妊娠合并卵巢肿瘤及瘤样病变58例临床分析

目的探讨妊娠合并卵巢肿瘤及瘤样病变患者的临床特征和处理对策。方法回顾性分析2009年1月至2010年12月福建省妇幼保健院收治的58例经手术病理诊断的妊娠合并卵巢肿瘤及瘤样病变患者的临床资料。结果 58例妊娠合并卵巢肿瘤及瘤样病变患者占同期妊娠的0.24%(58/23756),其中卵巢良性肿瘤及瘤样病变56例(96.6%),卵巢恶性肿瘤2例(3.4%)。妊娠前首次发现者5例(8.6%);孕早期发现者22例(37.9%),孕中期发现者18例(31.0%),孕晚期发现者13例(22.4%);孕早、中期均为超声检查发现,孕晚期均为剖宫产术中发现。56例卵巢良性肿瘤及瘤样病变患者中,50例(89.3%)行卵巢囊肿切除术,6例(10.7%)行附件切除术,随访8～18个月未见复发。2例妊娠合并卵巢恶性肿瘤患者中,1例卵巢浆液性囊腺癌行肿瘤细胞减灭术,术后辅助化疗8个疗程,随访12个月无瘤生存;1例卵巢肿瘤切除术后病理诊断卵巢幼年性颗粒细胞瘤,拒绝再次手术及化疗,术后2个月死亡。58例患者中,妊娠合并卵巢肿瘤蒂扭转行急诊手术8例,发生率为13.8%。58例患者的病理类型为成熟畸胎瘤24例(41.4%),浆液性囊腺瘤22例(37.9%),黄体囊肿10例(17.2%),颗粒细胞瘤1例(1.7%),浆液性乳头状囊腺癌1例(1.7%)。结论超声检查可以诊断和监测妊娠期卵巢肿瘤及瘤样病变,而剖宫产术中常规行双侧附件探查亦很重要。妊娠合并卵巢肿瘤蒂扭转患者以成熟畸胎瘤为最多见。     

妊娠合并卵巢肿瘤103例诊治分析

目的:探讨妊娠合并卵巢肿瘤的临床特点和诊断、处理方法。方法:对2005年1月至2010年12月我院收治的103例经手术及病理诊断的妊娠合并卵巢肿瘤患者的临床资料进行回顾性分析。结果:良性卵巢肿瘤99例(96.12%),非良性肿瘤中3例为交界性黏液性囊腺瘤,1例为黏液性囊腺癌。妊娠期卵巢良性肿瘤中以良性畸胎瘤为多见,有33例(32.04%)。孕早期超声诊断卵巢肿瘤42例;孕中期因常规检查超声诊断卵巢肿瘤15例,因急腹症经超声诊断的卵巢肿瘤9例;有37例患者因产科指征行剖宫产术时,术中探查发现卵巢肿瘤。9例急腹症行急诊手术,扭转7例,破裂2例;63例于剖宫产术中同时行卵巢肿瘤剥除术;另31例于顺产后,再行手术治疗。结论:超声检查在诊断及监测妊娠期卵巢肿瘤具有重要的指导意义,适时的手术并不影响妊娠结局。     

卵巢肿瘤合并妊娠85例分析

卵巢肿瘤合并妊娠在我国较为常见,常可出现一些并发症,还可影响本次妊娠的经过和结局,所以早期诊治关系到母婴安危。现将我院1979～1983年间收治的卵巢肿瘤合并妊娠85例作一回顾性分析。临床资料与结果此间我院共收治各类孕产妇45,041例,其中临床诊断卵巢肿瘤合并妊娠89例,最后经手术、病理及随访结果除外卵巢非赘生性肿瘤4例,实际卵巢肿瘤合并妊娠85例,发生率为1∶530次妊娠。年龄:均为21～40岁生育年龄妇女,其中21～25岁17例(20％),26～30岁54例(63.53％),31～35岁9例(10.59%),36～40岁5例(5.88％).21～30岁71例(83.53％)。孕产次:初孕妇79例(92.94%),经产妇6例(7.06％)。首次发现肿瘤的方式与孕周关系:见表1。     

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处理时机及方式对妊娠的影响。方法 回顾性分析我院1992年1月～2003年12月间收治的妊娠合并卵巢肿瘤患者117例，对比其处理方式与并发症发生情况及妊娠结局的关系。结果 妊娠合并卵巢肿瘤的急腹症并发症发生率较高，孕期采取非手术治疗者晚孕期并发症发生率显著高于孕28周前采取手术治疗者(P=0．044)，晚孕期手术治疗者早产发生率显著高于早、中孕期手术治疗者(P=0．048)。结论 本组资料显示妊娠合并卵巢肿瘤的手术最佳时机为早、中孕期，非手术治疗有增加妊娠期间急腹症并发症的风险，晚孕期手术治疗增加早产风险。     

