤中,随着细胞学诊断的发展,能早期诊断子宫颈癌,死亡率也逐年下降。目前卵巢癌的早期诊断仍较困难,剖腹时发现有约60%患者已扩散到卵巢以外,因此近十余年来,卵巢恶性肿瘤的死亡率未下降,卵巢癌早期诊断困难原因有:(1)对盆腔器官缺乏直接观察检查方法;(2)一般无自觉症状;(3)除特殊性肿瘤外,多为上皮性肿瘤,肿瘤标记很少。因此,妇产科医师对绝经后妇女应6个月行一次盆腔检查,有报告即使细心对无症状妇女进行双合诊普查,卵巢瘤的检出率约是0.1‰,此外,患者入院诊断时60～80%有盆腔扩散。为此,Baaber 和 Graber 介绍了绝经期后可触及卵巢综合征(Postmenopausal palpable ova-ry syndrome,简称 PMPO 综合征),作为早期卵巢癌筛选法。     

经阴道超声探测绝经后卵巢可及综合征的价值

目的　探讨应用阴道超声探测绝经后妇女的卵巢 ,早期发现绝经后卵巢可及综合征 (post menopausalpalpableovarysyndrome ,PMPOS)与卵巢肿瘤价值。方法　采用阴道超声诊断仪 ,常规测量子宫、卵巢的大小 ,卵巢肿物疑恶性时加做彩色多普勒血流测定及卵巢肿瘤标记物CA12 5的测定。卵巢体积按椭圆型公式计算为卵巢的长×宽×厚× 0 5 2 3。结果　 1998年 1月～ 2 0 0 3年 6月阴道超声探测我院门诊就诊患者绝经后妇女14 0 0 5例 ,结合临床资料进行分析 ,年龄 5 0～ 90岁 ,绝经年限最短 1年 ,最长 4 4年 ,中位绝经时间 14年。检查结果 :132 2 8例为正常萎缩卵巢 ,777人次超声探查出卵巢 >2 5cm ,其中 183名患者因卵巢肿物行手术治疗 ,其中绝经后卵巢可及综合征 81例 ,内瘤样病变 3例 ,病理性肿瘤 78例 ;在病理性肿瘤患者中 ,良性卵巢肿瘤 70例 ,恶性肿物 8例。恶性肿物中 7例CA12 5升高。结论　经阴道超声探测与彩色多普勒血流频谱的测定 ,同时卵巢肿瘤标记物CA12 5的测定是检出PMPOS的必备条件。     

绝经后女性卵巢间质细胞与骨密度的相关性研究

目的:探讨绝经后女性卵巢间质细胞与骨密度的相关性。方法:选择2019年1月至2021年1月在绵阳市中心医院就诊因子宫良性疾病需行全子宫切除术并选择预防性切除双侧输卵管、卵巢的绝经后妇女58例为研究对象,术后显微镜下对双侧卵巢间质细胞进行计数,同时在术前、术后1月、术后6月、术后1年测定腰椎骨密度值(BMD),使用术前测值作为其自身对照。结果:绝经后女性在预防性卵巢切除术后1年内BMD呈持续下降趋势,在术后1年时BMD下降约11.2%。绝经后卵巢间质细胞含量与术前BMD以及术后1年BMD下降程度呈正相关(r>0,P<0.05)。结论:女性绝经后卵巢仍对骨密度具有保护作用,若在因子宫良性病变行子宫切除手术的同时预防性行双侧卵巢切除术,将导致绝经后女性骨密度丢失迅速,并且可能与卵巢间质细胞含量有关。     

