腹腔镜下卵巢甲状腺肿的诊断和治疗(附7例病例分析)

Diagnosis and treatment of struma ovarii with laparoscopic procedure (report of 7 cases)

目的探讨腹腔镜在卵巢甲状腺肿诊断及治疗中的应用。方法回顾性分析北京协和医院近6年经腹腔镜治疗的卵巢甲状腺肿7例的临床资料,综合文献复习。结果该病发病率占卵巢成熟囊性畸胎瘤2.7%。临床表现为腹痛、腹胀、腹水及附件包块。7例中6例为良性,1例为恶性。除1例外院术后诊断为恶性甲状腺肿外,其余6例术前均未明确诊断。6例良性者行腹腔镜下肿瘤剔除术,其中5例术中冰冻切片病理确诊,1例术后石蜡切片病理诊断。1例恶性者行腹腔镜下保留生育功能的卵巢癌分期术,术后病理分期Ⅰ期。结论卵巢甲状腺肿是一种高度特异性卵巢畸胎瘤,具有发病率低、临床表现不特异、术前术中诊断困难的特点。腹腔镜手术可以提高该病的术中诊断率,并是良性甲状腺肿最佳的治疗方法。多数恶性卵巢甲状腺肿的病变局限于卵巢,对有熟练腹腔镜操作技巧的妇科医生来说,腹腔镜下的分期术是一种治疗恶性甲状腺肿很好的选择。

Objective: To investigate the use of laparoscopic procedure in the diagnosis and treatment of struma ovarii. Methods: 7 cases of struma ovarii in PUMC hospital were analyzed retrospectively and related literature reviewed. Results: Struma ovarii stood for 2.7% of teratoma. Clinical signs included abdominal pain, abdominal distention, ascites and abdominal mass. 6 of 7 cases were benign and I was malignant. Except the malignat case which was diagnosed by a previous operation, 6 of 7 cases were misdiagnosed before surgery. Of the 6 benign cases underwent laparoscopic cystectomy, 5 were diagnosed by frozen section. 1 malignat case underwent laparoscopic staging surgery, the pathological staging wasⅠ. Conclusion: Struma ovarii is highly specialized teratoma with low and during surgery. Laparoscopic procedure can improve diagnosis during operation and is the best choice of treatment. Since most malignant struma ovarii is localized to ovary, laparoscopic staging surgery is a good choice for gynecologist with excellent laparoscopic experience.