本文關(guān)鍵詞： 妊娠 卵巢腫瘤 病理類型 妊娠結(jié)局　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 探討妊娠合并卵巢腫瘤的診斷、病理類型、處理方法、妊娠母兒結(jié)局。方法 對山東大學(xué)齊魯醫(yī)院婦產(chǎn)科在2011年1月-2016年9月收治的經(jīng)手術(shù)及病理確診的206例妊娠合并卵巢腫瘤病例進(jìn)行回顧性分析,統(tǒng)計并分析妊娠合并卵巢腫瘤患者的基本資料、初診方式及時間、手術(shù)時機(jī)及術(shù)式、病理類型、母胎結(jié)局。結(jié)果206例病例中,孕前發(fā)現(xiàn)者16例(16/206 7.77%),其中3例通過婦科檢查發(fā)現(xiàn),13例經(jīng)超聲檢查發(fā)現(xiàn);妊娠14周前發(fā)現(xiàn)者68例(68/206 33.01%),其中,經(jīng)婦科檢查發(fā)現(xiàn)者6例,經(jīng)超聲檢查發(fā)現(xiàn)者62例;妊娠14～28周發(fā)現(xiàn)者18例(18/206 8.74%),經(jīng)婦科檢查發(fā)現(xiàn)者1例,超聲檢查發(fā)現(xiàn)者17例;妊娠28周后發(fā)現(xiàn)者34例(34/206 16.50%),均經(jīng)超聲發(fā)現(xiàn);剖宮產(chǎn)手術(shù)中首次發(fā)現(xiàn)者70例(70/206 33.98%)。其中,非剖宮產(chǎn)術(shù)中首次發(fā)現(xiàn)的136例患者中,共58例(42.65%,58/136)患者于孕期接受非剖宮產(chǎn)目的手術(shù)治療:妊娠14周前手術(shù)20例(14.71%,20/136),其中10例同時人工流產(chǎn),另10例中,其中1例(1/10 10%)失訪,其他9例(9/9 100%)均足月分娩;孕14～28周手術(shù)37例(63.79%,37/58),其中33例(33/35 94.29%)于足月后分娩;2例(2/35 5.71%)因患者強(qiáng)烈要求行中期妊娠引產(chǎn);1例(1/35 2.86%)因腫瘤復(fù)發(fā)于妊娠30周行治療性剖宮產(chǎn);1例失訪(1/37 5.41%)。孕28周后手術(shù)1例(1.72%,1/58),因雙側(cè)卵巢krukenberg瘤同時行治療性子宮下段剖宮產(chǎn)術(shù),早產(chǎn)兒存活。經(jīng)手術(shù)證實發(fā)生并發(fā)癥者共9例(9/206 4.37%),其中蒂扭轉(zhuǎn)7例(7/206 3.40%)、腫瘤破裂2例(2/206 0.97%)。各種病理類型中,妊娠合并卵巢良性腫瘤共193例,占93.69%;妊娠合并卵巢惡性腫瘤共7例,占3.40%;妊娠合并卵巢交界性腫瘤共6例,占2.91%。良性腫瘤中,較常見的病理類型按所占比例從高到依次為:成熟性畸胎瘤(93/206 45.15%),子宮內(nèi)膜異位囊腫(34/206 16.50%),粘液性囊腺瘤(35/206 16.99%),漿液性囊腺瘤(13/206 6.31%)。卵巢交界性腫瘤中,交界性漿液性囊腺瘤3例(3/206 1.46%),交界性粘液性囊腺瘤1例(1/206 0.49%),交界性子宮內(nèi)膜樣腫瘤1例(1/206 0.49%)。卵巢惡性腫瘤中,粘液性腺癌5例(5/206 2.43%),漿液性癌1例(1/206 0.49%),未成熟性畸胎瘤 1 例(1/206 0.49%),Krukenberg 瘤 1 例(1/206 0.49%)。結(jié)論孕早期的婦科檢查及孕早中期的超聲檢查有助于診斷,剖宮產(chǎn)術(shù)中仔細(xì)探查雙附件并送快速病理至關(guān)重要。孕周、卵巢腫瘤的性質(zhì)、年齡、生育要求是影響臨床決策的主要因素,良性腫瘤多數(shù)可通過期待治療至妊娠終止,可于剖宮產(chǎn)手術(shù)時一并切除腫瘤。通常,于妊娠14-28周行手術(shù)較安全,對于有癥狀、懷疑發(fā)生并發(fā)癥、高度懷疑惡性腫瘤的患者及時進(jìn)行手術(shù)干預(yù)。
[Abstract]:Objective to investigate the diagnosis, pathological types and management of ovarian tumors in pregnancy. Methods from January 2011 to September 2016, 206 cases of pregnancy complicated with ovarian tumor were treated in Qilu Hospital of Shandong University from January 2011 to September 2016. Statistics and analysis of the basic data of pregnancy complicated with ovarian tumor, the way and time of first visit, the time and method of operation, the pathological type, the maternal and fetal outcome. 16 cases were found before pregnancy, among which 13 cases were found by ultrasonography in 3 cases by gynecological examination, 68 cases by 68 / 206 33.01% before 14 weeks of pregnancy, 6 cases by gynecological examination and 62 cases by ultrasound examination. 