子宫恶性混合性苗勒管肿瘤32例临床特征分析

目的:分析子宫恶性混合性苗勒管肿瘤(MMMT)的临床特点、诊断、治疗及影响预后的相关因素。方法:回顾性分析西安交通大学第一附属医院2008年1月至2018年1月收治的32例子宫MMMT(1例子宫颈MMMT,31例子宫体MMMT)的临床资料,并对影响子宫MMMT的3年生存率的相关因素行Cox回归分析。结果:①患者平均年龄58.2±5.6岁,71.9%(23/32)为绝经后妇女。93.8%(30/32)表现为不规则阴道流血。77.8%(21/27)术前肿瘤标志物(NSE、CA_(125)、CA_(724)、CA_(199)等)有不同程度升高,多表现为轻度增高。②44.4%(12/27)术前诊断性刮宫病理检查结果与术后病理学诊断相符。93.3%(14/15)的盆腔MRI检查可实现术前早期诊断。③所有患者均行手术治疗,术后26例行化疗,3例接受放疗。④随访6～125个月。子宫体MMMTⅠ期患者1、3、5年总生存率分别为95.3%、61.9%、42.9%,Ⅱ、Ⅲ、Ⅳ期患者1、3、5年总生存率分别为80.0%、50.0%、30.0%。⑤Cox多因素分析示,肿瘤浸润子宫肌层深度≥1/2是影响生存的独立危险因素(OR 5.102,P=0.018)。结论:子宫MMMT多发生于绝经后妇女,预后差,临床表现多为阴道不规则流血,实验室检查肿瘤标志物轻度升高无特异性,术前行盆腔MRI检查联合诊刮可提高术前诊断率,早期及晚期患者5年生存率均低于50%,且肿瘤浸润子宫肌层深度≥1/2是影响生存的独立危险因素。     

恶性潜能未定型子宫平滑肌肿瘤12例临床病理分析

目的探讨恶性潜能未定型子宫平滑肌肿瘤的临床表现、组织病理学和影像学特征以及治疗和预后.方法选择因子宫平滑肌肿瘤于我院行手术治疗,病理诊断为恶性潜能未定型子宫平滑肌肿瘤12例进行回顾性分析,并对患者进行随访.结果恶性潜能未定型子宫平滑肌肿瘤占子宫平滑肌肿瘤的0.88%,平均发病年龄为42.67岁,11例患者未绝经,结节直径平均8.41 cm,5例结节内部血流阻力指数＜0.4,2例患者血清CA125水平高于正常.1例绝经前患者术后半年盆腔复发,1例绝经患者术后3年盆腔发生平滑肌肉瘤.结论B超及血清CA125等检查可能难以在术前诊断恶性潜能未定型子宫平滑肌肿瘤,病理检查为确诊手段.该肿瘤目前尚无统一的临床治疗手段,应进行密切随访,预后较好.     

不孕症患者合并卵巢肿瘤的临床特点分析

目的 探讨不孕症患者合并卵巢肿瘤的临床特点、诊断、手术处理及妊娠结局。方法 回顾性分析1999年1月1日—2004年12月31日在浙江大学医学院附属妇产科医院生殖内分泌科因不孕症住院手术后经病理检查证实的110例卵巢肿瘤患者的临床资料。按病理检查结果分为卵巢上皮性肿瘤组（上皮性肿瘤组）、畸胎瘤组和其他组,分别为49、42、19例。结果 上皮性肿瘤组、畸胎瘤组和其他组的术前确诊率分别为29％、81％和63％,前组明显低于后两组（P〈0．01）。110例患者中,97例为直径〈5cm的卵巢小肿瘤患者;97例完成腹腔镜下卵巢肿瘤剔除手术,11例行开腹手术,2例腹腔镜检查后转开腹手术;上皮性肿瘤组合并盆腔致密粘连的发生率为61％,明显高于畸胎瘤组的26％（P〈0．01）。有随访结果的102例患者中,共45例妊娠,妊娠率44％,其中18例自然受孕,21例体外受精妊娠,6例人工授精妊娠。结论 （1）不孕症合并卵巢肿瘤以直径〈5em的小肿瘤为主,术前诊断率低,腹腔镜检查可明确诊断。（2）卵巢上皮性肿瘤合并慢性盆腔炎发生率较高,术中应认清解剖关系,完整剔除肿瘤,同时尽量保护卵巢功能。（3）不孕症合并卵巢肿瘤患者在手术和辅助生育治疗后可获得良好的妊娠结局。     

