本文關(guān)鍵詞： 卵巢囊腫 附件扭轉(zhuǎn) 保守性手術(shù) 雌孕激素　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景：卵巢腫瘤蒂扭轉(zhuǎn)是婦產(chǎn)科最常見的急腹癥之一,其發(fā)病率約占卵巢腫瘤的10%[1],臨床表現(xiàn)主要以急性下腹部疼痛、腹部包塊及腹膜炎征象為主。盡早的診斷和治療可以預(yù)防很多相關(guān)的并發(fā)癥。如果沒有及時(shí)的診斷和處理,出現(xiàn)扭轉(zhuǎn)附件壞死,則需要切除該側(cè)的輸卵管及卵巢,將影響女性的內(nèi)分泌功能,尤其是年輕女性,會(huì)影響其生育功能。患者若沒有得到及時(shí)診斷和治療,嚴(yán)重者可因卵巢靜脈血栓的形成而導(dǎo)致肺栓塞,甚至死亡。目前的處理原則是診斷明確后盡快手術(shù)治療,傳統(tǒng)的手術(shù)方法是為避免血栓性疾病而行附件切除術(shù),但卵巢腫瘤蒂扭轉(zhuǎn)患者多為育齡期婦女,切除一側(cè)附件后將對其生殖內(nèi)分泌功能造成影響,使其生活質(zhì)量下降。近年來,如何對育齡期卵巢良性腫瘤扭轉(zhuǎn)患者施行保守性手術(shù)從而保留其患側(cè)附件越來越受到人們的重視�，F(xiàn)收集整理陽谷縣人民醫(yī)院婦產(chǎn)科收治的卵巢囊腫蒂扭轉(zhuǎn)的臨床資料,并進(jìn)行評價(jià)。 研究目的：探討不同卵巢囊腫蒂扭轉(zhuǎn)手術(shù)方式治療的安全性及有效性。 研究方法：回顧性總結(jié)了2009年1月至2013年6月在確診為卵巢囊腫蒂扭轉(zhuǎn)患者48例。根據(jù)其手術(shù)方式的不同分為兩組,保留附件的卵巢囊腫蒂扭轉(zhuǎn)復(fù)位+卵巢囊腫剝除術(shù)組(A組,26例)和附件切除術(shù)組(B組,22例)。從兩組患者發(fā)病時(shí)間、卵巢囊腫扭轉(zhuǎn)周數(shù)、手術(shù)時(shí)間、術(shù)中平均出血量、術(shù)后住院時(shí)間、激素水平等方面進(jìn)行評價(jià),以期尋求更合理的治療方式。 結(jié)果：卵巢囊腫蒂扭轉(zhuǎn)復(fù)位+卵巢囊腫剝除術(shù)組和附件切除術(shù)組的發(fā)病時(shí)間分別為10.2±5.2小時(shí)及15.9±5.6小時(shí),兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。卵巢囊腫蒂扭轉(zhuǎn)復(fù)位+卵巢囊腫剝除術(shù)組和附件切除術(shù)組的扭轉(zhuǎn)周數(shù)分別為1.7±0.5周及2.1±0.5周,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。卵巢囊腫蒂扭轉(zhuǎn)復(fù)位+卵巢囊腫剝除術(shù)組和附件切除術(shù)組的出血量分別為30.5±5.0m1及29.83±6.85m1,兩組比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。卵巢囊腫蒂扭轉(zhuǎn)復(fù)位+卵巢囊腫剝除術(shù)組和附件切除術(shù)組的手術(shù)時(shí)間分別為91.3±21.4分鐘及85.4±19.7分鐘,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。卵巢囊腫蒂扭轉(zhuǎn)復(fù)位+卵巢囊腫剝除術(shù)組和附件切除術(shù)組的住院天數(shù)分別為6.7±0.9天及6.9±0.8天,兩組比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。卵巢囊腫蒂扭轉(zhuǎn)復(fù)位+卵巢囊腫剝除術(shù)組和附件切除術(shù)組術(shù)后2個(gè)月兩組患者內(nèi)分泌激素的比較中,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),卵巢囊腫蒂扭轉(zhuǎn)復(fù)位+卵巢囊腫剝除術(shù)組激素水平恢復(fù)情況優(yōu)于附件切除術(shù)組。病理結(jié)果：根據(jù)術(shù)中冰凍及術(shù)后常規(guī)病理證實(shí),48例均為卵巢良性腫瘤。 結(jié)論：①早期診斷并進(jìn)行及時(shí)治療可有效的減少附件切除的機(jī)率,卵巢腫瘤蒂扭轉(zhuǎn)一經(jīng)確診應(yīng)積極手術(shù)探查。②術(shù)中附件的去留取決于腫瘤性質(zhì)及扭轉(zhuǎn)的時(shí)間及程度。③卵巢腫瘤蒂扭轉(zhuǎn)時(shí)間短,扭轉(zhuǎn)周數(shù)少的患者行卵巢囊腫剝除術(shù)是安全可行的。④卵巢腫瘤蒂扭轉(zhuǎn)保留卵巢的手術(shù)有助于保留卵巢的內(nèi)分泌功能。
[Abstract]:Background: torsion of ovarian tumor is one of the most common gynecological acute abdomen, the incidence of ovarian cancer 10%[1], the main clinical manifestations of acute lower abdominal pain, abdominal mass and peritonitis. Signs of early diagnosis and treatment can prevent many complications. If not timely diagnosis and treatment, there you need to reverse the attachment necrosis, fallopian tube and ovary resection of the side, will affect the endocrine function of women, especially young women, will affect their reproductive function. If the patient did not receive timely diagnosis and treatment, severe cases can lead to pulmonary embolism, but due to the formation of ovarian vein thrombosis or death. The treatment principle is after diagnosis surgical treatment as soon as possible, the traditional surgical method is to prevent thrombotic diseases and adnexectomy, but the torsion of ovarian tumor patients for women of childbearing age, with a The side attachment on the reproductive endocrine function affect the quality of life decreased. In recent years, how to age of benign ovarian tumor torsion underwent conservative surgery to preserve the ipsilateral accessory has attracted more and more attention. We collected in Yanggu County People's Hospital of Obstetrics and Gynecology Hospital of ovarian cyst torsion, and evaluate it.
