不孕症合并来源于下降不良卵巢的肿瘤两例并手术图文数据库和文献复习

目的由2例不孕症探查术中发现的特殊病例启发,回顾既往手术病例并检索复习文献,探讨卵巢下降不良的临床意义。方法报道2例原因不明腹腔包块或腹水合并不孕的病例,并回顾性分析2014年4月至2016年11月本院妇科内分泌组手术图文数据库中1 275例病例资料,结局指标包括不同手术指征病例中卵巢下降不良的发生率、不孕病例的妊娠结局等。结果因特发性不孕行腹腔镜检查的患者中,卵巢下降不良的发生率约为1.1%(11/988例)。其中,4例合并苗勒管畸形的患者中1例伴发Leydig细胞瘤,因肿瘤位于盆腔上方的卵巢上极,术前未能诊断;1例伴发不明原因腹水,术中方诊断粘液性囊腺瘤。4例合并子宫肌瘤、子宫内膜异位症、盆腔粘连、多囊卵巢综合征等不孕因素,3例除卵巢位置形态变异外无特殊发现。随诊至2017年4月,5例自然妊娠,1例IVF-ET妊娠,总体妊娠率54.5%。结论卵巢下降不良是一种罕见的先天性异常,最常见于不孕患者的手术检查中,不是导致不孕的独立因素。下降不良的卵巢和肿瘤之间的关系并不明确,其特殊的位置可能给术前诊断带来挑战。

Data analysis of two infertile patients with tumors derived from undescended ovary and reviewing surgery image database and relevant literature

Objective:To explore the clinical significance of ovarian maldescent by analyzing the data of two women with idiopathic infertility and abdominal mass or ascites underwent surgical exploration,and reviewing the surgery image database and relevant literature.Methods:The data of two patient with unexplained abdominal mass or ascites were reported and 1 275 patients in graphic database (from April 2014 to November 2016) of gynecologic endocrine group in Peking Union Hospital were reviewed.The incidence of ovarian maldescent in these patients and pregnancy outcomes of infertility patients were analyzed.Results:The incidence of ovarian maldescent in the patients with idiopathic infertility in our group was 1.1 ％ (11/988).Among four patients with Müllerian duct malformations,one patient complicated with Leydig cell tumor which could not be diagnosed before operation because the tumor was located on the top of the ovary above the pelvic cavity.Another patient was associated with unexplained ascites and mucinous cystadenoma was diagnosed during the operation.Four patients complicated with other infertility factors including uterine fibroids,endometriosis,pelvic adhesions,and polycystic ovary syndrome.There was no special discovery except ovarian abnormal position in three patients.Followed up to April 2017,5 patients conceived natural pregnancy and one patient got IVF-ET pregnancy,and the overall pregnancy rate of 54.5 ％.Conclusions:Undescended ovary is a rare congenital alteration,mostly occurred in operation incidentally,such as laparoscopic evaluation of infertility,especially when patients are combined with Müllerian duct deformity.There is no sufficient evidence to prove that undescended ovary is relevant to infertility and tumorigenesis,but unusual location of tumor may challenging the preoperative diagnosis.