159例卵巢手术患者的术前超声评价与手术指征的探讨

Approach for operative indications of 159 patients with ovarian surgery

目的:探讨卵巢手术患者的术前超声评价对手术指征的指导价值。方法:收集2013年1—12月在复旦大学附属肿瘤医院行卵巢手术的患者159例,就其超声物理特征、临床特征及病理资料进行回顾性分析。结果:159例患者共发现卵巢病灶171处。囊性病灶的恶性率以病灶最大径7 cm为界,差异有统计学意义(P<0.05);囊壁有乳头组的恶性率高于无乳头组,差异有统计学意义(P<0.05)。囊实性病灶的恶性率以5 cm为界,差异有统计学意义(P<0.05)。实性病灶的恶性率以病灶最大径5 cm或7 cm为界,差异均无统计学意义(P>0.05)。12例患者既往有胃肠道或乳腺恶性肿瘤,7例术后病理为转移性肿瘤(58.3%)。结论:对于超声提示的卵巢实性病变、>7 cm的囊性病变或>5 cm的囊实性病变具有手术指征;对于既往有胃肠道或乳腺恶性肿瘤的病例,需警惕转移性肿瘤的可能。

Objective： To explore the value of pre-operative sonographic findings in the assessment of the operative indications of patients with ovarian surgery. Methods： A total of 159 patients with 171 ovarian lesions were enrolled in the study. All patients were evaluated by ultrasound for morphological features of the masses. The final diagnosis, based on histopathological analysis, was used as a gold standard. Results： In ovarian cystic lesions, the ratio for malignancy in the lesions with the maximal diameter ≥7 cm was statistically higher than those 〈7cm（P〈0.05）. The ratio for malignancy in the ovarian cystic lesions with parietal papillary was significantly higher than those without papillary（P〈0.05）. In ovarian complex lesions, the ratio for malignancy in the lesions with the maximal diameter ≥5 cm was statistically higher than those 〈5 cm（P〈0.05）. There was no significant difference in solid lesions when the maximal diameter of 5 cm or 7 cm was set as the threshold for potential maglinancy. In 12 patients with history of gastric or intestinal or breast cancer, metastatic tumor was found in the ovary in 7 cases. Conclusion： The patients with the solid ovarian lesions, or the maximal diameter of cystic ovarian lesions 〉7 cm, or the maximal diameter of complex lesions 〉5 cm are indicated for surgical procedures. The patients with history of gastric or intestinal or breast cancer are more likely to have the metastatic tumor in the ovary.