卵巢交界性肿瘤129例临床分析

Clinical analysis on 129 cases with borderline ovarian tumors

目的探讨术中冰冻切片在卵巢交界性肿瘤(BOTs)诊断中的意义。方法收集天津市中心妇产科医院2011年1月-2012年12月收治的129例BOTs患者的病历资料,并对该资料的临床特点、诊治情况及术后复发情况等进行回顾性分析。结果患者冰冻切片与石蜡切片病理诊断符合率为79.37%,主要影响因素有病理类型和肿物大小。诊断不符者中病理类型以黏液性卵巢交界性肿瘤(MBOT)为主(19例,73.08%),直径>10 cm者较≤10 cm者诊断符合率低(64.44%vs.87.65%),差异有统计学意义(P=0.002)。复发者以双侧肿物、期别较高、具有微乳头、浸润性种植及未行全面分期手术者多见。大网膜转移6例(4.65%),盆腔淋巴结转移1例,再分期手术7例,术后病理分期均未见上升。结论 MBOT及肿物直径>10 cm者冰冻切片与术后石蜡病理诊断符合率较低,应引起临床及病理医师的注意。复发的相关因素为双侧肿物、分期、微乳头、浸润性种植及是否行全面分期手术。建议Ⅰ期患者可适当保留大网膜,淋巴结是否常规切除有待进一步讨论。初次手术未行全面分期者应充分与患者沟通后再决定是否行再分期手术。

Objective To explore the significance of intraoperaive frozen section in diagnosis of borderline ovarian tumors.Methods The data of 129 patients with borderline ovarian tumors treated in Tianjin Central Hospital of Gynecology and Obstetrics from January 2011 to December 2012 were collected,then the clinical characteristics,diagnosis,treatment,and postoperative recovery were analyzed retrospectively. Results The coincidence rate of frozen section and paraffin section was 79. 37%,the main influencing factors included pathological types and tumor size. Among the patients with inconsistent diagnosis,mucous borderline ovarian tumor was the main pathological type（ 19 cases,73. 08%）. The coincidence rate of diagnosis in the patients with tumor diameter〉10 cm was 64. 44%,which was statistically significantly lower than that in the patients with tumor diameter≤10 cm（ 87. 65%）（ P = 0. 002）. Recurrence mainly occurred in the patients with bilateral lesions,high stage,micro-nipples,invasion,and surgery without comprehensive staging. Omentum majus metastasis occurred in 6 patients（ 4. 65%）,pelvic lymph node metastasis occurred in one patient,and 7 patients underwent surgery after restaging.Postoperative pathological staging didn＇t increase. Conclusion The coincidence rates of frozen section and paraffin section in patients with mucous borderline ovarian tumor and tumor diameter〉10 cm are low,the clinicians and pathologists should pay more attention to the phenomenon. The related factors of recurrence include bilateral lesions,high stage,micro-nipples,invasion,and surgery without comprehensive staging. It is recommended to reserve omentum majus in the patients of stage Ⅰ,but lymph node resection or not needs further discussion.The clinicians should fully communicate with the patients without comprehensive staging before the first surgery to decide whether restaging surgery is necessary.