30岁以下卵巢肿瘤患者223例临床分析

目的:探讨年龄30岁以下卵巢肿瘤患者的临床特点、病理类型、治疗及预后.方法:回顾性分析1992年10月一2007年10月间、年龄30岁以下223例卵巢肿瘤患者的临床资料.结果:有明显临床症状就诊者占71.30%(168/223).良性肿瘤192例(86.10%),恶性肿瘤包括低度恶性潜能上皮性肿瘤(L,MP)31例(13.90%).生殖细胞肿瘤91例、上皮性肿瘤72例、性索间质肿瘤9例、卵巢瘤样病变5l例.良性肿瘤中蒂扭转者切除卵巢的比例高于非蒂扭转者.恶性肿瘤手术病理分期:I期28例、Ⅱ期l例、Ⅲ期2例,其中22例保留生育功能.11例LMP患者术后未化疗,其余20例恶性肿瘤患者中19例进行化疗.随访时间10～181个月,27例无瘤生存,4例死亡;21例月经正常,9例有生育计划的患者中.7次妊娠.4次足月分娩.总5年生存率为80.2l%,病理分期是影响生存率的主要因素.结论:30岁以下年轻患者卵巢肿瘤以良性、生殖细胞肿瘤为主.卵巢恶性肿瘤临床手术病理分期早期,手术应尽可能保留生育功能.化疗对卵巢及生育功能无明显影响.应重视年轻女性的临床表现并定期妇科检查.     

年轻卵巢恶性肿瘤患者139例临床分析

目的探讨年龄30岁以下卵巢恶性肿瘤患者的临床特点、病理类型、治疗方案及预后。方法回顾性分析2010年1月至2015年1月间就诊于中国人民解放军总医院、年龄位于30岁以下的139例卵巢肿瘤患者的临床资料,对其发病特征,病理类型,手术方式,术后辅助化疗进行分析。结果有明显临床症状就诊者占87.77%(122/139),卵巢恶性肿瘤病理分类包括上皮性肿瘤58例(41.73%)、生殖细胞肿瘤79例(56.83%)、性索间质肿瘤1例(0.72%)、转移性肿瘤1例(0.72%)。手术病理分期:Ⅰ期103例,Ⅱ期13例,Ⅲ期18例,Ⅳ期5例。109例行保留生育功能手术。127例行术后辅助化疗。随访超过24个月的患者中65例无瘤生存,复发8例,5例死亡;66例月经化疗后恢复正常,33例有生育计划的患者中21次妊娠,11例足月分娩。结论卵巢癌病理类型与年龄相关,幼女及青少年是生殖细胞为主。卵巢恶性肿瘤临床手术病理分期早期,手术应尽可能保留生育功能。应重视年卵巢疾病的临床表现并定期妇科检查,早期诊治可有效改善预后。     

青少年卵巢肿瘤的临床病理分析

目的:探讨青少年卵巢肿瘤的临床病理特点。方法:回顾性分析67例20岁以下的青少年卵巢肿瘤患者的临床表现、诊断、病理和治疗。结果:临床症状以腹痛、腹部包块为主,肿瘤扭转率高。良性肿瘤41例,交界性3例,恶性23例;组织学类型以生殖细胞肿瘤最多。恶性肿瘤中65.2%为FIGOI期。除8例恶性患者进行了肿瘤细胞减灭术外,其余59例均进行了保留生育功能的手术。15例恶性肿瘤患者术后化疗。单因素分析显示仅化疗方案影响生存期,BEP优于VAC。结论:青少年卵巢肿瘤的临床病理特点与成人不同,首选保留生育功能的手术,BEP是恶性患者的一线化疗方案。     

