本文選題：卵巢交界性腫瘤　切入點：診斷　出處：《青島大學(xué)》2017年碩士論文

【摘要】：目的:本文將探討卵巢交界性腫瘤臨床特點、病理特征、治療及復(fù)發(fā)影響因素。方法:回顧性分析2000年1月至2016年7月期間在青島大學(xué)附屬醫(yī)院行初次手術(shù)治療,術(shù)后石蠟病理診斷為卵巢交界性腫瘤的131例患者的病例資料,通過分析記錄病歷資料、電話隨訪患者術(shù)后復(fù)查及治療情況,復(fù)發(fā)患者及復(fù)發(fā)后治療情況,利用SPSS21.0進(jìn)行數(shù)據(jù)分析。結(jié)果:1、納入本研究的131例卵巢交界性腫瘤患者的年齡在13-81歲之間,平均發(fā)病年齡41.5±18.4歲,小于40歲者有52.67%(69例)�；颊咭颉安轶w”發(fā)現(xiàn)者58.8%(77例),因“腹痛”就診者16.0%(21例),因“捫及腹部包塊”及“腹脹”原因就診者均占9.9%(13例)。2、在BOTs的不同病理類型中,卵巢漿液性交界性腫瘤患者占68.7%(90例),卵巢粘液性交界性腫瘤患者26.7%(35例)。在不同的分期中,I期患者121例(92.4%),其中IA期患者有81例(61.8%),IB期1例(0.8%),IC期39例(29.8%),II期、III期患者均有5例(3.8%)。3、124例患者行血清CA125檢測,血清CA125升高(35.0IU/ML)者占55.65%,血清CA125在I期患者中升高率占51.75%,II期及III期患者中升高率均為100%。4、在彩色多普勒超聲檢查下,漿液性腫瘤最大徑線平均值為9.08±6.09cm,腫瘤位于雙側(cè)者占16.7%(15例);粘液性腫瘤最大經(jīng)線平均值為17.28±9.90cm,腫瘤均位于單側(cè),粘液性腫瘤徑線大于漿液性腫瘤(P0.05),漿液性腫瘤易發(fā)生在雙側(cè)卵巢(P0.05)。5、所有患者均行手術(shù)治療,其中開腹手術(shù)及腹腔鏡手術(shù)患者均占48.9%(64例),腹腔鏡中轉(zhuǎn)開腹手術(shù)患者有3例(2.1%),腹腔鏡手術(shù)患者腫瘤平均直徑約8.22±4.48cm,開腹手術(shù)患者腫瘤平均直徑約14.87±9.47cm(P0.05)。腹腔鏡組中造成醫(yī)源性腫瘤破裂的患者占32.81%(21例),開腹手術(shù)中造成醫(yī)源性腫瘤破裂的患者占32.15%(20例)(P0.05)。6、納入研究的患者術(shù)后復(fù)發(fā)率為7.6%(10例),復(fù)發(fā)時間間隔3.5-47個月,平均約18.6個月。保留生育功能手術(shù)中復(fù)發(fā)患者占12.9%(9/70),非保留生育功能手術(shù)中復(fù)發(fā)患者占1.96%(1/51)(P0.05)。復(fù)發(fā)患者中術(shù)后病理90%(9/10)仍為卵巢交界性腫瘤,10%(1例)進(jìn)展為惡性腫瘤。結(jié)論:1.卵巢交界性腫瘤患者發(fā)病年齡較年輕,其臨床癥狀隱蔽,多數(shù)因查體發(fā)現(xiàn)。2.卵巢交界性腫瘤術(shù)前準(zhǔn)確診斷率低,彩色多普勒超聲檢查及血清CA125檢測有助于診斷。3.卵巢交界性腫瘤分期早,以漿液性及粘液性兩種病理類型為主,兩種病理類型有著不同的臨床表現(xiàn)。4.卵巢交界性腫瘤術(shù)后具有復(fù)發(fā)傾向,初次手術(shù)手術(shù)方式是影響術(shù)后復(fù)發(fā)的主要因素,如復(fù)發(fā)可行再次手術(shù)治療。復(fù)發(fā)多局限于盆腔,很少發(fā)生惡變。卵巢交界性腫瘤術(shù)后復(fù)發(fā)時間間隔長,應(yīng)進(jìn)行長期隨訪。
[Abstract]:Objective: to investigate the clinical features, pathological features, treatment and recurrence factors of borderline ovarian tumors. Methods: from January 2000 to July 2016, the primary surgical treatment was performed in the affiliated Hospital of Qingdao University. The data of 131 cases of ovarian borderline tumor diagnosed by paraffin wax after operation were analyzed and recorded. Results the age of 131 patients with borderline ovarian tumors was between 13 and 81 years old, and the mean age of onset was 41.5 鹵18.4 years. There were 69 patients younger than 40 years old. 77 patients were found by "body check", 21 patients by "abdominal pain", 13 patients by "palpation of abdominal mass" and "abdominal distension". Among the different pathological types of BOTs, There were 90 cases of ovarian serous borderline tumor, 35 cases of ovarian mucinous borderline tumor, 121 cases of stage I of ovarian mucinous borderline tumor in different stages, 121 cases of stage I and 81 cases of stage IA, including 81 cases of stage IA, including 81 cases of stage Ib and 1 case of stage 0.8 of IC, 39 cases of stage II and III stage of ovarian mucinous borderline tumor. Serum CA125 was detected in 5 patients with 3. 