18例卵巢子宫内膜异位囊肿合并感染临床分析

A Clinical Analysis of 18 Cases of Ovarian Endometrioma With Infection

目的探讨卵巢子宫内膜异位囊肿(ovarian endometrioma,OE)合并感染的临床特点及诊疗策略.方法回顾性分析2016年1月-2018年6月福建省妇幼保健院收治的18例OE合并感染患者的临床病理资料,分析其临床特点、诊治及治疗预后.结果 18例患者中,11例同时表现发热、腹痛及盆腔包块,11例患者的白细胞(WBC)、C反应蛋白(CRP)、癌胚抗原125(CA125)同时升高.腹腔镜组术中出血量、术后肛门排气时间和术后住院时间与开腹组比较,差异有统计学意义(P<0.05).术后随访率66.7%(12/18),中位随访时间13个月(7~36个月).术后自然受孕者4例,其中1例足月顺娩一活胎,1例体外受精-胚胎移植(IVF-ET)受孕,2例自然流产.3例患者术后6~20个月时复查发现附件区囊肿,2例再次行囊肿切除术.结论卵巢子宫内膜异位囊肿合并感染患者临床表现缺乏特异性,多数为发热、腹痛及盆腔包块.术前诊断率低.腹腔镜手术较开腹手术有一定优势,积极手术并辅以规范术后治疗能尽量保护女性生育功能.

Objective To explore the clinical features, diagnosis and treatments of ovarian endometrioma with infection. Methods A total of 18 cases confirmed surgically and pathologically with ovarian endometrioma(OE) with infection in Fujian Provincial Maternal and Children Hospital from January 2016 to June 2018 were retrospectively analyzed for their clinical features, diagnosis, treatments and prognosis. Results Fever, abdominal pain and pelvic cysts were the main symptoms in 11 cases(11/18), 11 patients with elevated WBC, CRP, and CA125, The difference of intraoperative blood loss, postoperative anal exhaust time and postoperative hospital stay between laparoscopic group and open surgery group was statistically significant (P <0.05). The postoperative follow-up rate was 66.7%(12/18), and the median time was 13 months (range 7 to 36 months). Four patients were naturally conceived after surgery, and one of them delivered a living fetus at term. One case was fertilized by in vitro fertilization-embryo transfer (IVF-ET) and two cases were spontaneously aborted. Three cases recovered from 6 to 20 months after surgery and found cysts in the attachment area. Two cases underwent cystectomy again. Conclusion The signs of patients with ovarian endometrioma with infection mainly manifested as fever, abdominal pain and pelvic masses, but are lack of specificity. The preoperative diagnosis rate is low. Laparoscopic surgery has certain advantages over open surgery. Aggresive surgical operation and supplemented with standardized postoperative treatment can protect female fertility as much as possible.