青春期少女卵巢上皮性肿瘤的临床特点及治疗

目的探讨青春期少女卵巢上皮性肿瘤的临床特点及治疗方法。方法回顾性分析北京协和医院1983年1月-2002年10月间收治的全部13～19岁卵巢上皮性肿瘤患者29例。其中,良性肿瘤20例、交界性肿瘤4例、恶性肿瘤5例。结果患者平均年龄16．5岁,其中13-14岁3例(10％)、15．16岁9例(31％)、17-19岁17例(59％)。临床表现主要为腹痛、腹胀、下腹部巨大肿物。病理类型：黏液性肿瘤22例,浆液性肿瘤6例,子宫内膜样肿瘤1例。手术病理分期：交界性或恶性肿瘤患者9例中,Ⅰ期8例,Ⅲc期1例。治疗：良性肿瘤20例中,开腹行一侧附件切除术9例,腹腔镜下行卵巢囊肿剔除术11例;9例交界性或恶性肿瘤患者全部施行了肿瘤细胞减灭术和全面的分期手术,其中8例I期患者保留了生育功能,1例Ⅲc期患者未保留生育功能;5例恶性肿瘤患者中,4例接受了4-6个疗程以顺铂为主的化疗。随访期间良、恶性肿瘤无一例复发。结论青春期少女卵巢上皮性肿瘤的发生率随年龄的增长而增加;黏液性肿瘤是最常见的病理类型。对于多数良性肿瘤患者可以考虑腹腔镜下行肿瘤剔除术;对于交界性或恶性肿瘤患者应兼顾治愈肿瘤和保留生育功能,治疗方案应个体化。     

卵巢无性细胞瘤25例分析

报道我院１９７１年～１９９３年收治的卵巢无性细胞瘤２５例，分析表明：该肿瘤多见于３３岁以下的青年妇女，发病率占卵巢肿瘤的０．６８％，占卵巢恶性肿瘤的６．５１％。其治疗应根据肿瘤临床分期、病理组织学特征、年龄和生育要求决定手术范围及术后放疗或化疗。     

卵巢恶性肿瘤保留生育功能治疗52例临床分析

目的:评价卵巢恶性肿瘤保留生育功能手术和化疗对生育和卵巢功能的影响.方法:回顾性分析我院1996年6月至2010年6月卵巢恶性肿瘤行保留生育功能治疗并有完整随访资料的52例患者的临床资料,对其手术、术后化疗及术后月经和妊娠情况进行分析,并对是否行全面分期手术和不同病理类型行保留生育功能治疗后的生存率和复发率相比较,以及是否化疗的妊娠率进行比较.结果:52例患者中生殖细胞恶性肿瘤25例,上皮性恶性肿瘤12例,交界性肿瘤15例.复发3例,其中1例死亡.计划妊娠41例中妊娠成功16例,2例流产.术后化疗的38例患者中,2例化疗期间月经正常,36例在化疗1～2次后停经,但停止化疗后月经恢复.52例患者中行全面分期手术(15例)的生存率和复发率与行附件切除术或卵巢肿瘤剥除术(37例)比较,差异均无统计学意义(P均＞0.05).3种病理类型肿瘤患者保留生育功能治疗后的生存率和死亡率比较,差异均无统计学意义(P＞0.05).化疗患者中的妊娠率与未化疗患者的妊娠率比较,差异也无统计学意义(X2 =0.1186,P＞0.05).结论:卵巢恶性肿瘤保留生育功能治疗是有效和可行的,化疗对卵巢功能可能有影响,但可以逆转.保留生育功能手术以附件切除术或病灶切除术为宜,但结论尚有待大样本量研究及长期随访.     

310例儿童及青少年卵巢肿瘤临床分析

目的:分析儿童、青少年卵巢肿瘤的临床病理特点、诊治和预后。了解保留生育后的月经恢复及生育情况。方法:收集2000年1月~2015年8月青岛大学附属医院收治的年龄19岁的310例卵巢肿瘤患者的临床病例资料,包括发病特点、临床表现、辅助检查、治疗方法及相关预后。患者中,≤12岁81例(儿童组),13~19岁229例(青少年组)。结果:患者常见临床症状以腹痛、月经不规律为主。良性肿瘤269例(86.77%),恶性肿瘤36例(11.61%),交界性肿瘤5例(1.61%)。其中生殖细胞肿瘤最多191例(61.61%),其次是卵巢瘤样病变61例(19.68%)。儿童组中恶性及交界性肿瘤分别为14.81%(12/81)和0,青少年组中恶性及交界性肿瘤比例分别为10.48%(24/229)和2.18%(5/229)。B超及肿瘤标记物有助于卵巢良、恶性肿瘤的诊断。卵巢恶性生殖细胞肿瘤(MOGCT)大都采取保留生育功能的术式,5年总生存率、月经及后代生育情况均无明显影响。结论:儿童及青少年有腹痛、月经不规律及腹胀症状时,应充分排除卵巢肿瘤可能。儿童、青少年卵巢肿瘤有其自身特点,对恶性生殖细胞肿瘤首选保留生育功能术式。保留生育手术后生存率较高,月经及生育能力亦无不良影响。     

