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。

Diagnosis and Treatment Analysis of 425 Cases of Pregnancy with Ovarian Tumor

Objective：To investigate the pathology, diagnosis and treatment characteristics of benign and malignant ovarian tumors in pregnancy, and the effect of different surgical methods on pregnancy outcome. Methods：A total of 425 patients with pregnancy ovarian tumors as research objects who were treated in Shenzhen Maternal and Child Health Hospital Affiliated Southern Medical University from September 2010 to September 2016, retrospectively analysing its clinical data, including discovery time, pathological type, surgical method, pregnancy outcome, etc. Results: Cystic mature teratoma was the most common pathological type in patients with gestational ovarian tumors, followed by endometriosis cyst and mucinous cystadenoma. There were 30 cases of complications during pregnancy, accounting for 7.10%, among which torsion was the most common complication, followed by malignant and rupture hemorrhage. There are mainly two kinds of operation methods during pregnancy period: laparoscope and laparotomy surgery, the amount of blood loss in the laparoscopic group [(39.62±28.25) mL vs. (68.50±33.60) mL, t=2.563, P=0.015], length of hospital stay of laparoscopy group were less than the laparotomy surgery group [(6.46±2.03) d vs. (9.90±1.92) d, t=4.925, P＜0.001]. In addition, the average surgical gestational weeks of the laparoscope group were smaller than that of the laparotomy surgery group [(12.71±3.71) weeks vs. (16.71±4.89) weeks, t=2.490, P=0.018]. However, there was no significant difference between the two groups in the rate of cesarean section, low birth rate, preterm birth rate and abortion rate (all P＞0.05). The prognosis of malignant tumor in pregnancy is better after treatment in a timely and individualized manner. Conclusions: To eliminate malignant tumor by early detection early treatment will have a good prognosis. It is safety to choose surgical intervention during pregnancy. Surgical indications are recommended for surgical intervention. Both laparoscopy and laparotomy has no effect on pregnancy outcome. The choice of operation can be individualized.