妊娠合并卵巢恶性肿瘤9例临床分析

Ovarian Cancer at Pregnancy

目的:总结妊娠合并卵巢恶性肿瘤病例的临床特点和诊治经验。方法:回顾性分析2000年1月至2008年1月在北京协和医院妇产科收治的妊娠合并卵巢恶性肿瘤患者9例。结果:其中,卵巢上皮性肿瘤6例;卵巢性索间质肿瘤2例;生殖细胞肿瘤1例;均为Ic期。妊娠38周前超声发现包块诊断7例;产前未能诊断于剖宫产术中发现肿瘤2例。1例阴道分娩,8例行剖宫产。5例患者在孕29周前手术,无手术并发症。1例患者治疗性早产,其他新生儿无并发症。1例于术后32个月死亡,8例自手术至今生存20～100个月。结论:妊娠合并附件包块有恶性的可能,应予重视。手术时机宜选择在孕中期。妊娠合并卵巢恶性肿瘤除可能导致治疗性早产外,不增加新生儿并发症。孕期超声应重视双侧附件情况,强调在剖宫产的同时常规探查双侧附件。

Objective： To explore the clinical characteristics and treatment of malignant ovarian cancer during pregnancy. Methods： We analyzed the cases of malignant ovarian cancer during pregnancy identified between January 2000 and January 2008 in PUMCH. Patient age, history, pathology, tumor stage, treatment, surgical complications and fetal outcomes were reviewed. Results： There were 9 cases of malignant ovarian cancer during pregnancy identified between January 2000 and January 2008 in PUMCH. Six had malignant ovarian epithelial tumor, and the other 3 had other kinds of ovarian tumors. All cases were of stage Ic. Five cases were diagnosed by B ultrasound before 28 weeks of gestation, while 2 were not diagnosed until Caesar- ean section （CS） was performed for other obstetric reasons. Surgical excision was performed in 5 cases be- fore 29 weeks of gestation without surgical complications. Eight patients delivered through CS, and 1 patient delivered vaginally with therapeutic premature labor. One patient received chemotherapy when she was preg- nant. Conclusion： The incidence of malignancy in pregnancy-associated adnexal masses was not very low. Surgery should be performed during the second trimester. Except for one case of therapeutic premature labor, the fetal outcomes were not affected. A routine examination of the bilateral adnexa during the CS procedure should be emphasized.