绝经后卵巢肿瘤136例临床病理分析

目的　探讨 5 0岁以上绝经妇女发生卵巢肿瘤的临床病理学原因。方法　对 1998年 1月至 2 0 0 2年 7月发生的 136例 5 0岁以上绝经妇女卵巢肿瘤患者的临床资料及病理结果进行回顾性分析。结果　 136例中恶性卵巢肿瘤 5 9例 (43 4 % ) ,交界性肿瘤 6例 (4 4 % ) ,良性卵巢肿瘤 71例 (5 2 2 % )。恶性卵巢肿瘤以 6 0～ <6 5岁发生率最高 (48 5 % ) ,70岁以上发生率较低 (2 0 0 %～ 2 6 7% ) (P <0 0 5 )。在病理组织切片上 ,良性卵巢肿瘤以黏液性囊腺瘤为多 ,恶性卵巢肿瘤以浆液性囊腺癌为多。对 10 8例患者用彩色超声检查测量的肿瘤直径进行分析 ,其中以肿瘤直径 >10cm组恶性卵巢肿瘤发生率最高 ,与直径 <5cm组比较差异有显著性意义 (P <0 0 5 )。结论　绝经后应定期进行常规妇科检查和宫颈刮片细胞学检查 ,如有异常宜及时进行影像检查及肿瘤标志物和病理检查 ,积极地进行治疗。     

A case of Sertoli–Leydig cell tumor in a postmenopausal woman

Sertoli-Leydig cell tumor belongs to the group of sex cord-stromal tumors of the ovary. These neoplasms account for less than 0.5% of all ovarian tumors and are more often encountered in young women between the ages of 20 and 30 years who usually become virilized. We described an unusual case of Sertoli-Leydig cell tumor in a postmenopausal women who presented with a solid right pelvic mass, a large amount of ascites, and laboratory tests revealing an elevated CA125, all suggesting a pelvic malignancy. Although five similar cases of postmenopausal women with Sertoli-Leydig cell tumor of ovary have been reported in the literature, we believe that this is an useful addition to the literature.     

Clinical analysis of patients with Krukenberg tumor of the ovary

OBJECTIVE: The aim of this study was to analyze clinical data such as diagnosis, surgical treatment and follow-up of patients with Krukenberg tumor (KT). We also reviewed literature of the subject. MATERIAL AND METHODS: We retrospectively analyzes medical data of 34 patients who were operated in Gynecology Clinic of Medical University of Gdansk in years 1999-2003. The definition of KT was that of Krukenberg's. RESULTS: The mean age of patients was 52, 23 of them were postmenopausal. Fourteen patients were diagnosed with malignant disease before surgery for ovarian tumor--11 were treated for breast cancer, 2 underwent resection of the stomach and one had rectosigmoidectomy. Before surgery a diagnosis for ovarian tumor such as ultrasonography, computer tomography and Ca125 were performed--in most cases sonography findings revealed mixed cystic and solid tumor of 320 cm in diameter; in 70% cases serum Ca125 was elevated with the highest result of 772 IU/ml. From among 20 patients who were suspected for primary ovarian cancer with no other malignant disease before surgery 9 had stomach cancer, 6 colon cancer, in 2 cases ovarian tumor was a metastasis from breast and in 1 from gall bladder; in 2 patients primary tumor was not found. The surgery performed in patients with KT was that of done for primary ovarian cancer. In 5 cased partial resection of colon was necessary. Surgical findings revealed ovarian tumor of 3-10 cm in diameter, solid and bilateral in most cases. The mean survival in our group was 4,7 months. The mean time between diagnosis of malignant disease and metastases to the ovary was 18 months. The best overall prognosis was for patients with breast cancer and the worst for cases with stomach cancer. CONCLUSIONS: There is a poor prognosis for patients with Krukenberg tumor. The diagnosis is late, in most cases during surgery for ovarian tumor. The most often site of primary malignancy was breast and stomach.     

Stromal Leydig cell tumor of the ovary. Case report and literature review.

The stromal Leydig cell tumor is a very rare benign tumor originating from the ovarian stroma. Only seven cases have been reported, all in postmenopausal women, except for one in a 15-year-old girl. In the present case, masculinization developed over a few months in a 24-year-old woman. The serum concentration of testosterone was 4.7 ng/ml before operation. Left salpingo-oophorectomy and wedge resection of the right ovary were performed. The encapsulated left ovarian tumor was an ovarian stromal Leydig cell tumor on microscopic examination.     

Conversion of circulating estrone sulfate to 17beta-estradiol by ovarian tumor tissue: a possible mechanism behind elevated circulating concentrations of 17beta-estradiol in postmenopausal women with ovarian tumors.