卵巢肿瘤组织中p53和P－糖蛋白的表达及其临床意义

目的：评价卵巢肿瘤组织中突变型ｐ５３基因和Ｐ－糖蛋白（Ｐ－ｇｐ）表达的临床病理意义及其相互关系。方法：采用免疫组织化学法测定卵巢恶性肿瘤５３例，卵巢良性肿瘤２０例和正常卵巢组织１７例的ｐ５３和Ｐ－ｇｐ的表达，并与临床病理因素进行相关分析。结果：１．卵巢恶性肿瘤组织中ｐ５３和Ｐ－ｇｐ阳性表达率分别为４６．７％和３５．８％，卵巢良性肿瘤和正常卵巢组织中则无一例ｐ５３和Ｐ－ｇｐ表达。２．Ⅲ～Ⅳ期患者和低分化卵巢恶性瘤组织中ｐ５３表达阳性率高于Ⅰ～Ⅱ期和高、中分化者，而Ｐ－ｇｐ表达与临床分期、组织学类型和分级无明显相关性。３．Ｐ－ｇｐ表达阳性和阴性的卵巢恶性肿瘤患者，对化疗的有效率分别为３１．６％和６４．７％，而ｐ５３阳性表达与化疗效果无明显相关性。结论：组织中的ｐ５３和Ｐ－ｇｐ表达测定对判断卵巢恶性肿瘤的预后和对化疗的敏感性有一定的价值。     

卵巢肿瘤组织中p53和P－糖蛋白的表达及其临床意义

目的：评价卵巢肿瘤组织中突变型ｐ５３基因和Ｐ－糖蛋白（Ｐ－ｇｐ）表达的临床病理意义及其相互关系。方法：采用免疫组织化学法测定卵巢恶性肿瘤５３例，卵巢良性肿瘤２０例和正常卵巢组织１７例的ｐ５３和Ｐ－ｇｐ的表达，并与临床病理因素进行相关分析。结果：１．卵巢恶性肿瘤组织中ｐ５３和Ｐ－ｇｐ阳性表达率分别为４６．７％和３５．８％，卵巢良性肿瘤和正常卵巢组织中则无一例ｐ５３和Ｐ－ｇｐ表达。２．Ⅲ～Ⅳ期患者和低分化卵巢恶性瘤组织中ｐ５３表达阳性率高于Ⅰ～Ⅱ期和高、中分化者，而Ｐ－ｇｐ表达与临床分期、组织学类型和分级无明显相关性。３．Ｐ－ｇｐ表达阳性和阴性的卵巢恶性肿瘤患者，对化疗的有效率分别为３１．６％和６４．７％，而ｐ５３阳性表达与化疗效果无明显相关性。结论：组织中的ｐ５３和Ｐ－ｇｐ表达测定对判断卵巢恶性肿瘤的预后和对化疗的敏感性有一定的价值。     

