193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瘤样病变的临床情况及处理,为提高妊娠合并卵巢肿瘤的诊治水平提供资料.方法:回顾性分析我院收治的妊娠合并卵巢肿瘤及瘤样病变193例患者的临床及随访资料.结果:193例中卵巢良性肿瘤92例,占47.67%(以成熟性畸胎瘤最多见),瘤样病变占93例,占48.19%(以巧克力囊肿及黄体囊肿多见),恶性肿瘤8例,占4.15%.179例行囊肿剔除术,6例行附件切除术,8例妊娠合并卵巢恶性肿瘤患者中4例接受了术后化疗.结论:妊娠合并卵巢肿瘤及瘤样病变治疗以囊肿剔除术为主.在妊娠期卵巢恶性肿瘤中,早期恶性肿瘤多见,适时的手术干预并不影响妊娠结局.化疗在妊娠合并卵巢恶性肿瘤中的使用较少,有待进一步探讨研究.     

425例妊娠合并卵巢肿瘤患者的诊治分析

目的:探究分析妊娠合并卵巢肿瘤的病理和诊治特点,以及不同手术方式对妊娠结局的影响。方法:以南方医科大学附属深圳市妇幼保健院2010年9月—2016年9月收治的425例妊娠期卵巢肿瘤患者为研究对象,回顾性分析其临床资料,包括发现时间、病理类型、手术方式以及妊娠结局等。结果:妊娠期卵巢肿瘤患者中,囊性成熟性畸胎瘤是最常见的病理类型,其次是子宫内膜异位囊肿及黏液性囊腺瘤;妊娠期有30例(7.10%)患者发生并发症,其中蒂扭转最常见,其次是恶变及破裂出血;妊娠期卵巢肿瘤手术主要有腹腔镜和开腹手术2种,腹腔镜组的失血量([39.62±28.25)mL vs.(68.50±33.60)mL,t=2.563,P=0.015]、住院时间([6.46±2.03)d vs.(9.90±1.92)d,t=4.925,P<0.001]均小于开腹组。此外,腹腔镜组的平均手术孕周也小于开腹组([12.71±3.71)周vs.(16.71±4.89)周,t=2.490,P=0.018]。而2组之间的剖宫产率、低出生体质量儿发生率、早产率和流产率比较,差异均无统计学意义(均P>0.05)。妊娠期恶性肿瘤在及时且个体化的处理后预后较好。结论:妊娠期卵巢肿瘤需首先排除恶性可能,早发现、早处理预后较好。妊娠期手术治疗是安全的,推荐有手术指征者选择手术干预。腹腔镜和开腹手术对妊娠结局影响均较小,可以个体化选择手术方式。     

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％。     

425例妊娠合并卵巢肿瘤患者的诊治分析

目的:探究分析妊娠合并卵巢肿瘤的病理和诊治特点,以及不同手术方式对妊娠结局的影响。方法:以南方医科大学附属深圳市妇幼保健院2010年9月—2016年9月收治的425例妊娠期卵巢肿瘤患者为研究对象,回顾性分析其临床资料,包括发现时间、病理类型、手术方式以及妊娠结局等。结果:妊娠期卵巢肿瘤患者中,囊性成熟性畸胎瘤是最常见的病理类型,其次是子宫内膜异位囊肿及黏液性囊腺瘤;妊娠期有30例(7.10%)患者发生并发症,其中蒂扭转最常见,其次是恶变及破裂出血;妊娠期卵巢肿瘤手术主要有腹腔镜和开腹手术2种,腹腔镜组的失血量([39.62±28.25)mL vs.(68.50±33.60)mL,t=2.563,P=0.015]、住院时间([6.46±2.03)d vs.(9.90±1.92)d,t=4.925,P0.001]均小于开腹组。此外,腹腔镜组的平均手术孕周也小于开腹组([12.71±3.71)周vs.(16.71±4.89)周,t=2.490,P=0.018]。而2组之间的剖宫产率、低出生体质量儿发生率、早产率和流产率比较,差异均无统计学意义(均P0.05)。妊娠期恶性肿瘤在及时且个体化的处理后预后较好。结论:妊娠期卵巢肿瘤需首先排除恶性可能,早发现、早处理预后较好。妊娠期手术治疗是安全的,推荐有手术指征者选择手术干预。腹腔镜和开腹手术对妊娠结局影响均较小,可以个体化选择手术方式。     

