286例妊娠合并卵巢肿瘤的临床分析

Clinical study on pregnancy complicated ovarian mass diagnosis and treatment

目的:探讨妊娠合并卵巢肿瘤的临床病程特点,以及相应的诊断和处理对母儿结局的影响。方法:回顾分析2003年3月至2010年12月在上海市第一妇婴保健院住院分娩的286例妊娠合并卵巢肿瘤患者的临床资料,分析比较诊断时孕周,妊娠期间卵巢肿瘤的特点、对妊娠结局影响、分娩方式,病理特点等,并对上述因素进行相关分析。结果:妊娠合并卵巢肿瘤的孕妇阴道分娩54例,剖宫产232例,剖宫产率81.12%;剖宫产获得的232例病理结果中,良性肿瘤227例,交界性肿瘤5例。良性肿瘤行卵巢肿瘤剥除术或患侧附件切除术,交界性肿瘤行患侧附件切除术或肿瘤减灭术;妊娠合并卵巢交界性肿瘤组新生儿体重及分娩孕周均明显低于妊娠合并卵巢良性肿瘤组(P<0.05)。结论:妊娠合并卵巢肿瘤以良性肿瘤最常见。因早期妊娠时缺乏典型的临床症状而不易早期诊断,故应加强孕前及早孕期间的检查;妊娠早期应行B超检查提高卵巢肿瘤检出率;剖宫产术中应仔细探查双侧附件,及时发现卵巢肿瘤;妊娠合并交界性肿瘤,由于终止妊娠时期早,故围产期母儿并发症较高,其处理原则需根据患者年龄、生育情况、组织类型、肿瘤期别、妊娠期限、胎儿成熟度评价等而异。

Objective：To summarize the clinicopathological feature of ovarian tumor complicating pregnancy and investigate the influence of diagnosis and management on the maternal and child outcome.Methods：From Mar 2003 to Dec 2010,286 women with ovarian tumor complicating pregnancy underwent treatment in Shanghai first maternity and infant hospital were studied retrospectively.Those clinical index,including ovarian tumor feature,the influence of pregnancy outcome,delivery way,pathology and so on,were analyzed.Results：54 cases underwent vaginal delivery and 232 cases underwent cesarean section.The rate of cesarean section was 81.12%.232 pregnant women with ovarian tumors were found during cesarean section,including 227 cases with benign tumor and 5 cases with borderline tumors.Two cases with borderline mucinous cystadenoma,one case with borderline papillary cystadenoma,one case with borderline endometrioid fibroadenoma and one case with borderline serous papillary adenofibroma were observed in this study.All of 232 cases of ovarian tumors were managed by oophorocystectomy or adnexectomy in benign tumer and adnexectomy and tumor cytoreductive surgery in borderline tumors.Infant weight and gestational weeks in women with borderline ovarian tumor were significantly lower than those of patients with benign tumor（P0.01）.Conclusion：Benign tumor was the most common type in pregnant women complicating ovarian mass.It was difficult to diagnose ovarian mass in the first trimester because of asymptomatic,so prenatal examination shoud be intensified.Pregnant women should undergo ultrasound evaluation in first trimester and bilateral annex should be checked during cesarean section.Pregnant women with borderline tumors,due to early surgery intervention,so perinatal complications were relatively higher.Management principles was based on age,fertility,histological type,tumor stage,the period of pregnancy,fetal maturity evaluation and so on.