妊娠合并卵巢肿瘤82例诊治体会

目的探讨妊娠合并卵巢肿瘤的临床特征及对妊娠结局的影响。方法对2003年1月至2005年12月上海市第一妇婴保健院收治的82例经手术及病理诊断的妊娠合并卵巢肿瘤患者的临床资料进行回顾性分析。结果妊娠期卵巢良性肿瘤80例,占97.56%,以生殖细胞肿瘤为多见,透明细胞癌1例,黏液性囊腺瘤交界型1例;孕早期超声诊断病例14例,占孕期发现的总例数的48.28%;有8例出现并发症并行急诊手术,扭转5例,破裂3例,有11例术前行血CA125检查,升高7例,其中1例为黏液性囊腺瘤交界型;足月分娩78例,占95.12%。结论超声检查在诊断及监测妊娠期卵巢肿瘤具有重要的指导意义,适时的手术干预并不影响妊娠结局,血清CA125检查在妊娠期卵巢良恶性肿瘤鉴别的意义有待进一步探讨研究。     

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。     

早、中期妊娠合并颅内静脉窦血栓形成10例临床处理分析

目的:探讨早、中期妊娠合并颅内静脉窦血栓形成患者的治疗及终止妊娠的临床处理.方法:回顾性分析我院2000 ～2011年收治的10例孕早期(8例)和孕中期(2例)妊娠合并颅内静脉窦血栓患者的临床资料.结果:伴意识障碍、脑血管造影明确为静脉窦血栓6例患者(孕早期4例,孕中期2例),行股静脉或颈静脉入路药物局部溶栓及机械联合溶栓和碎栓治疗.其中孕早期2例结合静脉窦成形术,1例孕早期及1例孕中期术后还保留微导管.6例患者中5例术后2～7天神智转清,临床症状明显改善,其中1例孕早期术后1天自然流产;2例孕早期患者病情平稳行负压吸引术;2例孕中期患者,1例行依沙吖啶羊膜腔穿刺引产,1例行剖宫取胎术;仅1例孕早期保留微导管患者溶栓期间出现全身出血倾向,经积极治疗,维持至孕中期行依沙吖啶羊膜腔穿刺引产.3例孕早期神清患者经甘露醇脱水降颅压及低分子肝素积极抗凝治疗,1周后病情平稳行负压吸引术.1例孕早期昏迷患者因弥漫性脑出血、脑疝,经开颅减压治疗无效后死亡.9例患者终止妊娠后均无并发症发生,2例遗留功能缺损,1例合并视物模糊,余6例预后较好.结论:妊娠合并颅内静脉窦血栓形成应积极治疗原发病,先行抗凝、溶栓等治疗,待病情平稳后终止妊娠,妊娠终止方法依据产科特点选择.     

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。     

45例妊娠合并卵巢肿瘤及卵巢瘤样病变的临床分析

目的:探讨妊娠合并卵巢肿瘤及卵巢瘤样病变的处理及并发症的防治。方法:对我院45例妊娠合并卵巢肿瘤及卵巢瘤样病变的患者进行回顾性分析。结果:24例良性肿瘤,2例恶性肿瘤(4.4%),19例为卵巢瘤样病变;发生扭转4例(8.9%);破裂4例(8.9%);孕妇失血性休克1例;早产4例;新生儿重度窒息、死亡各1例。卵巢肿瘤及卵巢瘤样病变的直径≥5cm组中并发症及围生儿病率均明显高于直径<5cm组。结论:直径≥5cm的卵巢肿瘤及卵巢瘤样病变,孕期并发症明显增加,建议于孕中期手术,如怀疑恶性,应立即手术。     

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…     

Ultrasound study of ovarian cysts in pregnancy: prevalence and significance

Previous surveys of the prevalence and natural history of ovarian cysts have been based on those ascertained by clinical examination. This study examines the fate of 137 adnexal cysts discovered during the course of 26 110 ultrasound scans in early pregnancy. Of these 10% were operated on in the first instance, and a further 2% required operation during pregnancy for painful complications. In 3% cysts were removed at caesarean section or in the puerperium. Half the removed cysts were neoplastic including one low grade carcinoma. Of the 120 cysts treated conservatively, 89% could not be detected on ultrasound examination later in pregnancy. All cysts greater than 8 cm should be removed, as should smaller cysts that are multilocular, thick-walled or semi-solid.     

