妊娠与非妊娠女性卵巢肿瘤蒂扭转的临床特点及诊治比较

Comparative analysis of the clinical characteristics and treatment of ovarian tumor pedicle torsion in pregnant and non-pregnant women

目的探讨妊娠期与非妊娠期卵巢肿瘤蒂扭转患者的临床特征及诊治结局。方法回顾性分析2009年1月至2018年12月在西安交通大学第一附属医院住院治疗,并经手术确诊为卵巢肿瘤蒂扭转的163例患者的临床、手术及病理资料,根据妊娠与否,分为妊娠组和非妊娠组进行分析。结果(1)妊娠组下腹痛、伴恶心呕吐及腹膜刺激征发生率均低于非妊娠组,但差异无统计学意义(P均>0.05)。(2)妊娠组出现症状到住院的间隔时间长于非妊娠组,差异有统计学意义(P<0.05)。而妊娠组住院至手术的时间间隔显著短于非妊娠组(P<0.05)。(3)妊娠组卵巢囊肿平均直径小于非妊娠组,差异有统计学意义(P<0.05)。(4)非妊娠组患者术后病理类型最常见者为卵巢畸胎瘤34例(26.8%);妊娠组最常见的为卵巢生理性囊肿10例(27.8%)。(5)妊娠组4例早期妊娠患者要求术中同时行人工流产术;1例妊娠23周的孕妇出现腹痛症状后1周就诊,术后4 h自然流产;26例随访至足月,妊娠结局良好;5例术后失访。结论妊娠期卵巢肿瘤蒂扭转临床症状无特异,易延误诊治;妊娠期的附件手术未增加流产及母婴不良妊娠结局。

Objective To explore the clinical characteristics,diagnosis and treatment of patients with ovarian tumor pedicle torsion in pregnancy and non-pregnancy.Methods A retrospective analysis of the general,clinical,surgical and pathological data of 163 patients who were diagnosed with ovarian tumor pedicle torsion after surgery were admitted to the First Affiliated Hospital of Xi’an Jiaotong University from January 2009 to December 2018.It is divided into pregnant group and non-pregnant group.Results(1)The incidence of abdominal pain,nausea and vomiting,and peritoneal irritation in the pregnant group were lower than those in the non-pregnant group,but the differences were not statistically significant(all P>0.05).(2)The interval between the symptoms in the pregnancy group and the hospital stay was longer than that in the non-pregnancy group,and the difference was statistically significant(P<0.05).The interval between hospitalization and surgery was significantly shorter in the pregnant group than in the non-pregnant group(P<0.05).(3)The average diameter of cysts in the pregnant group was smaller than that in the non-pregnant group,and the difference was statistically significant(P<0.05).(4)In non-pregnancy group,the most common postoperative pathological type was teratomas in 34 cases(26.8%).In pregnancy group,the most common type was physiological cysts in 10 cases(27.8%).(5)In pregnancy group,4 patients with early pregnancy required simultaneous abortion.A 23-week pregnant woman presented with abdominal pain 1 week later and had a spontaneous abortion 4 hours after surgery;Twenty-six cases were followed up to term,and the pregnancy outcome was good;5 cases were lost to follow-up.Conclusion The clinical symptoms of ovarian tumor pedicle torsion during pregnancy are not specific,and it is easy to delay diagnosis and treatment.Adnexal surgery did not increase miscarriage or adverse pregnancy outcomes.