胎儿卵巢囊肿的产前评估和生后追踪

Prenatal evaluations and postnatal follow-ups of fetal ovarian cyst

目的了解胎儿卵巢囊肿发病特点、转归及超声评估的准确性，为产前诊断及生后随访治疗提供依据。方法对2008年1月至2013年9月产前超声检查疑似胎儿卵巢囊肿的病例进行产前评估，记录诊断孕龄、囊肿大小、部位、性质，有无合并其他畸形等，并跟踪随访患者的转归。结果共发现99例，其中单侧96例，复杂性和直径〉5cm单纯性囊肿57例（57．5％）；获诊孕龄平均28（19～39）周；失访32例；选择引产9例；剩余58例中，囊肿自然消退34例（58．6％），其中产前消退6例（10．3％），26例（44．8％）在出生后至1岁期间消退；手术13例（22．4％）；11例（18．9％）囊肿未增大及变化，仍定期随访观察。产前超声诊断准确率为91％（53158）。结论胎儿卵巢囊肿主要发生在孕晚期28周后，其中大部分会在临近产时或生后1周岁内自然消退，但产前诊断仅凭超声检查尚无法达到接近100％的准确率，对于大于5cm或复杂性囊肿，有必要对这类病例生后48h内进行严格的再评估和修正诊断，从而制定相应的治疗方案，以避免出现囊肿扭转丢失器官、误诊其他疾病。

Objective To explore the natural development of fetal ovarian cyst and assess the accuracy of ultrasonography in diagnosing fetal ovarian cyst and providing rationales for prenatal evaluation and postnatal tracing of fetal ovarian cyst. Methods From January 2008 to September 2013, pre-and post-natal medical records of ultrasonically suspicious fetuses with ovarian cysts were reviewed retrospectively. And the clinical data included gestation age, mass size, location, mass features and combined malformations, etc. Results Among 99 cases, 96 were unilateral and 57 cysts were over 5 cm or complicated. Their average gestational age was 28（19-39） weeks. And 32 cases were lost to follow-ups and 9 opted for termination. For the remaining 58 case, 34 cases （58. 6%） presented spontaneous regression. Prenatally, 6 cases （10. 3%） had spontaneous regressiorL And 28 cases （28.2%） regressed spontaneously after birth and before i year. Posmatal operations were performed for 13（22. 4% ） cysts. And 11 （18. 9%） cysts showed no obvious enlargement and were followed up to date. The prenatal accuracy rate of ultrasonic diagnosis was 91% （53/58）. Condusions Most fetal ovarian cysts found sonographically in the third trimester tend to regress spontaneously during the first year. For cysts over 5 cm or complicated, it is necessary to reevaluate just after birth and establish a correct diagnosis. Thus organ loss due to cyst torsion or misdiagnosing may be avoided.