不孕症患者合并卵巢肿瘤的临床特点分析

Clinical analysis of ovarian tumor in infertility women

目的探讨不孕症患者合并卵巢肿瘤的临床特点、诊断、手术处理及妊娠结局。方法回顾性分析1999年1月1日—2004年12月31日在浙江大学医学院附属妇产科医院生殖内分泌科因不孕症住院手术后经病理检查证实的110例卵巢肿瘤患者的临床资料。按病理检查结果分为卵巢上皮性肿瘤组(上皮性肿瘤组)、畸胎瘤组和其他组,分别为49、42、19例。结果上皮性肿瘤组、畸胎瘤组和其他组的术前确诊率分别为29%、81%和63%,前组明显低于后两组(P<0.01)。110例患者中,97例为直径<5 cm 的卵巢小肿瘤患者;97例完成腹腔镜下卵巢肿瘤剔除手术,11例行开腹手术,2例腹腔镜检查后转开腹手术;上皮性肿瘤组合并盆腔致密粘连的发生率为61%,明显高于畸胎瘤组的26%(P<0.01)。有随访结果的102例患者中,共45例妊娠,妊娠率44%,其中18例自然受孕,21例体外受精妊娠,6例人工授精妊娠。结论 (1)不孕症合并卵巢肿瘤以直径<5 cm 的小肿瘤为主,术前诊断率低,腹腔镜检查可明确诊断。(2)卵巢上皮性肿瘤合并慢性盆腔炎发生率较高,术中应认清解剖关系,完整剔除肿瘤,同时尽量保护卵巢功能。(3)不孕症合并卵巢肿瘤患者在手术和辅助生育治疗后可获得良好的妊娠结局。

Objective To determine the clinical characteristics and management of ovarian tumor in infertility women. Methods During the period from Jan. 1 1999 to Dec. 31 2004, 110 infertility women with ovarian tumor were analysed retrospectively, in terms of clinical and pathological features. According to the histological findings, the tumors were divided into three groups： epithelial tumor, teratoma and others. Results Among 110 cases, 49 cases were epithelial tumor,42 cases were teratoma,and 19 cases were others. A total of 97 cases were small ovarian tumor, and the maximal diameter was less than 5 cm. In epithelial tumor group only 29% were diagnosed before operation, significantly lower than the other two groups （P 〈 0.01 ）. In epithelial tumor group 61% were complicated with pelvic inflammatory disease （PID） ,significantly higher than teratoma group （26%, P 〈 0. 01 ）. A total of 102 cases （91%） were followed-up for 1.5 to 5 years. A total of 45 patients （ 44% ） had become pregnant. Among them 18 conceived spontaneously, 21 underwent in vitro fertilization-embryo transfer, and 6 received artificial insemination. Conclusions Most ovarian tumors found in infertility women are small cysts and only a few epithelial tumors are diagnosed before the operation. Physicians should be alert of infertility women with ovarian mass and laparoscopy should be performed as early as possible. Our data show the incidence of PID in epithelial tumor group is higher than others. Mter treatment by surgery and assisted reproductive technology, those infertility women with ovarian tumor may achieve fair pregnancy outcomes.