年轻非良性卵巢肿瘤患者保留生育功能57例临床分析

目的分析年轻非良性卵巢肿瘤患者保留生育功能治疗的现状及复发情况。方法选择2000年1月至2010年4月北京大学人民医院收治的年龄≤40岁、未完成生育功能、因交界性或恶性卵巢肿瘤行保留生育功能治疗的患者57例,分析临床资料并随访肿瘤的复发情况。结果在57例患者中,交界性卵巢上皮性肿瘤38例（66.7%）,恶性生殖细胞肿瘤17例（29.8%）,其他类型2例;肿瘤分期Ⅰ期49例（86.0%）,Ⅱ期2例,Ⅲ期6例;单侧附件切除手术者33例（57.9%）,行分期手术者17例（29.8%）;化疗29例（50.9%）。成功随访42例,中位随访时间40.5个月（10～119个月）。恶性肿瘤患者无复发;交界性肿瘤患者中,8例复发,复发率25.0%。交界性肿瘤复发组（8例）和非复发组（24例）患者中位无瘤生存时间分别为21.5个月和40.5个月（P〈0.01）。微乳头结构是交界性浆液性卵巢肿瘤患者复发的危险因素（P〈0.05）。结论≤40岁、未完成生育功能的非良性卵巢肿瘤患者中以交界性肿瘤最常见;目前保留生育功能的治疗存在不同程度的问题;但肿瘤本身的特点是影响复发的主要因素。     

青春期卵巢上皮性交界瘤7例临床分析

的探讨青春期卵巢上皮性交界瘤的临床特点。方法回顾性分析本院2000年1月～2006年12月收治的7例20岁以下卵巢上皮性交界瘤患者的临床和病理特征。结果患者年龄16～19岁（平均17．8岁）。主要症状为腹胀5例（71．4％，其中3例伴腹痛）、腹痛4例（57．1％），盆腹腔包块，直径7～30cm（中位数20cm）；B超检查盆腹腔囊实性包块6例，实性包块1例，直径7～32cm（中位数19．9cm）。根据术中冰冻病理检查情况，均采用保留生育功能手术（6例患侧附件切除术，1例卵巢肿瘤剔除术）。手术病理分期Ia期卵巢粘液性交界瘤4例（57．1％），Ia期浆液性交界瘤2例（28．6％），Ⅲc期浆液性交界瘤1例（14．3％）。随访18～94月（平均53．9月），6例（85．7％）无复发，1例Ia期浆液性交界瘤患侧附件切除术后18月复发。结论青春期卵巢上皮性交界瘤Ia期多见，病理类型为浆液性和粘液性肿瘤，各期患者保守手术治疗效果均较好。     

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。     

30岁以下卵巢上皮性癌患者21例临床分析

目的探讨年轻卵巢上皮性癌患者的临床表现、病理类型、手术病理分期、治疗及预后。方法回顾性分析1986年1月至2002年3月间在我院治疗、年龄<30岁的卵巢上皮性癌21例患者的临床资料。结果21例患者确诊为卵巢上皮性癌时的中位数年龄为24岁(16～29岁),占同期全体卵巢上皮性癌患者的4.99%(21/421)。21例均在月经初潮后发病。12例有各种症状,腹痛8例、腹胀4例、月经改变3例等。21例中,急诊手术5例,16例为择期手术。肿物最大径线平均为17.6cm。16例肿瘤为单侧,4例为双侧,1例不详。手术病理分期,Ⅰ期10例、Ⅲ期5例、分期不详6例。病理类型以黏液性乳头状囊腺癌(9例)和浆液性乳头状囊腺癌(6例)最多见。病理分化程度,除6例不详外,高分化11例,中分化2例,低分化2例。初治时行肿瘤细胞减灭术或分期手术15例,复发后行再次肿瘤细胞减灭术6例;除2例患者外,肿瘤均切除干净或基本切除干净。共8例患者保留了生育功能。18例患者进行了以铂类或紫杉醇为基础药物的联合化疗,其中7例化疗达6个疗程以上。平均随访50个月(2～192个月)。结果6例患者死亡,2例带瘤生存,11例无瘤生存,2例失访。3年生存率为89%,5年生存率为76%。结论30岁以下妇女患卵巢上皮性癌较罕见,患者于月经初潮后发病,肿瘤体积较大,单侧多见;临床手术病理分期早期、病理分化程度高分化,病理类型以黏液性囊腺癌为多见,经手术及化疗,预后相对较好。     