The diagnostic value of ultrasound examination in detection of ovarian tumors during pregnancy

OBJECTIVE: Ovarian neoplasms represent one of the diagnostics problems in obstetrics. The enlarged uterus changing the topography of the minor pelvis makes correct diagnosis of ovarian neoplasms difficult. DESIGN: The aim of our study was to evaluate the accuracy of ultrasound examination in diagnostics of ovarian neoplasms during pregnancy. MATERIALS AND METHODS: Ultrasound examination was performed in the group of 9,356 pregnant women, admitted to the Institute of Obstetrics and Gynaecology Medical University of ?ód? during the second and the third semester. RESULTS: We diagnosed 14 neoplasmatical ovarian tumors (0.17% examined population). Each of them was of the diameter larger than 50 mm. The other 2 tumors were not visualised in ultrasound examination, but during the laparotomy performed because of acute abdominal symptoms. 15 benign and 1 border line tumor were found among ovarian neoplasms. CONCLUSIONS: During ultrasound examination in pregnancy should contain routine assessment of both adnexa. There are difficulties in visualisation of adnexal lesions located behind uterus. Therefore the role of ultrasound tumor diagnostic in pregnant women is limited.     

Ovarian Tumours in Pregnancy

Ovarian tumours associated with pregnancy were reviewed for the period 1982-1991. The overall incidence of this complication was 1:653 deliveries; 62.7% of the tumours were diagnosed in the first and second trimesters of pregnancy. The value of routine pelvic examination and ultrasonic scan as a diagnostic aid in early pregnancy is emphasized; 25.4% of patients presented as an acute emergency; 23.9% of the tumours were incidentally discovered at Caesarean section which underlines the importance of examining the ovaries at operation. Benign cystic teratomas were the most common ovarian tumours found, followed by serous cystadenomas. The incidence of malignant tumours was 4.5%. Whenever an ovarian tumour is found, the possibility of malignancy should always be borne in mind. Treatment of ovarian tumours in pregnancy should be tailored according to the age of the patient, parity, clinical presentation, gestational age and biology of the tumour.     

Krukenberg tumor mimicking pregnancy luteoma

Background. Pregnancy-associated Krukenberg tumor is very rare, and the diagnosis in pregnancy is even more difficult. Usually symptoms are attributed to pregnancy luteomas, which are hormone-active benign neoplasms.

Case. A 22-year-old female presented at the 28th week of gestation with rapid onset of hirsutism and acne since the 20th week of gestation. Physical and ultrasonographic examinations revealed bilateral ovarian solid masses which were considered as pregnancy luteomas. The patient underwent exploratory laparotomy due to the onset of ascites and elevated tumor markers four months after delivery. Histopathologic examination revealed adenocarcinoma with signet-ring-type cells.

Conclusion. Krukenberg tumors should be considered in the differential diagnosis of pregnancy luteomas. Otherwise, early diagnosis of the tumor can be delayed.     

腹腔镜早期诊治可疑异位妊娠的临床意义

目的 评估可疑异位妊娠(ectopic pregrnancy，EP)患者腹腔镜(laparoscopy，LSC)早期诊断和急诊手术的临床价值。方法 回顾分析1998年8月至2003年8月收治的经LSC手术治疗的可疑EP患者186例，均在入院24h内接受急诊LSC手术。结果 185例手术经腹腔镜完成，l例中转开腹，均无并发症发生。术中诊断EP172例(均经病理证实)，术前诊断符合率92．5％；其余病例依次为卵巢囊肿9例(4．8％)，宫内妊娠黄体破裂5例(2．7％)。32例合并不孕患者中25例有盆腔粘连，17例有输卵管卵巢病变，均行相应处理。12例少见异位妊娠(包括4例输卵管间质部妊娠，4例卵巢妊娠，3例腹腔妊娠，l例子宫肌壁间妊娠)，15例休克型异位妊娠，经腹腔镜手术亦获满意治疗效果。结论 急诊LSC手术不仅可早期确诊可疑EP患者，为保守性治疗赢得时间，而且还可同时对不孕症患者进行诊治。急诊LSC手术治疗休克型及少见异位妊娠亦是可行且安全的。     

Accurate diagnosis of early ectopic pregnancy

Commonly used preoperative diagnostic procedures were analyzed for their ability to predict the presence of early ectopic pregnancy. Patients presenting to the emergency room with acute onset of pelvic pain were evaluated with culdocentesis, pelvic ultrasonography, and qualitative serum and urine pregnancy testing. Clinical examination and urine pregnancy testing were found to be poor predictors of either the presence or absence of an early ectopic pregnancy. The combination of a sensitive serum human chorionic gonadotropin (hCG) determination and pelvic ultrasonography accurately predicted ectopic pregnancy in 93% of proved cases. This predicted accuracy was superior to that of culdocentesis alone or in combinations of culdocentesis and ultrasound or qualitative serum pregnancy testing.     

