手術治療妊娠期卵巢腫物對妊娠結局的影響

湯雅玲　陳寶花

[摘要] 目的 探討手術治療妊娠期卵巢腫物的安全性及其對妊娠結局的影響。方法 方便選取2012年1月—2015年12月于妊娠期在該院行卵巢腫物手術治療的58例患者的臨床資料進行回顧性分析。結果 58例患者中，在妊娠中期行擇期手術者36例，早產1例；急診手術22例，其中妊娠早期10例，流產2例；妊娠中期8例，流產1例；妊娠晚期4例，早產2例。18例行患側附件切除術，40例行腫物剝除術。病理分型中 良性腫物53例（91.3%），以成熟性畸胎瘤最多見，粘液性囊腺瘤次之；瘤樣病變主要是子宮內膜異位囊腫和黃體囊腫；惡性腫瘤4例（6.8%），其中未成熟畸胎瘤2例，無性細胞瘤1例，粘液性囊腺癌1例；交界性腫瘤1例（1.7%）。結論 妊娠合并卵巢腫物患者中，惡性腫瘤占一定比例，推薦有手術指征者在妊娠中期行擇期手術可以改善妊娠結局。

[關鍵詞] 妊娠；卵巢腫瘤；妊娠結局

[中圖分類號] R5 [文獻標識碼] A [文章編號] 1674-0742（2017）12（a）-0045-03

[Abstract] Objective To study the safety of surgical treatment of ovarian cyst during pregnancy and its effect on the pregnant outcome. Methods 58 cases of patients with ovarian cyst during pregnancy in our hospital from January 2012 to December 2015 were conveniently selected for review. Results Of 58 cases， there were 36 cases with selective operation in the second trimester of pregnancy， 1 case was premature labor； of 22 cases with emergency operation， 10 cases were in the early pregnancy， 2 cases were premature labor， 8 cases were in the second trimester of pregnancy， 1 case was premature labor； 4 cases were in the third trimester of pregnancy， and 2 cases were premature labor， 18 cases were treated with appendectomy of affected sides， 40 cases were treated with cyst removal surgery， in terms of the pathological typing， there were 53 cases with benign tumors（91.3%）， mostly mature teratoid tumor， followed by mucinous cystadenoma， and the tumor-like lesions were mainly endometrioma and corpus luteum cyst， 4 cases were with malignant tumors（6.8%）， including 2 cases with immature teratoma， 1 case with dysgerminoma， 1 case with mucinous cystadenocarcinoma and 1 case with borderline tumor（1.7%）. Conclusion The malignant tumors hold a certain proportion in patients with pregnancy combined with ovarian masses， and the selective surgery for patients with surgical signs can improve the pregnant outcome.

[Key words] Pregnancy； Ovarian masses； Pregnant outcome

妊娠合并卵巢腫物在臨床上并不少見，其發生率約為1/81～1/8 000[1]。多數患者無明顯癥狀，僅在常規產前檢查時被發現；部分患者因發生腫物破裂、蒂扭轉等急腹癥被發現。處理時機及處理方法的選擇是影響妊娠結局的關鍵。該文通過回顧分析2012年1月— 2015年12 月之間于妊娠期在該院行卵巢腫物手術的58例患者的臨床資料，探討合適的手術時機及方法，現報道如下。

1 資料與方法

1.1 一般資料

方便收集于妊娠期在廈門大學附屬第一醫院行卵巢腫物手術治療的患者完整臨床資料。納入標準：①在確定妊娠至妊娠37周之前診斷。②妊娠期行手術治療。③排除剖宮產術中同時行卵巢腫物手術者。總共有58例，年齡在16～38歲之間，平均（26.12 ±4.33） 歲；孕周6～34周之間。

1.2 手術方法

表現為明顯急腹癥的患者，行急診手術；無癥狀者若超聲提示腫物囊實性、或直徑>8 cm且隨訪至14周不消、或腫瘤標記物異常升高者，于妊娠14～20周之間擇期手術。手術操作時所有患者均采用腰麻或硬膜外麻醉，開腹手術，手術時常規探查雙側附件，聯系快速病理；根據術中情況決定進行卵巢腫物剝除或附件切除術；術后酌情給予保藥物胎治療。endprint