Noninflammatory ovarian masses in girls and young women

OBJECTIVE: We reviewed the presentation, treatment, and pathologic diagnoses of girls and young women less than 21 years old with noninflammatory ovarian masses that required surgery and established whether treatment had changed over time. METHODS: We retrospectively reviewed charts of all girls and young women under 21 years old with International Classification of Diseases, 9th Revision (ICD-9) codes specific for noninflammatory ovarian masses treated at our institution from June 1980 to July 1998 (n = 140). RESULTS: The median age at surgery was 15 years (range 2 days-21 years). Ovarian cysts occurred in 57.9% (81 of 140) of patients, benign tumors (including mature cystic teratomas) in 30% (42 of 140), malignant tumors in 7.9% (11 of 104), and torsed but normal ovaries in 4.3% (six of 140) of the study sample. Patients older than 15 years were more likely to have ovarian cysts and benign tumors than younger patients (P =.019). There were no malignancies among girls with neonatal cysts. The incidence of ovarian torsion was 17.8% (25 of 140). Patients with ovarian cysts, mature cystic teratomas, and normal ovaries were more likely to have torsion than those with other benign or malignant tumors (P <.001). Operative approach and surgical procedure were compared before and after July 1, 1989. Laparoscopy was performed more commonly after July 1, 1989 (P =.009). However, patient age (P <.001) rather than time of surgery (P =.83) was the most important predictive factor in a multivariate analysis for use of laparoscopy. In addition, multivariate analysis revealed that patient age (P =.02) rather than time of surgery (P =.79) was also predictive of surgeon type (gynecologist or pediatric surgeon). CONCLUSION: The most frequent cause of an ovarian mass requiring surgery in a girl or young woman under 21 years of age is an ovarian cyst, which justifies consideration of a laparoscopic approach. Patient age rather than time of surgery predicted operative approach and surgeon type. Caution should be exercised in patients over age 12 months with a complex mass on ultrasound and clinical evidence of hormonal activity, as these masses are usually malignant.     

45岁以上子宫内膜异位症患者的临床特点及分析

目的:探讨45岁以上子宫内膜异位症(内异症)患者的临床特点和治疗。方法:回顾性分析我院手术治疗的288例45岁以上内异症患者的临床资料。结果:288例患者主要临床表现为盆腔包块(76.7%)、痛经(49.3%)、异常阴道流血(29.2%);术中发现合并其他妇科疾病者76.0%,其中妇科恶性肿瘤或癌前病变5.9%;根治性手术60.4%,保留卵巢功能的手术34.7%,保留生育功能的手术4.9%;术后73例(25.3%)行假孕治疗,18例(6.3%)行假绝经治疗;78例(27.1%)行激素替代治疗。随诊超过6个月者175例(60.8%),复发率2.9%(5/175)。结论:45岁以上内异症临床表现不典型,常与其他激素依赖性疾病并存,合并妇科恶性肿瘤及癌前病变的几率较高,建议行根治性手术,术后进行激素替代治疗不增加复发。     

Malignant tumors of the female genital track in the elderly

OBJECTIVE: In senium the increase in the incidence of most malignant neoplasms, as well as gynecological cancers is found. In this period of life the vast number of women do not apply for the preventive and follow-up examinations, which increases the number of malignant diseases diagnosed at advanced clinical stages. The coexisting another diseases often limits the possibility of the operative treatment in those cases. DESIGN: To assess the profile of malignant tumors of the genital tract and their treatment in women above 70 year old. MATERIAL AND METHODS: 61 women aged from 71 yrs. to 88 yrs. treated operatively between 1997-2001 due to gynecological cancers were included into the study. The structure and detectability of the neoplasms, as well as the type of performed surgical procedures were analysed. RESULTS: 30 endometrial cancers (49.2%), 16 ovarian cancers (26.2%), 14 vulvar cancers (22.9%) and 1 cervical cancer were diagnosed and surgically treated. The endometrial cancer stage I was detected in 18 cases, stage II in 4 cases and stage III in 8 cases. In each case the radical operation was done (total hysterectomy, lymphadenectomy and appendectomy). The ovarian cancer stage I was detected in 3 cases, stage II in 2 cases, stage III in 5 cases, and stage IV in 6 cases. Only in 5 cases out of this group the radical surgery was performed (total hysterectomy, omentectomy and appendectomy). The vulvar cancer stage I was detected in 2 cases, stage II in 11 cases, and FIGO stage III in 4 cases. In each of these women the vulva and bilateral inguinal lymph nodes were resected, and in 2 cases additionally at the same time the Miles operation was performed. The cervical cancer clinical stage I was detected, and the Wertheim operation was performed. CONCLUSIONS: The most often diagnosed malignant neoplasm in women above 70 yrs. was the endometrial cancer. The worst first-time diagnosis structure was observed in the ovarian cancer, what significantly decreased the ability of surgical treatment in this group.     

