卵巢甲状腺肿68例临床分析

Clinical study on 68 cases with struma ovarii

目的 探讨卵巢甲状腺肿的临床特点、治疗及预后.方法 回顾性分析中国医学科学院北京协和医院1990年1月至2012年1月间收治的68例卵巢甲状腺肿患者的临床资料.结果 （1）一般情况：68例患者的中位年龄42岁（17 ～81岁）;其中良性卵巢甲状腺肿64例（94％）,恶性卵巢甲状腺肿4例（6％）.（2）临床表现：32例（47％）患者为健康体检时超声检查发现盆腔包块就诊,28例（41％）患者以腹痛就诊,8例（12％）患者自行扪及下腹包块就诊.54例患者术前有血清CA125检查,仅8例（15％）异常.所有患者均行术前超声检查,其中51例（75％）为多房囊性包块,14例（21％）为囊实性包块,3例（4％）为实性包块.肿瘤的平均直径为（8±3）cm.4例（6％）患者术中可见腹水.68例患者中,67例患者病变位于单侧卵巢,仅1例为双侧.术前患者均无甲状腺功能亢进（甲亢）的临床表现,术后有19例患者行甲状腺功能检查,结果均正常.（3）治疗：所有患者均接受手术治疗.64例良性卵巢甲状腺肿患者中,25例行囊肿剔除术,15例行单侧附件切除术,2例行双侧附件切除术,22例行子宫全切除＋单侧或双侧附件切除术.4例恶性卵巢甲状腺肿患者中,3例行保留生育功能手术,其中1例行保留生育功能的分期手术、2例行患侧附件切除术,1例行子宫全切除＋双侧附件切除术,2例患者术后接受化疗.（4）预后：良性卵巢甲状腺肿患者的中位随访时间为5.4年（6个月～21年）,均无复发.4例恶性甲状腺肿患者的中位随访时间为11.5年（9～ 20年）,有3例复发,复发时间分别为术后2、7、16年.复发后均接受再次手术治疗,其中2例患者接受甲状腺切除术联合131I治疗;到随访结束时,4例患者均存活.结论 卵巢甲状腺肿是少见的卵巢单胚层畸胎瘤.囊肿剔除或附件切除可能是良性卵巢甲状腺肿适宜的治疗方法,而恶性卵巢甲状腺肿发病率低,缺乏标准的治疗方案.因恶性卵巢甲状腺肿有远期复发风险,需要严密随访.

Objective To study the clinical features,treatment and prognosis of struma ovarii.Methods From January 1990 to January 2012,a total of 68 patients were diagnosed struma ovarii at the Department of Obstetrics and Gynecology,Peking Union Medical College Hospital.Clinical data of these patients were studied retrospectively.Results （1） Characteristics of patients：the median age of patients was 42 years old （17-81 years）.Of those patients,64 cases （94%） were diagnosed begin struma ovarii and 4（6%） were malignant struma ovarii.（2） Clinical feature：32（47%,32/68） patients were identified with pelvic mass by ultrasonic test,28 cases（41%） had clinical abdominal pain,8（12%） touched a mass from abdominal wall.Preoperative CA125 were tested in 54 patients,but only 8 cases（15%） had moderate elevation.All patients receive ultrasound examination,and 51 cases （75%） were mulitcystic lesions with many septi,3（4%） solid lesions and 14（21%） solid-cystic tumors.The mean diameter of tumors was（8 ± 3） cm.Ascites was present in 4 （6%,4/68）patients.Sixty-seven patients had unilateral lesions,and 1 patient had bilateral lesions.No patient had hyperthyroidism presentation.Nineteen cases underwent thyroid function test after operation,and the results were normal.（3） Treatment：all patients underwent surgical treatment.Among patients with begin struma ovarii,25 cases underwent cystectomy,15 cases unilateral,2 bilateral salpingo-oophorectomy,22 cases hysterectomy ＋ unilateral or bilateral salpingo-oophorectomy.Four malignant struma ovarii,1 patient underwent fertility-sparing staging surgery,2 patients unilateral salpingo-oophorectomy,1 case hysterectomy ＋ bilateral salpingo-oophorectomy.Two patients received chemotherapy after surgery.（4） Prognosis：all patients were followed up in Peking Union Medical College Hospital.The median follow-up time of benign struma ovarii was 5.4 years （6 months-21 years） and there were no recurrence.The median follow-up time of malignant struma ovarii was 11.5 years （9-20 years）.Three cases had long-term recurrence at 2,7 and 16 years respectively after surgery.They were received surgical treatment after recurrence and all were alive.Two cases were given by thyroidectomy and 131I treatment.Conclusions Struma ovarii is a rare ovarian monodermal teratoma.Tumorectomy or salpingo-oophorectomy is the appropriate therapeutic treatment for benign struma ovarii.The incidence of malignant struma ovarii is low,and there are no standard treatments.Because of higher long-term recurrence rate,these patients need close follow-up.