腹腔镜下治疗卵巢良性畸胎瘤39例临床探讨

卵巢良性畸胎瘤是卵巢肿瘤中最常见疾病之一，又称皮样囊肿，占卵巢肿瘤的10～20％。近年来，随着腹腔镜手术技术的应用和发展，腹腔镜可在电视监视下行良性畸胎瘤剥出术或附件切除术。自2002年6月至2004年6月采用腹腔镜手术治疗卵巢良性畸胎瘤39例，取得满意效果，现将结果报告如下：     

卵巢巨大成熟畸胎瘤1例

患者 ,女 ,2 1岁 ,藏族 ,已婚 ,因近 2月下腹部进行性增大伴隐痛 ,加重 3d ,于 2 0 0 3- 0 4 - 17入院。患者 2月前无明显诱因出现下腹部进行性增大伴隐痛 ,食欲差 ,恶心无呕吐 ,自觉消瘦 ,无发热、发冷、午后盗汗、尿频、尿急、尿痛、腹泻等不适 ,未就诊。 3d前因劳累后下腹部疼痛加剧 ,故来我院就诊。入院查体 :面色及睑结膜苍白 ,双侧腹股沟各有一蚕豆大小的淋巴结 ,质硬 ,压痛阳性 ,活动度好 ,其它表浅淋巴结末触及肿大。腹部膨隆 ,下腹正中耻骨联合上三横指有一2cm的瘢痕。右下腹可触及一足球大小之肿物 ,形态尚规则 ,质中、活动尚可 ,…     

电视腹腔镜下手术治疗卵巢良性畸胎瘤126例临床分析

目的：探讨电视腹腔镜下卵巢良性畸胎瘤手术的技巧及临床应用价值。方法：对126例卵巢成熟型囊性畸胎瘤患者在腹腔镜下行囊肿剔除术或附件切除术，分析其手术适应证、术中、术后情况及并发症。结果：本组卵巢畸胎瘤均在腹腔镜下完成手术，单侧118例，双侧8例，囊肿直径3—9cm，104例行囊肿剥除术，22例行患侧附件切除术。平均手术时间50min，术中出血量平均45ml。术后体温第2天恢复正常115例，占91．3％。术后住院平均4．2d。术后无1例切口感染、出血、脏器损伤或化学性腹膜炎及肉芽肿等并发症发生。随访6—40个月，所有病例均无复发。结论：该手术是一种安全、有效的方法，具有损伤小、出血少、恢复快、并发症少等优点。     

双卵巢及右输卵管成熟畸胎瘤1例

患者女,28岁。因体检发现盆腔包块1周入院。平素月经规则,无腹痛,无异常阴道排液。查体：血压120／70mmHg,心肺无异常,腹软,下腹无压痛、反跳痛。妇科检查：     

比较两种术式治疗卵巢成熟性畸胎瘤的效果

目的比较经阴卵巢畸胎瘤剥出手术与腹腔镜卵巢畸胎瘤剥出手术的临床效果。方法回顾经阴卵巢畸胎瘤剥出手术30例的临床资料并与同期腹腔镜手术30例的手术时间、失血量、术后病率、肠功能恢复及住院费用、住院日及恢复时间等项临床指标并进行分析比较。结果阴道组手术时间、术后肠道排气时间、术后病率、住院费用两组比较有统计学差异(P<0.05)。术中出血、术后住院日及恢复时间,两组比较无统计学差异(P>0.05)。结论经阴道行卵巢成熟性畸胎瘤剥除术是一种安全微创的手术,与腹腔镜比较,经阴卵巢畸胎瘤剥出手术手术时间短、术后病率低、肠功能恢复快、住院费用低,适用于已婚卵巢畸胎瘤患者。     