18 cases were found at 14 / 28 weeks of pregnancy, 1 case was found by gynecological examination, 17 cases were found by ultrasound, 34 cases (34 / 206 16.50%) were found after 28 weeks of pregnancy, all were detected by ultrasound; 70 cases (70 / 206 33.98) were first found in cesarean section. Of the 136 patients who were first found in non-cesarean section, 58 patients received non-cesarean operation during pregnancy: 20 patients underwent surgery 14 weeks before gestation, 10 of them had simultaneous induced abortion, and one of the other 10 patients lost one of the 1 / 10 percent of the total. The other 9 cases (9 / 9 100) were born on term; Of the 37 patients who underwent surgery at 143.79 weeks, 33 were 33 / 35 94.29) after term, 2 / 2 / 35 / 35 / 5.71) because of the patient's urge to have induced labor in the second trimester of pregnancy, 1 case (1 / 35 2.86) underwent a therapeutic cesarean section at 30 weeks of pregnancy due to recurrence of the tumor. In one case, 1.72% of the uterus was treated with caesarean section due to bilateral ovarian krukenberg tumor, and all of them were treated with caesarean section of the lower uterine segment at the same time. There were 9 cases of complications confirmed by surgery, including 7 cases of pedicle torsion (7 / 206 3.40%), 2 cases of tumor rupture (2 / 206 0.97%), 193 cases of pregnancy complicated with ovarian benign tumor (93.69 990%) and 7 cases of pregnancy complicated with ovarian malignant tumor (7 cases). There were 6 cases of pregnancy complicated with borderline ovarian tumor, accounting for 2.91%. The more common pathological types were: mature teratoma 93 / 206 45.15J, endometrial cysts 34 / 206 16.50m, mucinous cystadenoma 35 / 206 16.99m, serous cystadenoma 13 / 206 6.31. In ovarian borderline tumors, 3 cases of borderline serous cystadenoma, 1 case of borderline mucinous cystadenoma, 1 case of borderline mucinous cystadenoma, 1 case of borderline endometrioid tumor, 1 case of borderline endometrioid tumor, 1 case of ovarian malignant tumor, 3 cases of borderline serous cystadenoma, 1 case of borderline mucinous cystadenoma, There were 5 cases of mucous adenocarcinomas, 1 case of serous carcinoma, 1 case of serous carcinoma, 1 case of immature teratoma, 1 case of immature teratoma, 1 case of Krukenberg tumor, 1 case of Krukenberg tumor, 1 case of Krukenberg tumor. Conclusion the gynecological examination in early pregnancy and ultrasound examination in middle and early pregnancy are helpful for diagnosis. Careful exploration of double appendages and rapid pathology during caesarean section is of great importance. The nature, age, and fertility requirements of ovarian tumors are the main factors influencing clinical decision-making during cesarean section. Most benign tumors can be treated until pregnancy terminates. Usually, it is safe to perform surgery at 14-28 weeks of gestation. For patients with symptoms, suspected complications, and highly suspected malignant tumors, surgical intervention is timely.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.31;R714.2

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