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。     

妊娠合并妇科肿瘤的腹腔镜手术

文章着重对妊娠期宫颈肿瘤及妊娠期卵巢肿瘤的腹腔镜应用展开论述,与开腹手术相比,腹腔镜手术在胎儿妊娠结局上并没有差别,但腹腔镜手术具有腹部伤口小,手术时间短,手术过程中出血少,术后患者的恢复快等优势,使得腹腔镜在妊娠合并妇科肿瘤领域应用越来越广泛。     

卵巢肿瘤中c-kit基因突变的临床研究

目的探讨c-kit基因在卵巢恶性上皮性肿瘤中的突变情况及其在卵巢肿瘤发生发展中的作用。方法2004年1月至2005年12月在哈尔滨医科大学附属第一临床医学院、第三临床医学院应用PCR扩增和基因测序的方法检测卵巢恶性上皮性肿瘤、卵巢交界性肿瘤、卵巢良性肿瘤及正常卵巢组织中c-kit基因第11号外显子序列。结果c-kit基因在卵巢恶性上皮性肿瘤、卵巢交界性肿瘤、卵巢良性肿瘤及正常卵巢组织中的突变率分别为72.1％、44．4％、11．5％、0，卵巢恶性上皮性肿瘤及交界性肿瘤中c-kit基因突变率均高于卵巢良性肿瘤及正常卵巢组织，差异有显著性意义（P〈0．05）。卵巢恶性上皮性肿瘤与卵巢交界性肿瘤中c-kit基因突变率差异无显著性意义（P〉0.05）。在卵巢恶性上皮性肿瘤中，低分化组的c—kit基因突变率为88．9％，明显高于中、高分化组（P〈0．05），c—kit基因的突变率随FIGO分期的进展及淋巴结的转移而升高（P〈0．05），c—kit基因的突变与卵巢肿瘤的病理类型无关（P〉0．05）。结论c-kit基因突变在卵巢恶性上皮性肿瘤的发生发展中可能发挥重要作用，可作为诊断卵巢良恶性肿瘤的参考指标。c-kit基因突变与卵巢恶性上皮性肿瘤的预后有关，可作为判断卵巢恶性上皮性肿瘤患者预后的指标之一。     

卵巢交界性肿瘤保留生育功能的手术途径选择

目的:研究卵巢交界性肿瘤行腹腔镜或开腹保留生育功能手术对短期预后及妊娠的影响。方法:收集天津市中心妇产科医院2009年1月—2015年7月卵巢交界性肿瘤行保留生育功能手术患者共74例,其中开腹组30例,腹腔镜组44例。比较2组患者复发及妊娠情况。结果:开腹组较腹腔镜组年轻(P=0.018)、开腹组肿瘤最大径线超过腹腔镜组(P=0.000),腹腔镜组中未分期手术患者较开腹组多(P=0.000)。术后总复发率为6.7%(5/74),2组复发率比较差异无统计学意义(P=0.980)。保留生育功能术后患者总妊娠率为33.8%(25/74),其中开腹组为30.0%(9/30),腹腔镜组为36.4%(16/44),2组间比较差异无统计学意义(P=0.570);腹腔镜组未分期手术妊娠患者比例高于开腹组(P=0.041),其中术后妊娠患者中无复发。结论:腹腔镜保留生育功能的未分期手术短期预后及术后妊娠情况满意,对卵巢交界性肿瘤患者选择性行腹腔镜保留生育功能的未分期手术是安全可行的。     

