本文選題：妊娠 + 卵巢腫瘤��； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：妊娠合并卵巢腫瘤是常見的妊娠期合并癥，卵巢腫瘤一旦在妊娠期間發(fā)生蒂扭轉可直接威脅母嬰安全，具有起病急，進展快、臨床表現(xiàn)復雜多樣、易導致誤診、漏診的特點，危險性、嚴重性均較非妊娠期大，治療時要兼顧母嬰兩個因素，因此，總結妊娠合并卵巢腫瘤蒂扭轉的臨床表現(xiàn)、診斷方式、處理方法顯得尤為重要。本文收集2006年1月-2013年2月中國人民解放軍第202醫(yī)院收治的妊娠合并卵巢腫瘤蒂扭轉病人共31例，對其臨床資料進行分析。并結合相關文獻，從而探討妊娠合并卵巢腫瘤蒂扭轉的臨床特征、診斷方式、處理方法及其對妊娠結局的影響，同時探討采用先高位結扎卵巢動、靜脈后復位扭轉的附件并將卵巢腫物核除術式的療效，以及腹腔鏡手術對孕期卵巢腫瘤蒂扭轉治療的安全性。 目的：探討妊娠合并卵巢腫瘤蒂扭轉的臨床特征、診斷方式、處理方法及其對妊娠結局的影響，提高妊娠期卵巢腫瘤蒂扭轉的診斷與治療水平。 方法：收集2006年1月-2013年2月中國人民解放軍第202醫(yī)院收治的31例妊娠合并卵巢腫瘤蒂扭轉患者的臨床資料，結合相關文獻進行回顧性分析。 結果：保守治療2例，手術治療明確妊娠合并卵巢腫瘤蒂扭轉29例，其中1例術前誤診為闌尾炎。手術治療中開腹手術19例（9例采取高位結扎卵巢動、靜脈，保留患側卵巢術式，10例采取常規(guī)切除患側附件術式），腹腔鏡手術10例（5例采取高位結扎卵巢動、靜脈的新術式，5例采取常規(guī)切除患側附件術式）。所有病例發(fā)生于孕早期（14w）4例，占12.9％；孕中期（14w~28w）25例，占80.6％；孕晚期（28w）2例，占6.5％。29例手術患者中良性腫瘤29例，無惡性腫瘤，術中見卵巢腫瘤大小在4~14cm之間，平均7.31±2.66cm。最常見的病理類型為畸胎瘤14例（48.3％），其次為漿液性囊腺瘤6例（20.7％），黃體或黃素化囊腫4例（13.8％），粘液性囊腺瘤3例（10.3％），子宮內(nèi)膜異位囊腫2例（6.9％）。29例手術患者中足月分娩24例，早產(chǎn)3例，流產(chǎn)2例。保守治療的2例患者足月分娩1例，，流產(chǎn)1例。 結論：妊娠合并卵巢腫瘤蒂扭轉因其特殊的生理、解剖變化，容易出現(xiàn)誤診，需要與多科室緊密參與診斷治療。病理類型最常見的為成熟型囊性畸胎瘤，其次為漿液性囊腺瘤、黃體或黃素化囊腫、粘液性囊腺瘤、子宮內(nèi)膜異位囊腫。妊娠合并卵巢腫瘤蒂扭轉易發(fā)生于孕中期，一旦發(fā)生應立即手術治療，合理的術式選擇不增加早產(chǎn)及流產(chǎn)發(fā)生率。術中探查對于無明顯感染的良性卵巢腫瘤蒂扭轉患者，可采用高位結扎卵巢動、靜脈后將扭轉的卵巢復位，再核除腫瘤的術式，既解決了卵巢病變，又保留了卵巢組織及功能。腹腔鏡手術可應用于妊娠中期治療卵巢腫瘤蒂扭轉。
[Abstract]:Pregnancy with ovarian tumor is a common complication of pregnancy. Once ovarian tumor occurs during pregnancy, it can directly threaten the safety of mother and child. It has the characteristics of acute onset, rapid progress, complicated clinical manifestations, easy misdiagnosis and missed diagnosis.The risk and severity are greater than that of non-pregnancy, so it is very important to summarize the clinical manifestation, diagnosis and treatment of pregnancy complicated with ovarian tumor pedicle torsion.31 cases of pregnancy complicated with ovarian tumor pedicle torsion were collected from January 2006 to February 2013 in the 202 Hospital of the Chinese people's Liberation Army and their clinical data were analyzed.In addition, the clinical features, diagnostic methods, management methods and their effects on pregnancy outcome of ovarian tumor pedicle torsion were discussed. At the same time, high ligation of ovary was used as the first ligation of ovary.The efficacy of retrovenous reduction of torsional appendages and removal of ovarian tumor nucleus, and the safety of laparoscopic surgery in the treatment of ovarian tumor pedicle torsion during pregnancy.Objective: to investigate the clinical features, diagnostic methods, management methods and their effects on pregnancy outcome of ovarian tumor pedicle torsion in pregnancy, and to improve the diagnosis and treatment level of ovarian tumor pedicle torsion during pregnancy.Methods: from January 2006 to February 2013, 31 cases of pregnancy complicated with ovarian tumor pedicle torsion were collected and analyzed retrospectively.Results: there were 2 cases of conservative treatment and 29 cases of pregnancy complicated with ovarian tumor pedicle torsion. One case was misdiagnosed as appendicitis before operation.Of the 19 patients undergoing laparotomy, 9 were treated with high ligation of the ovarian artery and vein, 10 with conventional excision of the affected side of the ovary and 5 with high ligation of the ovary.The new operation of vein was performed in 5 cases by routine excision of the accessory of the affected side.All the cases occurred in the first trimester of pregnancy in 4 cases (12.9%), in the second trimester of pregnancy, 25 cases (80.6%) in the second trimester of pregnancy, and in the third trimester of 28 weeks (29 cases), there were 29 cases of benign tumor, no malignant tumor, and the size of ovarian tumor was between 7.31 鹵2.66 cm during operation, and the mean size of ovarian tumor was 7.31 鹵2.66 cm during the second trimester of pregnancy.The most common pathological types were teratoma (14 cases), serous cystadenoma (6 cases), serous cystadenoma (6 cases), luteal or luteinized cyst (4 cases), mucinous cystadenoma (3 cases), endometrial cystoma (2 cases), endometrial cystoma (2 cases, n = 29), full-term delivery (n = 24), preterm delivery (n = 3).There were 2 cases of abortion.Conservative treatment of 2 cases of full-term delivery in 1 case, abortion in 1 case.Conclusion: because of its special physiological and anatomical changes, pregnancy complicated with ovarian tumor pedicle torsion is prone to misdiagnosis, so it is necessary to take part in diagnosis and treatment closely with multiple departments.The most common pathological types were mature cystic teratoma, serous cystadenoma, luteal or luteinized cyst, mucinous cystadenoma and endometriosis cyst.The pedicle torsion of ovarian tumor is easy to occur in the second trimester of pregnancy. If it occurs, it should be treated immediately, and the reasonable operation should not increase the incidence of premature delivery and abortion.Intraoperative exploration of benign ovarian tumor pedicle torsion without obvious infection can be performed by high ligation of ovarian artery, reduction of torsional ovary after vein, and removal of tumor by nucleus, which not only resolves ovarian disease, but also preserves ovarian tissue and function.Laparoscopic surgery can be used in the treatment of ovarian tumor pedicle torsion in the second trimester of pregnancy.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.2;R737.31

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