摘要
目的探讨妊娠期卵巢囊肿蒂扭转的临床病理特征。方法回顾性分析2009年1月至2018年11月手术证实的妊娠期卵巢囊肿蒂扭转患者42例患者的一般资料、临床、手术及病理资料。结果①42例患者的平均年龄(27.9±3.6)岁,其中妊娠早期20例(47.6%),妊娠中期18例(42.9%),妊娠晚期4例(9.5%)。②42例患者中,腹痛持续无缓解16例(38.1%),腹痛有缓解24例(57.1%),无腹痛病史2例(4.8%),伴有恶心、呕吐27例(64.3%),不伴恶心、呕吐15例(35.7%)。③妊娠期卵巢囊肿蒂扭转急诊手术32例(76.2%),择期手术10例(23.8%)。42例术中均行卵巢囊肿扭转复位,行卵巢囊肿切除32例(76.2%),附件切除9例(21.4%),囊肿剖开探查1例(2.4%)。卵巢囊肿蒂扭转≤900度38例(90.5%),其中6例(15.8%)卵巢坏死行附件切除,4例扭转1080度,且其中3例(75.0%)卵巢坏死行附件切除。④术后的病理类型为卵巢黄体囊肿15例(36.6%),卵巢单纯性囊肿14例(34.1%),卵巢成熟性囊性畸胎瘤7例(17.1%)、卵巢黏液性囊腺瘤3例(7.3%),卵巢浆液性囊腺瘤2例(4.9%)。⑤42例患者中,2例分娩,继续妊娠40例术后1个月内未发生不良妊娠,足月分娩12例;因产科因素剖宫产10例,1例妊娠29周(术后5个月)因脐带过渡扭转致死胎;6例定期产前检查中;11例术后1个月后失访。结论妊娠期卵巢囊肿蒂扭转常发生在孕早中期,卵巢囊肿扭转≤900度发生坏死概率较小,最常见的病理类型为卵巢生理性囊肿;经诊断后行急诊手术,扭转复位卵巢囊肿切除在随访患者中安全有效的。
Objective To investigate the clinical-pathological characteristics of ovarian cyst torsion in pregnant women.Methods 42 cases of ovarian cyst torsion in pregnancy were analyzed of general conditions,clinical features,surgical features and pathological features from January 2009 to November 2018.Results①The mean age was 27.9±3.6 years.20 cases(47.6%)in first trmester,18 cases(42.9%)in second trimester,4 cases(9.5%)in the last trimester.②In the 42 ovarian cyst torsion cases,16 cases(38.1%)were persistent pain and no relief,24 cases(57.1%)were intermittent relief of persistent pain,2 cases(4.8%)without pain history,27 cases(64.3%)with nausea and vomiting,15 cases(35.7%)without nausea and vomiting.③32 cases(76.2%)underwent emergency surgery,10 cases(23.8%)underwent selective surgery.32 cases(76.2%)underwent reverse torsion to preserve normal ovarian tissue during the surgery,9 cases(21.4%)with accessory resection,1 case(2.4%)with ovarian incision.The torsion of 38 cases(90.5%)less than 900 degrees,6 cases(15.8%)of them underwent accessory resection.4 cases with 1080 degrees torsion,three of them(75.0%)underwent accessory incision.④The pathological types:ovarian corpus luteum cyst 15 cases(36.6%),ovarian simple cyst 14 cases(34.1%),mature teratoma of ovary 7 cases(17.1%),ovarian mucinous cystadenoma 3 cases(7.3%)and ovarian serous cystadenoma 2 cases(4.9%).⑤In the 42 cases,two of them were delivered,others were continued pregnancy.There was no abnormal pregnancy in the first month after surgery.12 cases were full term delivery,cesarean section was performed in 10 cases due to obstetric factors,one died for transitional twist of umbilical cord,6 cases are regular follow-up.11 cases were lost to follow up.Conclusion Ovarian cyst torsion often occurs in the early and middle trimester of pregnancy.Ovarian cyst torsion≤900 degrees has a small probability of necrosis.The most common pathological type is ovarian physiological cysts.Emergency surgery with torsion reduction and excision of ovarian cysts after diagnosis is safe and effective during the follow-up period.
作者
张立芳
刘英杰
张宇迪
ZHANG Lifang;LIU Yingjie;ZHANG Yudi(Department of Gynecology,Beijing Obstetrics&Gynecology Hospital,Capital Medical University,Beijing 100026,China)
出处
《中国妇产科临床杂志》
CSCD
北大核心
2019年第4期342-345,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