CA199在卵巢成熟畸胎瘤不同胚层中的表达比较

目的探讨CA199在卵巢成熟畸胎瘤中的表达及临床意义。方法回顾性分析1 827例卵巢肿瘤和囊肿患者的临床病理资料,比较卵巢成熟畸胎瘤中CA199水平及相关因素。结果卵巢成熟畸胎瘤组患者CA199中位数为21.6kU/L,与其他良性卵巢囊肿（中位数为14.4kU/L）和交界性卵巢肿瘤（中位数为12.5kU/L）比较,差异有统计学意义（P〈0.05）。logistic回归分析显示,CA199在成熟畸胎瘤中的高表达与肿瘤的大小、肿瘤的单双侧有关（r=0.046,P〈0.01;r=0.741,P〈0.05）。成熟畸胎瘤CA199升高组各胚层CA199水平比较,差异无统计学意义（P〉0.05）。但成熟畸胎瘤中含有支气管组织者CA199阳性率显著高于含有消化道组织和甲状腺组织等者（P〈0.01）。结论 CA199是与卵巢成熟畸胎瘤密切相关的肿瘤标志物,其高表达与肿瘤的大小和单双侧有关。     

卵巢生殖细胞肿瘤的临床统计分析

本文报道近十年来本院收治的卵巢生殖细胞肿瘤１７２例，占同期卵巢肿瘤的２５．５％。其中成熟型畸胎瘤１６２例，卵巢甲状腺肿１例，未成熟型畸胎瘤５例，成熟型畸胎瘤恶变２例，无性细胞瘤１例，混合型生殖细胞瘤（卵黄囊瘤合并成熟型畸胎瘤）１例。本组资料显示：成熟型畸胎瘤合并妊娠者对围产儿无明显不良影响，本文并讨论了未成熟型畸胎瘤的治疗原则。     

The incidence of ovarian tumors in the third trimester of pregnancy

METHOD AND RESULTS: Between 1993 and 2000, 7529 patients underwent cesarean section (24.3% of 31,798 delivering women) at University Hospital in Poznań. There were 52 cases of simultaneous adnexal surgery among them because of ovarian tumors (1 case/144 abdominal deliveries; 1 case/612 pregnancies). In 43 cases tumor was accidentally diagnosed at time of operative delivery (1/174 abdominal deliveries). The average age of all delivering women was 27 +/- 7 yrs, among abdominally delivering 28 +/- 7 yrs. The respective value for patients with ovarian tumor was significantly higher--30 +/- 7 yrs. The mean diameter of the tumor was 4.8 +/- 4.7 cm, but the largest 30 cm. In 9 cases adnexectomy was performed, remaining patients were treated conservatively. Benign cyst teratoma was diagnosed in 26.9%, cystis simplex in 21.2%, fibroma in 15.4%, endometriosis and luteal cyst every in 9.6%. There were two cases of malignant tumors, both diagnosed earlier: dysgerminoma and adenocarcinoma. CONCLUSIONS: 1. incidence of ovarian tumors of pregnant women was previously probably underestimated, 2. the risk of malignant ovarian tumor is relatively low.     

Ovarian cancer during pregnancy: analysis of 15 cases

GOAL: Our goal was to analyze and describe cases of ovarian cancer in pregnant women treated at our hospital. METHOD: Retrospective study based on clinical histories from patients diagnosed and treated at our hospital for ovarian cancer and pregnancy from 1987 to 2005. RESULTS: Fifteen cases of ovarian cancer were diagnosed among pregnant women; the ratio is 0.11/1000 deliveries. Among them, 66.6% of patients were asymptomatic, and 86.6% had been diagnosed via ultrasound. Of the diagnosed tumors, 40% were malignant epithelial tumors, 26.6% of them were of low malignant potential. The 20% were germinal cell tumors. Of these primary ovarian malignancies, the 59.9% were stage I. The remaining 20% were metastatic tumors. Forty percent of the total were treated conservatively (salpingo-oophorectomy) and 60% with hysterectomy and bilateral salpingo-oophorectomy. Chemotherapy was administered to 66.6% of the patients, in two cases during pregnancy. Eighty percent of the newborns were healthy and presented no sequelae or malformations. Global survival at 5 years was 76%. CONCLUSIONS: Ovarian cancer is rare in pregnant women. Most malignant ovarian neoplasias in pregnant women are at early stages and are associated with good prognosis both for the mother and for the neonate.     