Ovarian metastases from cancer of the lung: Problems in interpretation—A report of seven cases

Seven women, 26 to 66 (average 42) years of age, from whom ovarian tumors were removed before (three cases), synchronously with (three cases), or less than 1 year after (one case) the discovery of a pulmonary neoplasm are the subjects of this report. The ovarian tumor was unilateral in six cases and bilateral in one case and was unassociated with intraabdominal spread. The lung tumors, which were similar to the ovarian tumors on microscopic examination, were central in six cases and peripheral in one; three of them were small cell undifferentiated carcinomas, two large cell undifferentiated carcinomas, one a poorly differentiated adenocarcinoma, and one an atypical spindle cell carcinoid tumor. In each case the question of the primary site of the tumor had been raised clinically. The histological similarity of the ovarian and pulmonary tumors in all the cases to well-recognized forms of pulmonary neoplasia as well as additional clinical and pathological features of the cases led to an interpretation of a pulmonary origin of the tumors in all the cases.     

Coexisting ovarian malignancy in young women with endometrial cancer

OBJECTIVE: In premenopausal women with endometrial cancer, ovarian preservation may be a consideration. Our objective was to examine the occurrence of coexisting ovarian malignancy and to identify predictors of adnexal involvement. METHODS: With institutional review board approval, a retrospective chart review was conducted of young women with endometrial cancer identified at 4 affiliated institutions from 1996 to 2004. RESULTS: Among 102 young women (aged 24-45 years) who underwent hysterectomy for endometrial cancer, 26 (25%) were found to have coexisting epithelial ovarian tumors: 23 were classified as synchronous primaries, and 3 as metastases. Ovarian cancer histology was endometrioid in 92% of cases. Among the 26 cases of coexisting ovarian involvement, 12 (46%) had grade 1 endometrial cancer on preoperative biopsy, 4 (15%) had normal preoperative imaging of the adnexa, and 4 (15%) had benign-appearing ovaries at the time of intraoperative assessment. On final pathology, 18 of 26 cases (69%) occurred in patients with grade 1 endometrial cancers, and 15 (58%) occurred with inner myometrial invasion. Our study further highlights the risk of conservative management with 1 case of ovarian cancer diagnosed 9 months after hysterectomy with ovarian conservation for a stage IA, grade 1 endometrial cancer and a case of advanced endometrial cancer metastatic to the ovaries developing 3 years after successful resolution of a grade 1 endometrial cancer treated with megestrol acetate (Megace). CONCLUSION: Careful preoperative and intraoperative assessment of the adnexa is mandatory in young women with endometrial cancer. Those who desire ovarian preservation should be counseled regarding the high rate of coexisting ovarian malignancy.     

卵巢恶性肿瘤与血小板增多关系的临床研究

目的 :探讨卵巢恶性肿瘤伴发血小板增多的临床规律及病理特点。方法 :回顾分析 2 2 7例卵巢恶性肿瘤患者的临床及病理资料 ,4 8例合并血小板增多。结果 :血小板增多的患者中 >4 0岁者超过 80 % ;血小板增多的卵巢恶性肿瘤患者占卵巢恶性肿瘤患者的 2 1.15 % ,其中晚期 (Ⅲ期 +Ⅳ期 )患者占 80 %以上。病理类型 :4 8例中 ,卵巢上皮癌38例 ,生殖细胞恶性肿瘤 5例 ,性索间质肿瘤 3例 ,转移性恶性肿瘤 2例 ;卵巢上皮性癌中血小板增多的发生率为 2 5 .33% ,所有患者均经有效治疗 ,治疗后血小板计数下降。结论 :卵巢恶性肿瘤伴发血小板增多 ,以上皮性癌占多数 ,晚期患者多见 ,预后差。血小板增多常提示有隐匿的恶性肿瘤存在。     

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。