宫腹腔镜联合检查在原因不明不孕症诊断和治疗中的临床价值

目的探讨宫腹腔镜联合检查在原因不明不孕症诊断和治疗中的重要性。方法回顾性分析2012年5月至2015年12月因原因不明不孕症在北京协和医院行宫腹腔镜联合检查的患者519例,宫腹腔镜联合检查寻找"原因不明"不孕症的病因。结果在519例原因不明不孕症患者中,宫腹腔镜联合检查未发现异常者占10.2%(53/519),发现盆腔异常者占89.8%(466/519);盆腔异常患者分别为72.4%(376/519)盆腔粘连合并子宫内膜异位症、12.3%(64/519)盆腔粘连、3.7%(19/519)子宫肌瘤或卵巢囊肿以及1.3%(7/519)子宫内膜息肉。宫腹腔镜联合检查后随访12~36个月,最终纳入386例患者统计术后自然妊娠情况,术后总自然妊娠率为53.9%(208/386),年龄≥35岁患者的自然妊娠率为29.8%(31/104)。结论临床诊断为原因不明不孕症的患者,应行宫腹腔镜联合检查,在宫腹腔镜联合检查下能更直观地发现不孕症的病因,并且可进行针对性的治疗,提高妊娠率。高龄患者术后自然妊娠率明显下降,尝试自然妊娠的时间不宜过长。     

卵巢子宫内膜异位症恶变26例临床病理分析

目的 探讨探讨卵巢子宫内膜异位症（内异症）恶变的临床病理特征。方法 回顾分析26例卵巢内异症恶变患者的临床和病理资料。结果 患者以痛经和检查发现盆腔肿块为主要临床表现。行B超或彩色多普勒超声检查者18例,其中10例发现盆腔肿块中含实质性结构。肿瘤组织类型以内膜样腺癌和透明细胞癌常见。58％（15／26）患者的肿瘤显微镜下可见不典型内异症。协际妇产科联盟分期：Ⅰ期21例（81％）,Ⅱ期3例（12％）,Ⅲ期2例（8％）。结论 卵巢内异症恶变早期临床诊断存在困难,B超或彩色多普勒超声检查有重要参考价值。重视观察异位内膜组织形态变化,有利于认识卵巢内异症恶变的发生和发展过程,提高诊断和治疗水平。     

38例子宫角部妊娠超声检查分析

目的 探讨超声检查对子宫角部妊娠的诊断及临床应用价值。方法 对３８例患者超声检查进行回顾性分析。结果 胚囊型１３例，在宫腔波即将消失或消失的同时可探及胚囊光环，与宫腔相通。不均质包块型８例，在突起的宫角内可探及团状不均质回声似蜂窝状结构强弱相同。残留型１７例，在突起的宫角内可探及环状暗区间有强回声或团状强回声或团状强回声与宫腔相通。结论 胚囊型易被忽视，妊娠早期超声检查可及早发现。不均质包块型易被     

Is the early growth delay in the diabetic pregnancy accompanied by a delay in placental development?

We have previously shown that some fetuses in early diabetic pregnancy judged by the crown-rump length are smaller than expected from the menstrual history. Nine out of 26 fetuses in the present study were significantly (6 to 17 days) smaller than normal, and at birth they weighed 300 g less than the remainder. To examine whether this early somatic growth delay was accompanied by a delay in placental development, we correlated plasma levels of human placental lactogen (HPL) to menstrual age and growth delay. Multiple regression analysis showed that inclusion of the early growth delay as an explanatory variable significantly improved the correlation. The best correlation was achieved when menstrual ages were corrected by 90% of the early growth delay, suggesting that the somatic growth delay is accompanied by a similar delay in placental development. We recommend that every diabetic woman should undergo an ultrasound examination in early pregnancy, with determination of fetal size, and that management throughout pregnancy should be guided by the ultrasound age rather than that calculated from the first day of the last menstrual period.