妊娠期附件肿物临床特点及其与妊娠结局的关系

Clinical Characteristics of Adnexal Mass during Pregnancy and Its Relationship with Pregnancy Outcome

目的评估不同治疗方法及肿物大小是否会影响妊娠期被诊断为附件肿物的患者的妊娠并发症和新生儿不良结局的风险。方法回顾2014—2021年山东大学齐鲁医院妇产科收治的诊断为妊娠期合并附件肿物且肿物直径≥5 cm的患者的临床资料,收集患者的年龄、孕次、孕周、超声特点、生产方式、病理结果、妊娠并发症及新生儿不良结局等信息。结果共收集了162例患者的临床资料,其中采用手术治疗的共30例,21例(70.00%)患者采取了经腹手术,其余9例(30.00%)患者采取了腹腔镜手术,其中2例(6.67%)患者因附件肿物发生扭转进行了急症手术,此2例患者经随访并无不良妊娠结局;接受手术的患者中有2例(6.67%)患者出现妊娠不良结局。采用保守治疗的患者共132例,25例(18.94%)患者出现妊娠不良结局。手术组患者肿物的肿物体积比保守组稍大,而保守组患者行剖宫产的比例较手术组高(P<0.001),保守组发生妊娠并发症的风险比手术组要高(P<0.05)。能获取病理结果的共有144例,其中成熟型畸胎瘤(33.33%)所占的比例最大,其次为囊腺瘤(27.08%),共发现恶性肿瘤5例及交界性肿瘤3例。直径在11~14 cm之间的附件肿物病理为恶性及交界性的风险较其他大小的肿物要大(P<0.05),不同大小的附件肿物之间发生扭转及腹痛等并发症、妊娠并发症及新生儿并发症差异无统计学意义。结论在此次研究中发现,采取手术治疗可降低妊娠不良结局的风险,同时还发现直径在11~14 cm之间的附件肿物为恶性及交界性的风险较其他直径的肿物要大。

Objective To assess whether different treatments and tumor size affect the risk of pregnancy complications and adverse neonatal outcomes in patients diagnosed with adnexal masses during pregnancy.Methods A review was performed of pregnant patients diagnosed with adnexal mass 5 cm or greater in diameter during the period of 2014 to 2021 in the Department of Obstetrics and Gynecology of Shandong University Qilu Hospital.We collected the information of their age,number of pregnancies,gestational age,ultrasound characteristics,mode of delivery,pathological results,pregnancy complications and adverse neonatal outcomes.Results We collected the clinical data of 162 patients,of whom 30 underwent surgical treatment,21(70.00%)underwent transabdominal surgery,the remaining 9(30.00%)underwent laparoscopic surgery,and two(6.67%)underwent emergency surgery due to torsion of adnexal masses,both of whom had no adverse pregnancy outcomes at followup;adverse pregnancy outcomes occurred in two patients(6.67%)who took surgery.132 patients were treated conservatively,25(18.94%)had adverse pregnancy outcomes.The tumor volume in the surgical group was slightly larger than that in the conservative group,while the proportion of cesarean section in the conservative group was higher(P<0.001),and the risk of pregnancy complications in the conservative group was higher than that in the surgical group(P<0.05).The pathological results were obtained in 144 cases,among which mature teratoma(33.33%)accounted for the largest proportion,cystadenoma(27.08%)was the second.Malignant tumors were found in 5 cases and borderline tumors in 3 cases.In surgically treated patients,adnexal masses between 11-14 cm in diameter have a higher risk of pathologically malignant and borderline lesions than other sizes(P<0.05),and no significant difference was found in the conservative group.The different size of the mass did not affect the risk of pregnancy complications and neonatal adverse outcomes in patients with adnexal mass during pregnancy.Conclusion In this study,we found that surgical treatment can reduce the risk of adverse pregnancy outcomes,and also found that adnexal masses between 11-14 cm in diameter have a greater risk of malignancy and borderline than other sizes of masses.