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。

Clinical analysis of 58 cases with ovarian tumors and tumor-like lesions of pregnancy

Objective To investigate the clinical features and treatment of ovarian tumors and tumor- like lesions with pregnancy. Methods Data of 58 eases of pregnancy associated with ovarian tumor and tumor- like lesions patients confirmed by operation and pathology from January 2009 to December 2010 in Fujian Provincial Maternal and Child Health Hospital were retrospectively reviewed. Results The 58 cases of ovarian tumor and tumor- like lesions in pregnancy ac- counted for 0. 24% （ 58/23 756 ） in all the pregnant women in the same period, including 56 cases （96.6%） of benign o- varian tumor and tumor- like lesions and 2 cases （3.4%） of ovarian malignant tumors. 5 cases （8. 6%） were confirmed before pregnancy was found; 22 eases （37. 9%） were found in the first trimester, 18 cases （31.0%） were found in the sec- ond trimester and in the third trimester 13 eases （22.4%） was found during cesarean section. Among the 56 cases with benign ovarian tumor and turmr- like lesions, 50 eases （89. 3%） underwent cyst excision and 6 cases （10. 7%） received appendix resection. Ks for the 2 eases of pregnancy complicated with malignant ovarian tumor, one received cytoreductive surgery and 8 cycles chemoradiotherapy, another case only underwent ovarian tumor excision and refused to add further operation and chemo- therapy. Pathological types： mature teratoma in 24 eases （41.4%）, serous cystadenoma in 22 cases （37. 9%）, corpus luteurn cyst in 10 cases （17. 2 %）, granular cell tumor in I eases （1. 7 %）, papillary serous adenocarcinoma in 1 cases （1. 7 %）. 8 cases （13. 8%） with pedicle torsion of ovarian tumors underwent emergency operation. Conclusion Ultrasound can diagnosis and monitoring ovarian tumors and tumor- like lesions during pregnancy, and bilateral adnexal exploration during cesarean section is very important.Mature teratomas is the most common pathological type in pregnancy associated with ovarian tumor and torsion.