妊娠合并卵巢肿瘤超声诊断分析

目的总结妊娠合并卵巢肿瘤超声及手术病理特征。方法以术后病理诊断为标准,对北京协和医院1990年10月至2013年9月收治的105例妊娠合并卵巢肿瘤孕妇的超声表现、手术治疗方法及妊娠结局进行总结分析,比较良性肿瘤与交界性和低度恶性肿瘤超声声像图特征。结果 105例孕妇妊娠期超声检查发现58例65个卵巢肿瘤,剖宫产手术发现49例49个卵巢肿瘤。105例114个卵巢肿瘤（单侧96例、双侧9例）超声及手术病理诊治结果：（1）65个卵巢肿瘤术前超声表现：二维超声显示58个肿瘤形态规则、边界清晰,内部多见强回声或中高回声区,且多数肿瘤内壁无乳头状突起（50/58）;超声诊断为良性肿瘤50个,8个肿瘤未作出定性诊断;术后病理诊断卵巢良性肿瘤58个;术前二维超声显示7个肿瘤形态规则,边界清晰,内壁多见乳头状突起（5/7）,超声诊断5个肿瘤不除外恶性,2个肿瘤未作出定性诊断,术后病理诊断交界性肿瘤6个,低度恶性肿瘤1个。（2）肿瘤来源：超声检查及剖宫产手术发现的114个卵巢肿瘤病理检查证实为良性肿瘤107个,交界性肿瘤6个,低度恶性肿瘤1个。其中卵巢生殖细胞肿瘤84个,上皮性肿瘤19个,性索间质肿瘤9个,生殖细胞肿瘤合并上皮性肿瘤2个。（3）手术治疗方法：早孕期手术治疗7例,剔除肿瘤8个,中孕期手术治疗11例,剔除肿瘤11个,晚孕期剖宫产术中治疗87例,剔除肿瘤95个。（4）妊娠结局：105例孕妇足月分娩82例,因重度子痫、胎膜早破等指征早产18例,早孕期人工流产4例,中孕期引产1例;105例孕妇手术治疗后围生儿均安全。结论妊娠合并卵巢肿瘤多为良性,超声多表现为单侧肿瘤、形态规则、边界清晰、内部可见强回声或中高回声区、内壁无乳头状突起;少数交界性及低度恶性肿瘤超声表现为单侧肿瘤、形态规则、边界清晰、内壁可见乳头状突起。妊娠期超声

Ultrasound diagnosis and analysis of pregnancy with ovarian tumor

Objective To summarize the sonographic features and pathological features of ovarian tumor during pregnancy. Methods One hundred and five women with 114 pathologically proved ovarian tumors during pregnancy in Peking Union Medical College Hospital were retrospectively recruited. According to pathological diagnosis, the clinical treatment, the result of the pregnancy and sonographic examinations were reviewed and analyzed. The sonographic features of benign tumors were compared with low-grade malignant tumors. Results Among the 105 pregnant women with a total of 114 ovarian tumors, 65 tumors were found by ultrasound exam. The other 49 tumors were found during cesarean section. The sonographic features of pathologically proved ovarian tumors include regular shape and well-defined margins, with 58 of benign tumors and 7 of borderline or low-grade malignant tumors. Compared with borderline or low-grade malignant tumors, benign tumors manifested as strong echoes or high echogenic mass without papillae in the tumors（50/58）. As for borderline or low-grade malignant group, tumors manifested as papillae within the tumors（5/7）. Pathological classification of the 114 ovarian tumors included 84 germ cell tumors, 19 epithelial tumors, 9 sex cord-stromal tumors, and 2 germ cell tumors combined epithelial tumors. Surgical treatments were performed in 7 cases during the first trimester, while 11 cases during the second trimester, and 87 cases during the third trimester. Pregnancy outcome of the 105 pregnant women included term delivery in 82 cases, premature delivery in 18 cases, artificial abortion during first trimester in 4 cases, and induced abortion during second trimester in 1 case. Conclusions Most ovarian tumors treated in pregnancy are benign. The sonographic features of benign tumors include regular shape with well-defined margins, strong echoes or high echogenic mass within the tumors. While the sonographic features of borderline or malignant tumors include papillae within the tumors. Ultrasound assessment of