23例妊娠合并卵巢恶性肿瘤临床分析

目的探讨妊娠合并卵巢恶性肿瘤的诊断和处理。方法回顾性分析23例妊娠合并卵巢恶性肿瘤的临床特征、诊断、处理、病理及预后。结果23例中上皮性癌7例，恶性生殖细胞肿瘤15例，混合性上皮-间质肿瘤1例。肿瘤以国际妇产科联盟分期（FIGO）Ⅰ期最多，11例，占47．8％。全部病例进行手术治疗和化疗。其中15例行保守性手术，即患侧附件切除术，4例在妊娠终止后追加根治性手术，另8例行根治性手术。晚期患者有1例死亡，为Ⅲ期内胚窦瘤。15例新生儿均无畸形。结论妊娠合并卵巢恶性肿瘤应依据疾病分期、组织类型、孕龄以及母亲主观愿望采用不同处理方案，实现“个体化治疗”。卵巢恶性生殖细胞肿瘤Ⅰ、Ⅱ、Ⅲ期均可考虑保守性手术，晚期上皮性癌则应行根治手术。术后辅助化疗是重要治疗手段。无论手术或化疗，多可保留胎儿，待近足月分娩。孕期超声检查对诊断妊娠合并卵巢恶性肿瘤有重要意义，加强产前、产时对妊娠合并卵巢恶性肿瘤的诊断、处理有利于改善妊娠、分娩结局。

Ovarian cancer during pregnancy:clinical study of 23 cases

Aim To study the treatment and management of ovarian cancers during pregnancy. Methods 23 cases of malignant ovarian tumors combined with pregnancy treated between 1998 and 2007 were reviewed retrospectively. Results In the patients reviewed, 7 were found with malignant epithelial tumors, 15 with malignant germ cell tumors and 1 with mixed epithelial-mesenchymal neoplasm of the ovary. 11 （47.8%）of the patients were diagnosed in stage Ⅰ.And all had operation and chemotherapy. 15 of them got the conservative surgery, of which four received radical surgery after delivery, while another eight received radical surgery. One patient with endodermal sinus tumor in the stagem died . All 15 newborns have no abnormalities. Conclusions The management of malignant ovarian cancers during pregnancy differed based on staging of disease , different histological types, gestational age and subjective desire of the mother. For ovarian malignant germ cell tumors including stage Ⅰ , Ⅱ, and Ⅲ surgery can be conservative. For advanced epithelial cancers, aggressive surgery should be made. Pregnancy often could be allowed to continue until near term labor. Chemotherapy could be considered as the important therapeutic tool after surgery. Ultrasonic inspection has important significance in diagnosis.