手术治疗妊娠期卵巢肿物对妊娠结局的影响

汤雅玲　陈宝花

[摘要] 目的 探讨手术治疗妊娠期卵巢肿物的安全性及其对妊娠结局的影响。方法 方便选取2012年1月—2015年12月于妊娠期在该院行卵巢肿物手术治疗的58例患者的临床资料进行回顾性分析。结果 58例患者中，在妊娠中期行择期手术者36例，早产1例；急诊手术22例，其中妊娠早期10例，流产2例；妊娠中期8例，流产1例；妊娠晚期4例，早产2例。18例行患侧附件切除术，40例行肿物剥除术。病理分型中 良性肿物53例（91.3%），以成熟性畸胎瘤最多见，粘液性囊腺瘤次之；瘤样病变主要是子宫内膜异位囊肿和黄体囊肿；恶性肿瘤4例（6.8%），其中未成熟畸胎瘤2例，无性细胞瘤1例，粘液性囊腺癌1例；交界性肿瘤1例（1.7%）。结论 妊娠合并卵巢肿物患者中，恶性肿瘤占一定比例，推荐有手术指征者在妊娠中期行择期手术可以改善妊娠结局。

[关键词] 妊娠；卵巢肿瘤；妊娠结局

[中图分类号] R5 [文献标识码] A [文章编号] 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临床上并不少见，其发生率约为1/81～1/8 000[1]。多数患者无明显症状，仅在常规产前检查时被发现；部分患者因发生肿物破裂、蒂扭转等急腹症被发现。处理时机及处理方法的选择是影响妊娠结局的关键。该文通过回顾分析2012年1月— 2015年12 月之间于妊娠期在该院行卵巢肿物手术的58例患者的临床资料，探讨合适的手术时机及方法，现报道如下。

1 资料与方法

1.1 一般资料

方便收集于妊娠期在厦门大学附属第一医院行卵巢肿物手术治疗的患者完整临床资料。纳入标准：①在确定妊娠至妊娠37周之前诊断。②妊娠期行手术治疗。③排除剖宫产术中同时行卵巢肿物手术者。总共有58例，年龄在16～38岁之间，平均（26.12 ±4.33） 岁；孕周6～34周之间。

1.2 手术方法

表现为明显急腹症的患者，行急诊手术；无症状者若超声提示肿物囊实性、或直径>8 cm且随访至14周不消、或肿瘤标记物异常升高者，于妊娠14～20周之间择期手术。手术操作时所有患者均采用腰麻或硬膜外麻醉，开腹手术，手术时常规探查双侧附件，联系快速病理；根据术中情况决定进行卵巢肿物剥除或附件切除术；术后酌情给予保药物胎治疗。endprint