Ovulation induction and the risk of ovarian tumors

In the last years it has been observed a more and more increasing number of women submitted to therapies for induction of ovulation (disorders of the ovulation represent 33% of the causes of female infertility). In 1998, these therapies had been administrated to approximately two million of USA women. Various Authors have assumed a possible relationship between induction of ovulation and ovarian tumors. Between 1982 and 1997, at least 43 cases of ovarian tumors have been published (among these, there were also 25 cases of epithelial tumors) occurring in women previously treated with ovulation induction. The mean age of patient was 30.3 years, approximately 20 years younger than normal patient population for the same tumors. Among the possible causes of epithelial ovarian tumors, there is the trauma of the ovary surface caused by the continuous repeating of the ovulation phenomenon (incessant ovulation). Gynecologist should be aware of this potential risk for their patients. Multicentric studies should be evaluated in order to establish the risk of ovarian cancer in women treated for infertility problems. A survey of the international literature is made in order to analyse the epidemiological studies and to discuss the relationship between ovulation inducing agents and ovarian tumors.     

Histologic subtypes and laterality of primary epithelial ovarian tumors

OBJECTIVES: To determine if the likelihood of bilateral primary ovarian tumors differs by histologic subtype. METHODS: Using data collected by the Surveillance Epidemiology and End Results (SEER) program, the analysis included 22,328 women 25-84 years of age who were diagnosed with a borderline or malignant epithelial ovarian tumor during 1992-2000, categorized as to laterality and histologic subtype. RESULTS: Malignant serous tumors were bilateral in 57.5% of cases. Corresponding figures for mucinous, clear cell, endometrioid and other epithelial tumors were 21.3%, 13.3%, 26.8%, and 35.6%, respectively. Borderline serous tumors were bilateral in 29.8% of the cases compared to only 7.0% of mucinous tumors. The tendency for serous tumors to present as bilateral was consistent across all categories of race, age, and stage. CONCLUSIONS: Serous tumors of the ovary are more commonly bilateral than ovarian tumors of other histologic subtypes. The reasons for this tendency remain to be determined.     

Ovarian cancer incidence in the United States, 1992-1999

OBJECTIVE: The purpose of this epidemiological study was to report histology-specific age-adjusted ovarian cancer incidence rates that were standardized to the recently adopted year 2000 United States standard population. METHODS: We utilized data gathered from eleven population-based cancer registries of the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute for the years 1992 through 1999. Our analyses included data on 23,484 microscopically confirmed cases of primary malignant ovarian cancer that were diagnosed in women residing in the eleven SEER registries. RESULTS: We categorized the 117 different histologies that were diagnosed in the 23,484 ovarian cancer cases into ten major classifications. The overall age-adjusted incidence rate for all ovarian cancer cases was 16.23 cases per 100,000 women. Epithelial tumors displayed the highest age-adjusted incidence rate (15.48), followed by germ cell tumors (0.41), sex cord-stromal tumors (0.20), and all other miscellaneous ovarian tumors (0.13). Serous epithelial tumors were the most commonly observed epithelial group (6.77 cases per 100,000 women), followed by other miscellaneous epithelial tumors (3.76), mucinous epithelial tumors (2.22), endometrioid epithelial tumors (2.11), and clear cell epithelial tumors (0.64). Notable differences were observed in the age-adjusted incidence rates for White and Black women. CONCLUSIONS: Age-adjusted incidence rates of ovarian cancer vary by histology. This is the first study to standardize histology-specific age-adjusted incidence rates of ovarian cancer to the new 2000 United States standard population.     

The diagnostic value of multiple tumor markers in malignant ovarian neoplasms

Ovariancanceristhemostfrequentcauseofdeath fromgynecologicalcancer.Almost90%ofpatientsare diagnosedwithmetastaticdiseaseinthepelvisorabdo menandforthesepatients5yearsurvivalratesareless than30%.Incontrast,thesmallproportionofpatients diagnosedwithstageIovariancancerconfinedtotheo varieshavea5yearsurvivalrateinexcessof90%[1].Tumormarkerisakindofsubstancecorrelatedwiththe occurrenceoftumor.Itarisesfromthetumortissue,ex istsinthetumor,orexcretesintobloodorotherbody fluid[2].Nowadaysmorethan100ki…     

