妊娠合并卵巢肿瘤46例临床分析

卵巢肿瘤是妇产科常见病、多发病，妊娠合并卵巢肿瘤亦不少见，据统计，其发生率约为0．08％～0．9％。其危害性较非孕期大，对母儿均可产生不良影响，因此早期诊断，及时治疗非常重要。我院10年共收治妊娠合并卵巢肿瘤46例，现分析如下。     

妊娠合并子宫肌瘤130例临床分析

目的探讨妊娠合并子宫肌瘤的临床处理。方法回顾性分析我院5年来130例妊娠合并子宫肌瘤患者处理方法以及产科结局。结果发现妊娠期间肌瘤增大者共11例，72．73％发生于孕早中期，变性类型多样，红色变性占57．69％；130例妊娠合并子宫肌瘤者中，发生早产14例，占10．77％(14／130)，发生产后出血6例，占4．62％(6／130)，其发生率高低与肌瘤的数量、部位及大小之间无明显关系；剖宫产者122例，占93．85％。结论妊娠合并子宫肌瘤易发生各种产科并发症，剖宫产率高，剖宫产术中行肌瘤剔除术应慎重。     

妊娠合并卵巢肿瘤所致急腹症的诊断及处理

妊娠合并卵巢肿瘤所致的急腹症临床较少见,现将其发生率、诊断及处理分述如下。１发生率妊娠合并卵巢肿瘤发生率约为１∶８４～１∶１０００［１～３］。其中良性约占９７１６％,恶性约为２８４％［２］。各类卵巢肿瘤中以良性畸胎瘤最常见,约占４９３４％［２］...     

妊娠合并卵巢肿瘤的处理

明确妊娠合并卵巢肿瘤的临床特征和处理对策。方法回顾性分析７２例妊娠合并卵巢肿瘤的临床结局。结果妊娠合并卵巢成就畸胎瘤、巧克力囊肿和黄体囊肿的发生率分别为３０．６％、１９．４％和１８．１％。     

286例妊娠合并卵巢肿瘤临床分析

妊娠合并卵巢肿瘤的发病率各种文献报道有较大差异,目前对妊娠合并卵巢恶性肿瘤临床处理原则尚存在着一定的分歧。本文回顾性分析我院近3年来286例妊娠合并卵巢肿瘤,就临床特征和处理原则进行了讨论。1材料和方法1.1资料来源自2002年10月至2005年9月我院共分娩25104例,其中阴道     

妊娠合并卵巢肿瘤65例临床分析

妊娠合并卵巢肿瘤的发生率文献报道差异很大。卵巢肿瘤与妊娠同时存在时较非孕期危害更大,故一旦诊断,即应慎重处理。我们回顾分析了我院5年间收治的妊娠合并卵巢肿瘤65例,现就其诊断与处理讨论如下。1　资料与方法1.1　临床资料　1994年1月至1999年8月,我院收治妊娠合并卵巢肿瘤65例。同期产科共分娩21295例。本组患者22～38岁,其中22～30岁46例,占708%。初产妇62例,经产妇3例,其中双胎1例、三胞胎1例。左侧卵巢肿瘤28例(431%)、右侧33例(508%)、双侧4例(62%)。12　诊断　妊娠合并卵巢肿瘤时症状不明显,除非有并发症。本组10例早孕期有先兆…     

妊娠合并卵巢肿瘤的诊断方式与处理

妊娠合并卵巢肿瘤亦不少见 ,有时诊断较为困难 ,一旦诊断 ,慎重处理颇为重要 ,因孕期卵巢手术对母亲及胎儿都有一定的危险性 ,而保守处理又顾虑肿瘤扭转、恶变等并发症或影响继续妊娠及分娩。本文分析我院 9年间收治的妊娠合并卵巢肿瘤 5 4例 ,探讨其诊断与处理方法1　临床资料1.1　一般资料　 1991年 10月至 1999年 10月 ,我院分娩总数 90 5 4例 ,同期收治妊娠合并卵巢肿瘤病人 5 4例 ,发生率为 0 6 %。年龄 2 0 42岁 ,孕次 17次。卵巢肿瘤发生在左侧 2 1例 ,右侧 2 2例 ,双侧 11例。1.2　诊断方式及时间　 5 4例妊娠合并卵巢肿瘤诊断方式…     