8 and 3 124 patients. The increase rate of serum CA125 in patients with stage I and stage II and III stage was 55.65 and 55.65, respectively. The increase rate of serum CA125 in patients with stage I and stage III was 100 and 4, respectively. Under the examination of color Doppler ultrasound, the increase rate of serum CA125 in patients with stage I and stage III was 100. 4%, 55.65% and 55.65%, respectively. The mean maximum diameter of serous tumor was 9.08 鹵6.09 cm, and that of bilateral tumor was 16.7cm, while that of mucinous tumor was 17.28 鹵9.90 cm. The diameter of mucous tumor was larger than that of serous tumor (P0.05), serous tumor was prone to occur in bilateral ovarian tumor P0.05. 5. All patients were treated by operation. The mean diameter of tumor was about 8.22 鹵4.48 cm in laparoscopic operation and 14.87 鹵9.47 cm in laparotomy group. The patients with iatrogenic tumor rupture accounted for 32.81%, and the patients with iatrogenic tumor rupture caused by laparotomy accounted for 32.1515 cases, 20 cases with iatrogenic tumor rupture. The recurrence rate of the patients included in the study was 7.610 cases, the interval of recurrence was 3.5-47 months. The average of 18.6 months was about 18.6 months. The recurrence rate of 12.9% / 70% in fertility preserving operation and 1.96% / 51% P 0.05 in non-reserved reproductive function surgery. The postoperative pathology of 90% 10% of recurrent patients was still ovarian borderline tumor (10%) and 1 case of ovarian borderline tumor (n = 1). Conclusion: one case of ovarian borderline tumor is malignant tumor. The patients with borderline ovarian tumors develop at a younger age. The clinical symptoms were concealed, most of them were found by physical examination. The accurate diagnosis rate of ovarian borderline tumor before operation was low. Color Doppler ultrasonography and serum CA125 detection were helpful in diagnosis of ovarian borderline tumor. Serous and mucinous types were the main pathological types. The two pathological types had different clinical manifestations. 4. Ovarian borderline tumors had recurrent tendency after operation, and the primary operation mode was the main factor that affected the recurrence of ovarian borderline tumors. If recurrence is feasible, the recurrence is limited to pelvic cavity and rarely occurs malignant change. The interval between recurrence and recurrence of ovarian borderline tumor is long and should be followed up for a long time.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.31

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