AIM: Elevated serum levels of 17beta-estradiol (E2) are frequently found in postmenopausal women with ovarian tumors not classified as estrogen-producing. Conversion of circulating estrone sulfate (E1S) to E2 is one alternative way of E2 formation in target tissues in postmenopausal women. Our aim was to find out if conversion of circulating E1S to E2 by the tumor tissue could be a reason for elevated serum E2 levels in postmenopausal women with 'non-estrogen-producing' ovarian tumors. METHOD: Serum E2 was measured in 12 postmenopausal women with 'non-estrogen-producing' ovarian tumors (nine benign, three malignant). Total hydrolysis of and [3H]E2 formation from [3H]E1S by the tumor tissue homogenates was studied in vitro. RESULTS: Serum E2 showed significant positive correlations with total hydrolysis of and [3H]E2 formation from [3H]E1S in the total material as well as in the benign tumor subgroup. [3H]E2 formation was the most important independent variable. CONCLUSION: Conversion of circulating E1S to E2 by the tumor tissue could be one important reason for elevated S-E2 levels in postmenopausal women with 'non-estrogen-producing' ovarian tumors.     

Uterine tumor resembling ovarian sex cord tumors in a patient using tamoxifen: report of a case and review of literature

Increasing number of uterine malignancies have been reported in breast cancer patients using tamoxifen. Most of these are endometrial adenocarcinomas. However, only a few cases of endometrial stromal sarcomas have been reported to be linked with tamoxifen usage. A 58-year-old postmenopausal women who had been using tamoxifen for 4 years after a surgery for breast cancer is presented with chronic pelvic pain. Preoperative investigations were indicative of a uterine myoma so that a standard total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Postoperative histologic diagnosis was a uterine tumor resembling ovarian sex cord tumors, which is an exceedingly rare entity itself. The present case is the first designated diagnosis of this rare tumor, with a possible association of tamoxifen usage.     

妇科恶性肿瘤化疗后发生糖尿病患者的临床分析

目的 探讨妇科恶性肿瘤患者化疗后发生糖尿病与化疗的关系。方法 采用回顾性分析方法对我院1990年1月至2001年10月收治化疗后发生糖尿病18例妇科肿瘤患者(A组)的化疗的年龄、化疗方案、肿瘤类型及化疗中肝功能、电解质异常情况进行总结,并对其疾病转归进行随访,并与同期化疗且化疗前患糖尿病67例(B组)相比较。结果A组以卵巢恶性肿瘤为主,部分患者化疗结束后糖尿病可缓解;B组以子宫内膜癌为主,部分患者化疗中糖尿病加重,化疗结束后减轻。两者疾病构成比差异有显著性。结论化疗可能对胰腺有影响而诱发糖尿病,应引起重视。     

化学药物对卵巢恶性肿瘤患者血糖代谢的影响

目的 探讨化学药物对卵巢恶性肿瘤患者血糖代谢的影响。方法 收集1997年1月－2001年12月收治的卵巢恶性肿瘤患者375例化学药物治疗（化疗）前后的血糖检测报告及相关临床资料,并对其进行回顾性分析。结果 375例患者中,化疗前合并糖尿病9例,其余化疗前血糖水平正常。化疗后空腹血糖升高32例,占8.5%。32例中明确诊断为糖尿病14例,糖耐量低减9例,一过性血糖升高9例,分别占同期接受化疗的卵巢恶性肿瘤患者的3.7%、2.4%和2.4%。其中,接受以紫杉醇类药物为主的中患者208例,发生血糖异常23例,占同类化疗11.1%(23/208),占同期化疗6.1%（23／375）;接受以铂类药物为主的化序患者141例,发生血糖异常8例,占同类化疗5.7%(8/141),占同期化疗2.1%（8／375）;接受其他化疗方案患者26例,发生血糖异常1例,占同期化疗0.3%（1／375）。以紫杉醇类为主化疗与以铂类为主化疗引起的血糖异常的发生率相比较,差异有显著性（P＜0.05）。化疗诱发的血糖异常多数发生的化疗后1－3个疗程。结论 卵巢恶性肿瘤患者接受化疗后可能会出现血糖异常,甚至发生糖耐量低减或糖尿病,以紫杉醇为主的化疗方案治疗中这种情况更加常见,且多发生于治疗的第1－3个疗程,对此应予以重视。     

Hyperandrogenism in a postmenopausal woman presenting with a metastatic ileum endocrine tumor

OBJECTIVE: To elucidate the mechanism of the hyperandrogenism found in a postmenopausal woman presenting an ileum endocrine tumor with ovarian metastases. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A postmenopausal woman was referred for hirsutism. Basal plasma testosterone was high, 6.6 nM/L (normal, 相似文献