286例妊娠合并卵巢肿瘤的临床分析

目的:探讨妊娠合并卵巢肿瘤的临床病程特点,以及相应的诊断和处理对母儿结局的影响。方法:回顾分析2003年3月至2010年12月在上海市第一妇婴保健院住院分娩的286例妊娠合并卵巢肿瘤患者的临床资料,分析比较诊断时孕周,妊娠期间卵巢肿瘤的特点、对妊娠结局影响、分娩方式,病理特点等,并对上述因素进行相关分析。结果:妊娠合并卵巢肿瘤的孕妇阴道分娩54例,剖宫产232例,剖宫产率81.12%;剖宫产获得的232例病理结果中,良性肿瘤227例,交界性肿瘤5例。良性肿瘤行卵巢肿瘤剥除术或患侧附件切除术,交界性肿瘤行患侧附件切除术或肿瘤减灭术;妊娠合并卵巢交界性肿瘤组新生儿体重及分娩孕周均明显低于妊娠合并卵巢良性肿瘤组(P<0.05)。结论:妊娠合并卵巢肿瘤以良性肿瘤最常见。因早期妊娠时缺乏典型的临床症状而不易早期诊断,故应加强孕前及早孕期间的检查;妊娠早期应行B超检查提高卵巢肿瘤检出率;剖宫产术中应仔细探查双侧附件,及时发现卵巢肿瘤;妊娠合并交界性肿瘤,由于终止妊娠时期早,故围产期母儿并发症较高,其处理原则需根据患者年龄、生育情况、组织类型、肿瘤期别、妊娠期限、胎儿成熟度评价等而异。     

Elective vs. conservative management of ovarian tumors in pregnancy.

OBJECTIVES: To determine optimal management of the ovarian tumors in pregnancy. METHODS: This study included 89 cases of the ovarian tumor in pregnancy that required surgery at Holy Family hospital of the Catholic University from January, 1990 to December, 2001. Among 89 cases, 36 and 53 were emergency and elective surgery, respectively. Student's t-test and the chi(2)-test were used for statistical analysis and a P-value of <0.05 was considered statistically significant. RESULTS: The most common size of torsion of ovarian tumors during pregnancy was 6-10 cm and the incidence was the most frequent during the first trimester of pregnancy. The incidence of preterm delivery (<37 weeks) was higher in emergency surgery, but there was no difference in the gestational age at delivery, also no difference in the birth weight or the method of delivery. CONCLUSIONS: Although surgery for ovarian tumors in pregnancy is delayed until the onset of symptoms, adverse pregnancy outcome is not worsened when compared with that after elective surgery. We propose that conservative management would be used in optimal management of pregnant women with ovarian tumors.     

Factors influencing the choice of laparoscopy or laparotomy in pregnant women with presumptive benign ovarian tumors

Objective

To evaluate the factors associated with physicians’ choice of laparotomy or laparoscopy in pregnant women with presumptive benign ovarian tumors.

Methods

Retrospective comparative analysis of pregnant women who underwent laparotomy or laparoscopy for ovarian tumors and who delivered at Samsung Medical Center, Seoul, Korea, between July 1995 and April 2008.

Results

Univariate analysis revealed that the following factors had a significant or a borderline significant association with the choice of operation type: maternal age (P = 0.044); surgeon type (professor vs clinical fellow; P = 0.094); tumor mass size (P = 0.081); gestational age (P = 0.035); and time since surgery (P < 0.001). Multivariate analysis showed that tumor size (P = 0.030), gestational age (P = 0.027), and time since surgery (P = 0.004) were independent factors associated with physicians’ choice of laparoscopy or laparotomy for the management of presumptive benign ovarian tumors during pregnancy.