卵巢畸胎瘤的CT诊断

目的 分析卵巢畸胎瘤的CT表现，提高CT诊断的准确性。资料与方法 搜集经手术和病理证实的43例49个卵巢畸胎瘤，对其CT表现作回顾性分析。结果 49个卵巢畸胎瘤中，成熟性畸胎瘤45个，未成熟性畸胎瘤3个，卵巢甲状腺肿1个。45个为囊性，其中单房29个(64％)，双房8个(18％)，多房8个(18％)。2个为囊实性，2个为实性，后者均为未成熟性。46个(96％)畸胎瘤含脂肪密度组织，16个(32％)瘤内见毛发，25个(51％)见向囊内突起的头结节，25个(5l％)瘤内见钙化或牙齿。根据CT表现，成熟性畸胎瘤可分为液性为主型、液脂型、头结节型、脂肪瘤型和囊肿型。术前CT诊断敏感性和准确性分别为96％和88％。结论 绝大多数卵巢畸胎瘤有典型的CT表现，少数不含脂肪的囊肿型肿瘤定性仍有困难。     

卵巢未成熟畸胎瘤三例分析

卵巢未成熟畸胎瘤临床少见 ,笔者报告我院 3例经手术病理证实的卵巢未成熟畸胎瘤 ,并结合文献进行分析。3例卵巢未成熟畸胎瘤 ,年龄 2 8～ 30岁 ,平均 2 8.66岁。出现症状到就诊时间均在 2个月内。主诉下腹部包块 ,伴腹胀、腹痛。 3例患者先行ＣＴ平扫 ,再行增强扫描 (图 1、2 ) ,均在右侧卵巢处发现一个实质性包块 ,ＣＴ诊断为未成熟畸胎瘤 ,经手术病理证实均为卵巢未成熟畸胎瘤 3级。卵巢未成熟畸胎瘤发病率占畸胎瘤的 0 .90 %～ 1.44 %。好发于少女和青年妇女。患者多因下腹部出现包块 ,且在短期内迅速增大而就医。肿瘤体积大 ,直径 7～ …     

卵巢成熟畸胎瘤并急性并发症的CT表现

目的:探讨CT对卵巢成熟畸胎瘤并急性并发症的诊断价值。方法:回顾性分析10例经手术病理证实的卵巢成熟畸胎瘤并急性并发症的CT表现。结果:10例共11个卵巢成熟囊性畸胎瘤,其中7个蒂扭转,5例出现扭转的蒂部与肿瘤形成的囊实性双肿块,4例囊壁增厚。3例畸胎瘤破裂出血,其中2例合并盆腔积血。结论:通过典型的征象分析,CT对于术前诊断卵巢成熟畸胎瘤并急性并发症具有较大的意义。     

卵巢囊性畸胎瘤66例超声显像的分析

卵巢囊性畸胎瘤６６例超声显像的分析曾云宽①关键词卵巢畸胎瘤中图法分类号Ｒ７１１．７５良性囊性畸胎瘤，术前诊断率较低。１９９２－０５～１９９６－０８，我院用超声检查卵巢囊性畸胎瘤６６例，现将声像结果分析报道如下。１资料与方法本组６６例，年龄２０岁～４６...     

卵巢畸胎瘤的MRI诊断价值

目的：探讨卯巢畸胎瘤的MRI征象特点及其诊断价值。方法：搜集经手术病理证实的12例卵巢畸胎瘤的MRI资料进行回顾性分析。结果：12例卵巢畸胎瘤中,左侧9例,右侧3例,最大直径13．8cm,9例为圆形或椭圆形,3例为不规则形。10例见脂质信号,6例见明显的双低钙质信号。11个良性者5例显示壁结节,2例实性肿块,1例恶性者信号欠均匀,并有腹膜转移、腹腔积液。结论：对于发生于卵巢的肿瘤,含有脂质的双高信号或钙质的双低信号考虑为卵巢畸胎瘤。     

CT images of a malignant-transformed ovarian mature cystic teratoma with rupture: a case report

A malignant transformation or a tumor rupture is a rare complication of ovarian mature cystic teratoma (MCT). A tumor rupture in a malignant-transformed MCT has never been reported in the literature. We present the CT images of a 39-year-old woman showing a large, predominantly cystic mass in the lower abdomen, with fat-fluid-level ascites. A contrast-enhanced solid component, with regional discontinuity within the cystic lesion, is also demonstrated. The pathologic diagnosis of the ruptured MCT unveils the malignant transformation (squamous cell carcinoma) and mesenteric carcinomatosis.     