Objective: To explore the safety and effectiveness of different ovarian cysts pedicled in the treatment of torsional operation.
Research methods: a retrospective analysis from January 2009 to June 2013 in the diagnosis of ovarian cyst torsion in 48 cases. According to the different operation mode into two groups, retain the attachment of ovarian cyst torsion reduction and ovarian cystectomy group (A group, 26 cases) and oophorectomy group (B group, 22 cases). Two groups of patients from the time of onset, ovarian cyst torsion weeks, operation time, average bleeding volume, postoperative hospitalization time, evaluate the hormone level and so on, in order to seek more reasonable treatment.
Results: ovarian cyst torsion reduction and the onset time of enucleation of ovarian cyst surgery group and oophorectomy group were 10.2 + 5.2 and 15.9 + hours of 5.6 hours, there was significant difference between two groups (P0.05). Ovarian cyst torsion reduction and ovarian cystectomy group and appendix resection group torsion weeks were 1.7 + 2.1 + 0.5 weeks and 0.5 weeks, there was significant difference between two groups (P0.05). Ovarian cyst torsion reduction and ovarian cystectomy group and oophorectomy group bleeding were 30.5 + 5.0m1 and 29.83 + 6.85m1, two groups had no statistically significant difference (P0.05). Ovarian cyst torsion reduction and enucleation of ovarian cyst laparoscopic operation group and oophorectomy group were 91.3 + 21.4 and 85.4 + minutes 19.7 minutes, there was significant difference between two groups (P0.05). Ovarian cyst torsion reduction and ovarian cystectomy group and Oophorectomy group hospitalization days were 6.7 + 0.9 and 6.9 + 0.8 days, the two groups had no statistically significant difference (P0.05). Ovarian cyst torsion reduction and enucleation of ovarian cyst 2 months of two groups of patients with endocrine surgery group and adnexectomy group after operation in group two than compared with the difference was statistically significant (P0.05), ovarian cyst torsion reduction and ovarian cyst removal surgery group hormone level recovery was better than the oophorectomy group. The pathological results confirmed that: according to the frozen and routine postoperative pathology, 48 cases were benign ovarian tumors.
Conclusion: early diagnosis and timely treatment can effectively reduce the probability of oophorectomy, reverse confirmed positive surgical pedicle of ovarian tumor during operation. The attachment or depends on the tumor nature and torsion. The time and degree of torsion of ovarian tumor torsion cycle time is short, less number of patients with ovarian cystectomy is safe and feasible. The torsion of ovarian tumors retained ovarian surgery helps preserve ovarian endocrine function.

【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】：2014
【分類號】：R737.31

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