The diagnostic value of multiple tumor markers in malignant ovarian neoplasms

Objective:To study the diagnostic value of multiple tumor markers in malignant ovarian neoplasm.Methods:Sera obtained from 430 patients with ovarian masses (110 cases were malignant ovarian tumors,320 cases were benign ovarian tumors) before operation,and from 50 healthy women as control.Serologic examination of tumor markers included CA125,TSGF,SA,CEA,AFP,HCG and Fer.Results:The serum levels of CA125,TSGF,SA and Fer in patients with ovarian cancer were higher than those in patients with benign ovarian tumors (P<0.05),also in control group (P<0.05).In the diagnostic value of application for malignant ovarian neoplasm,CA125,TSGF and SA were better than the others.The sensitivity,specificity and accuracy in diagnosis of ovarian cancer were 86.4%,82.8%and 83.7% respectively for CA125 alone,78.2%,81.3%and 80.5% for TSGF alone,74.5%,81.9%and 80.0% for SA alone,whereas 95.5%,45.6%and 58.4% for multiple tumor markers combined in which 1 or more indices showed positive,93.6%,80.6%and 84.0% for that in which 2 or more indices showed positive,and 87.3%,90.3%and 89.5% for that in which 3 or more indices show positive.Conclusion:multiple tumor markers examination could improve the diagnosis of ovarian cancer,and examination of CA125,TSGF and SA combined is most ideal.     

Ovarian tumors in the reproductive age group

OBJECTIVES: Analysis of the type and localization of the ovarian tumors in the reproductive age group of women. MATERIALS AND METHODS: The study group consisted of all women operated on Gynecologic Surgery Department of Polish Mothers's Memorial Hospital-Research Institute due to ovarian tumors in 1996-99. As the reproductive age we defined 18-39 year, when the majority of deliveries occurs. RESULTS: We analyzed 326 patients operated on the ovarian tumors. In 60 cases (18.4%) we noticed ovarian malignant tumors, in 7 (2.1%) borderline tumors and in 259 (79.5%) benign cysts. In the reproductive age (130 women) the incidence of ovarian malignancies was significantly lower (4.6%), higher for benign tumors (93.1%) and constant for borderline malignancy (2.3%), p < 0.005. The most common malignancy among all patients was epithelial cancer--83.4% (germ cell and metastatic--8.3%, both), but in the reproductive age group (6 cases) germ cell tumors were the majority--66.8% (epithelial and metastatic--16.6%, both), p < 0.005. In women aged 18-39 yr. with ovarian malignancies 4 of them had I stage of the disease and 2 were in the stage III. 121 women in the reproductive age were operated on the benign ovarian tumors; 107 (88.4%) had unilateral cysts and 14 (11.6%) had tumors in both ovaries. On histology we revealed 31.1% of endometrioid cysts, 28.9%--teratomas, 19.3%--serous, 3.7%--mucinous and others (hemorrhagic, functional, sex cord, inflammatory) in the remaining 17%. CONCLUSION: In the reproductive age ovarian tumors are mainly unilateral benign cysts. Only a few of ovarian tumors were malignant but the majority of them were in the early stage of the disease.     

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。     

Ovarian carcinoma during pregnancy: A study of 23 cases in Israel between the years 1960 and 1984

Data from a study on malignant ovarian tumors in pregnancy in Israel are presented. During the 25-year period of the survey, 23 new cases of malignant ovarian tumors during pregnancy were diagnosed, representing an incidence of 0.12/100,000 females over the age of 14; over half of the patients were in their third decade of life at the time of diagnosis of the tumor. Ovarian malignant tumors during pregnancy are more prevalent in Jewish women of European-American origin than in those of Asian-African descent. Borderline carcinomas were found in 35% of our patients; epithelial invasive tumors were found in 30%; the other tumors were dysgerminoma (17%), granulosa cell tumor (13%), and undifferentiated carcinoma (5%). Most of the patients (74%) were diagnosed in stage I. In three cases, ovarian cancer was diagnosed during surgery for tubal pregnancy, and in two during cesarean section at term. In early-stage disease and low-potential-malignancy tumors, surgery can be conservative; thus, 14 of 23 bore a live child. In advanced disease, aggressive surgery, chemotherapy, and/or radiotherapy should be instituted. Factors affecting prognosis were age of patient, histologic type of tumor, and clinical stage of disease. Overall, the survival is much better than that for ovarian tumors in general, because most of the tumors are of low potential malignancy and are diagnosed at an early stage.