CT findings of mature cystic teratoma with malignant transformation: comparison with mature cystic teratoma

Purpose

To evaluate the imaging findings of mature cystic teratoma with malignant transformation (malignant teratoma) compared with the corresponding mature cystic teratoma (benign teratoma).

Materials and methods

This study enrolled 1325 patients with 12 malignant teratomas and 1313 benign teratomas. We compared the computed tomographic (CT) findings of eight malignant teratomas and 15 benign teratomas; both groups were matched in terms of tumor size (>9.9 cm) and patient age (>45 years). The CT images were retrospectively evaluated with focus on soft tissue components; size, border (regular or irregular), the presence or absence of nodular formation, enhancement, the angle formed between the soft tissue components and the inner wall of the cyst (acute or obtuse), and transmural growth as well as metastasis including lymphadenopathy and disseminated disease. Using the Fischer's Exact test, each evaluating parameter was compared between the two groups.

Results

Soft tissue components were observed in 75% (six of eight) of malignant teratomas and in 33% (five of fifteen) of benign teratomas; 100% (six of six) of soft component in malignant teratomas had a nodular formation and none of soft component in benign teratomas showed nodular formation; 83% (five of six) of soft component in malignant teratomas had enhancement as well as an obtuse angle between the soft tissue components and the inner wall of the cyst. None of soft component in benign teratomas showed enhancement and 20% (one of five) of soft component in benign teratomas had an obtuse angle; 33% (two of six) of soft component in malignant teratomas showed transmural growth, 13% (one of eight) of malignant teratoma showed lymphadenopathy, and 38% (three of eight) showed disseminated disease. None of benign teratomas showed transmural growth, lymphadenopathy, or disseminated disease. A statistically significant difference between patients with and without malignant transformation was seen in terms of nodular formation, obtuse angle, and enhancement of the soft tissue components (P<.05).

Conclusion

Malignant teratoma is characterized by the following imaging findings: the presence of a nodular forming and enhancing soft tissue component, an obtuse angle between the soft tissue and the inner wall of the cyst, as well as extracapsular tumor growth with extension into adjacent structures or metastasis. Therefore, we can differentiate malignant teratoma from benign teratoma using CT findings.     

腹腔镜下卵巢切除或卵巢囊肿剔除术与传统开腹手术的对比分析

目的 对比分析腹腔镜下卵巢切除或卵巢囊肿剔除术与传统开腹手术的临床效果。方法回顾性分析2011年12月~2013年12月因卵巢囊肿在我院行卵巢切除或卵巢囊肿剔除术治疗的患者110例,将患者按照不同的手术方式分为腹腔镜组（采用腹腔镜微创手术治疗）及开腹组（采用传统外科手术治疗）,各55例,采用统计学方法比较两组的临床效果。结果①计量资料：腹腔镜组住院时间、术后抗炎时间、术后排气时间、术后下床时间及手术时间与开腹组比较均明显缩短,术中出血量明显减少（P＜0.05）。②计数资料：腹腔镜组术后镇痛率与开腹组比较明显较低,而术后并发症发生率明显较高（P＜0.05）。结论在腹腔镜下对卵巢囊肿患者实施卵巢切除和卵巢囊肿剔除术能使其治疗效果显著提高,改善预后。     

Malignant transformation of a mature retroperitoneal teratoma into adenocarcinoma

Retroperitoneal mature teratoma is a rare congenital tumor, far behind ovarian and testicular localizations. Malignant transformation of teratomas is extremely uncommon. We report a case of a 23-year-old female, who presented with chronic pelvic heaviness, abdominopelvic ultrasound revealed a cystic mass in the right iliac fossa, initially considered as a functional ovarian cyst. Given the persistence of the patient''s symptoms a pelvic MRI was requested. It showed a right retro-colic cystic unilocular with parietal nodule. The two ovaries showed normal appearance. A retroperitoneal teratoma was suggested given the retroperitoneal topography of the mass, and the presence of a tissular parietal nodule. She underwent surgery and the diagnosis was confirmed after histological study     

