腹腔镜与开腹手术治疗中期妊娠卵巢肿瘤的比较

目的探讨腹腔镜手术治疗中期妊娠卵巢肿瘤的可行性和安全性。方法2006年1月～2011年1月我院32例中期妊娠合并卵巢肿瘤分别行全麻下腹腔镜手术（腹腔镜组，n=14）和开腹手术（开腹组，n=18）。腹腔镜手术一般距离宫底或肿瘤上缘（以大者为准）至少3横指处做第一切口，余切口随之改变，气腹形成后，监测生命体征及氧饱和度直至手术结束后1h。卵巢肿瘤剥除术：用剪刀切开肿瘤包膜，将肿瘤完整剥出装袋取出，若肿瘤直径〉8cm，穿刺抽吸囊液后剥除肿瘤。患侧附件切除术：提起附件边凝边切，取出同卵巢肿瘤剥除术。结果腹腔镜组肿瘤剥除术10例，附件切除术4例，无一例中转开腹。开腹组肿瘤剥除术13例，附件切除术5例。腹腔镜组手术时间（73．9±26．8）min与开腹组（72．8±22．2）min比较无统计学差异（t=0．127，P=0．900）。腹腔镜组术中出血量（56．4±25．9）ml与开腹组（48．9±22．5）ml比较无统计学差异（t=0．876，P=0．388）。腹腔镜术后住院（5．0±0．8）d，显著短于开腹组（8．7±2．8）d（t=-4．779，P=0．000）。术后病理：腹腔镜组成熟性畸胎瘤12例，黏液性囊腺瘤2例；开腹组成熟性畸胎瘤5例，黏液性囊腺瘤10例，浆液黏液混合性囊腺瘤2例，交界性乳头状囊腺瘤1例。卵巢肿瘤蒂扭转9例，其中成熟性畸胎瘤8例，黏液性囊腺瘤（伴囊壁钙化）1例。患者术后均无并发症，随访至分娩，腹腔镜组新生儿Apgar评分（9．8±0．4）分与开腹组（9．7±0．5）分比较无统计学差异（t=0．584，P=0．564）；新生儿出生体重（3357．7±471．2）g与开腹组（3421．9±155．9）g比较无统计学差异（t=-0．513，P=0．612）；新生儿出生孕周（38．5±1．3）周与开腹组（39．1±0．9）周比较无统计学差异（t=-1．466，P=0．154）；早产率与开腹组无统计学差异7．7％（1／13） vs．0，P=0．448]。结论腹腔镜手术治疗中期妊娠卵巢肿瘤是安全可行的。

Comparison between Laparoscopic and Open Surgery for Ovarian Tumor during the Second Trimester of Pregnancy

Objective To investigate the safety and feasibility of laparoscopic surgery for ovarian tumor during the second trimester of pregnancy. Methods Between January 2006 and January 2011, 32 cases of mid-term pregnancy were admitted to our hospital for ovarian tumors. They underwent laparoscopic surgery（ laparoscopy group, n = 14） or open surgery（open group, n = 18） under general anesthesia. The laparoscopic surgery process was described as the following：the first incision was made at no less than 3 fingers＇ width from the uterus base or the upper edge of the tumor （the bigger one preferred）. The remaining incisions were made based on the first one. Once pneumoperitoneum was made, vital signs and oxygen saturation were monitored until 1 hour after the surgery. Ovarian tumorectomy ： ovarian cyst envelope was cut by scissors,then the tumor was removed and intactly taken out in a bag. If the diameter of the ovarian tumor exceeded 8 centimeters,we would puncture it and suck the cyst fluid before removing the tumor. Adnexectomy： the appendage was lifted and cut after coagulation,then the following procedure was similar to tumorectomy. Results All the laparoscopic surgeries including 10 cases of tumorectomy and 4 cases of adnexectomy were successfully performed and no case was converted to open surgery. Of the open group, 13 cases underwent tumorectomy and 5 cases adnexectomy. No significant differences could be found between the open and laparoscopy group in operation time （72.8 ± 22.2） min vs. （73.9 ~ 26.8 ） min,t = 0. 127,P = 0. 900 ] and blood loss （48.9 ~ 22.5 ） ml vs. （56.4 ~ 25.9 ） ml, t = 0. 876, P = 0. 388 ]. However significant statistical difference could be found between the laparoscopy and open group in postoperative hospital stay （5.0 ± 0.8） d vs. （ 8.7 ± 2.8） d, t = -4. 779 ,P = 0. 000]. The results of postoperative pathological examination：in the laparoscopy group, there were 12 cases of mature teratoma and 2 cases of mucinous cystadenoma; in the open group, there were 5 cases of mature teratoma, 10 cases of mucinous cystadenoma, 2 cases of mucinous and serous cystadenoma and 1 case of borderline papillary cystadenoma. There were 9 cases of ovarian tumor torsion including 8 cases of mature teratoma and 1 case of mucinous cystadenoma with cyst wall calcification. No complications were found in postoperative patients in both groups. A follow-up was carried out among the patients until delivery. As compared with the open group, no statistical significance was found in Apgar score of newborns （9.8 ± 0.4） vs. （9.7 ± 0.5 ） , t = 0.584,P=0.564], neonatal birth weight （3357.7 ±471.2）g vs. （3421.9 ± 155.9）g, t = -0.513,P =0.612], neonatal gestationalweek （38.5 ±1.3）weeks vs. （39.1 ±0.9）weeks, t= -1.466,P=0.154] and preterm birth rate 7.7% （1/13） vs. 0, P = 0. 448 ] in the laparoscopy group. Conclusion Laparoscopic surgery for treating ovarian tumors during the second trimester of pregnancy is safe and feasible.