Conclusions

In the latter years of the present study, physicians at the study center preferred the laparoscopic approach for managing presumptive benign ovarian tumors during pregnancy. Furthermore, they preferred this approach to laparotomy for pregnancies at a relatively early gestational age and for treating small tumors.     

Premature ovarian failure and pregnancy

Setting: A case study of a woman with presumed premature menopause is presented. Results: After more than 4 years of premature menopause judged by subjective symptoms, bleeding history, and postmenopausal levels of gonadotropins, a woman conceived spontaneously 2 months after the start of hormone replacement treatment (HRT). Previously, ovarian stimulation with clomifen citrate had failed. She delivered prematurely due to preeclampsia and intrauterine growth retardation. Conclusions: Reviewing the literature finds that pregnancy is reported in woman with premature ovarian failure after the use of birth-control pills, HRT, ovarian stimulation, and in spontaneous cycles. Lack of oocyte donors and prohibition of the donor technique in some countries make other options valuable when optimal infertility treatment cannot be offered.     

具有分泌性激素功能的卵巢肿瘤50例分析

目的探讨具有分泌性激素功能的卵巢肿瘤的临床特征与内分泌症状,为正确诊断提供临床参考资料。方法回顾性分析1980年1月至2003年1月在北京协和医院就诊的具有分泌性激素功能的卵巢肿瘤50例,分别对症状、肿瘤种类、性激素等相互间关系进行统计学分析。结果50例中以卵巢颗粒细胞瘤为多见,其次为卵巢支持间质细胞瘤等。主要为雄激素与雌激素增多症状,其中雄激素异常的常见临床表现依次为多毛、阴蒂增大与喉结出现。多毛为首发表现,多见于卵巢支持间质细胞瘤与卵巢类脂质细胞瘤。雌激素异常的主要临床表现为绝经后出血与月经紊乱,多见于颗粒细胞瘤。结论多毛、阴蒂增大等是雄激素过多的最常见表现,睾酮≥6.0nmol/L者应高度怀疑发生肿瘤的可能,治疗以手术为主。     

Pregnancies following conservative treatment of malignant ovarian tumors

Summary Sixteen patients with malignant ovarian tumors were treated conservatively; 1 had a serous cystadenoma of low potential malignancy; 6 had a mucinous cystadenoma of low potential malignancy; 2 had a pure dysgerminoma; 2 had a mature solid teratoma; 3 had a mucinous cystadenocarcinoma; and 2 had an endodermal sinus tumor. Postoperative chemotherapy was given in 12 cases and 1 patient with a pure dysgerminoma had radiotherapy. Eighteen pregnancies occurred in 13 patients. One full-term and one 8 month premature infant died in utero, and 2 infants had malformations; the other 14 infants are all well. The patient with moderately differentiated mucinous cystadenocarcinoma who delivered a premature infant and 2 patients with endodermal sinus tumors died of recurrence.     

Successful management of endodermal sinus tumor of the ovary associated with pregnancy

BACKGROUND: Pregnancy complicated by endodermal sinus tumor of the ovary has rarely been reported. CASE: A 32-year-old pregnant woman was found to have an ovarian tumor. At 19 weeks of gestation, tumorectomy was performed and a diagnosis of primary endodermal sinus tumor of the ovary (stage Ic) was made. Pregnancy was continued without postoperative chemotherapy. At 36 weeks of gestation, she underwent cesarean section combined with second-look laparotomy. A normal infant was delivered and there were no signs of recurrence. Subsequently, three courses of combination chemotherapy with bleomycin, etoposide, and cisplatin were administered. There was no evidence of recurrence at 27 months after initial treatment. CONCLUSIONS: Successful management of endodermal sinus tumor of the ovary in a pregnant woman is reported.