卵巢囊性成熟性畸胎瘤的X线诊断和临床意义(附131例分析)

目的 :探讨 X线检查对卵巢囊性成熟性畸胎瘤的诊断价值和临床指导意义。方法 :131例行常规 X线检查发现囊性成熟性畸胎瘤 ,所有病例均经手术病理证实。结果 :X线报告符合率为 97.3% ,优于 B超。 145个卵巢囊性成熟性畸胎瘤中 ,47个仅表现为低密度阴影 ,36个仅表现为特异性的骨片、牙齿等致密影 ,6 2个既有低密度影 ,又有致密影。结论 :常规 X线检查在诊断卵巢囊性成熟性畸胎瘤方面占一些优势。     

A massive retroperitoneal mature teratoma from a “burned-out” testicular teratoma and seminoma

Germ cell tumors are the most common nonhematologic malignancy of young men which often present with metastasis to the retroperitoneum, however a primary retroperitoneal mass should also be considered. The case presented herein reports a 42-year-old male presenting with a massive heterogenous retroperitoneal mass determined to be a mature cystic teratoma. Further investigation revealed a multifocal right testicular mass containing both a viable pure seminoma and a fibrous scar demonstrating germ cell neoplasia in situ thus representing the rare phenomenon of a “burned-out” mixed germ cell testicular tumor. When the radiologist is faced with a large retroperitoneal fat-containing mass, the differential includes a renal angiomyolipoma, liposarcoma, or germ cell tumor (whether primary or secondary). If pathology reveals a germ cell tumor, it is imperative to perform a thorough evaluation of the gonads, as it is much more common for a retroperitoneal germ cell tumor to be a metastasis from the gonads, rather than primary in origin.     

腹腔镜全子宫并双侧输卵管切除对绝经后妇女卵巢功能的影响

目的：探讨腹腔镜全子宫并双侧输卵管切除对绝经后妇女卵巢功能的影响。方法选取2011年7月—2013年7月汉中市中心医院妇科行腹腔镜全子宫切除术的绝经后子宫良性肿瘤患者145例（含19例脱落病例）作为研究对象,根据是否切除双侧输卵管分组,观察组86例切除双侧输卵管,对照组59例保留双侧输卵管,剔除脱落病例,观察组最终纳入75例,对照组最终纳入51例。记录2组手术时间、术中出血量、住院时间;随访术后24个月,对比手术前、术后3、12、24个月雌二醇（estradiol,E2）、卵泡刺激素（follicle stimulating hormone,FSH）、黄体生成素（luteinizing hormone,LH）、收缩期血流峰值流速（Vmax）、舒张末期最小血流速度（Vmin）、阻力值（resistance value,RI）、搏动指数（pulsatility index, PI）变化,并行改良更年期综合征（Kupperman）评分,记录随访24个月内输卵管病变、盆腔包块及再手术发生率。结果2组术后12、24个月E2、FSH、LH与术前比较,差异有统计学意义（P＜0.05）,术后3个月与术前比较,差异无统计学意义（P＞0.05）;观察组术后12、24个月E2显著低于对照组,FSH、LH显著高于对照组（P＜0.05）。2组术后Vmax、Vmin显著下降,RI、PI显著上升,与治疗前相比差异有统计学意义（P＜0.05）,但2组间术前及术后3、12、24个月各时间点对比,差异无统计学意义（P＞0.05）。观察组随访末期Kupperman评分显著高于对照组,差异有统计学意义（P＜0.05）。观察组术后输卵管病变、盆腔包块发生率分别为0、5.33%,显著低于对照组的19.61%、17.65%,差异有统计学意义（P＜0.05）。结论腹腔镜全子宫并双侧输卵管切除对卵巢功能有不良影响,会加重绝经后症状,但可降低术后输卵管病变、盆腔包块发生率。