手术治疗盆腔假性囊肿临床探讨
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摘要
研究目的：盆腔假性囊肿又称为盆腔腹膜囊肿或盆腔包涵囊肿,多继发于盆腔手术后或感染后,是临床上较为常见的一类疾病。相关文献报道并不多,目前临床上没有明确的诊断标准,术前诊断主要依靠既往病史、临床症状、辅助检查加以判断鉴别,由于其大部分缺乏典型性,故术前临床诊断率低。随着复杂妇科手术和妇科感染的日益增多,盆腔假性囊肿的发病率也有逐年提高的趋势,迫切需要临床医师了解这一类疾病的一些临床特点及术前诊断要点,合理的选取治疗方式及了解治疗效果。
本文回顾性分析了北京协和医院自2005年至2008年收治的75例行手术治疗的盆腔假性囊肿患者的病例,旨在探讨盆腔假性囊肿的术前诊断要点,评价手术治疗盆腔假性囊肿的效果,同时对患者进行随访了解术后复发率。
研究方法：回顾性分析了北京协和医院自2005年至2008年收治的75例盆腔假性囊肿患者的病例,并进行电话随访,以了解治疗后的情况。所得全部数据均输入SPSS16软件进行统计分析。
结果：75例盆腔假性囊肿患者,平均年龄在38.28±7.08岁,其中32%无临床症状,41.3%有下腹隐痛不适,26.7%不育。37.3%既往无任何手术操作史,66.7%有下腹部手术史。腹部彩超92%提示无回声,提示混合回声仅占8%,其中61.3%提示有分隔合并无血流,52%的包块位于左侧,包块平均直径为7.8±2.825厘米。所有患者CA125检查结果均小于200U／ml。术前妇科查体70.7%的包块活动差,无压痛者占77.3%。术前诊断率为29.3%。治疗上单纯囊肿切除术复发率高于囊肿剔除+其他术式；腹腔镜手术的手术时间、失血量明显少于开腹手术；腹腔镜手术与开腹手术术后复发率无明显的差异；术后平均复发时间10.96±4.15月。
结论：1、术前诊断要点：盆腔假性囊肿患者多数既往有盆腹部手术史；临床表现不典型,可表现为下腹部隐痛不适、不育或无症状；术前查体提示囊性包块,活动差;B超检查若提示盆腔左侧无回声、有分隔无血流,直径较大的包块对诊断有重要意义；CA125<200U/ml。2、治疗手段：以B超辅助下的穿刺抽吸治疗为主,以腹腔镜或开腹手术为辅。手术治疗建议依据患者年龄合理选择术式,腹腔镜下患侧附件切除术为推荐术式。3、预后：手术治疗盆腔假性囊肿复发率低于穿刺治疗；手术治疗中单纯囊肿剔除术复发率高于其他术式；腹腔镜手术时间、失血量明显少于开腹手术,但两者复发率无明显差别；不育患者术后受孕率低；术后平均复发时间10.96±4.15月。
Objective:To investigate the clinical characteristics and the auxiliary examination characteristics of pelvic pseudocyst.Evaluation of surgical treatment and the recurrence rate of pelvic pseudocyst.
Methods:Utilize the software of SPSS 16.0 to perform the regression analysis.The samples are 75 patients who had already been confirmed by pathology.Telephone follow-up was made to know their prognosis.
Results:Average age of these 75 samples is 38.28±7.08 years.32% of them had no clinical symptoms.41.3% of them had low abdominal pain.26.7% of them were infertile. 37.3% of them had no history of any surgical procedure.66.7% of them had surgical history. According to abdominal ultrasonography,92% of them showed no echo while 8% indicated mixed echo.61.3% of cysts with no echo had separate merger with no blood flow.52% of the masses are in the left side and the average diameter of the masses is 7.8±2.825 centimeter.
CA125 test results of all patients were less than 200U/ml. Gynecological checkup before surgery showed that 70.7% of the masses are inactive and 77.3% of them are no tenderness. Preoperative diagnosis rate was 29.3%. The recurrence rate of cyst excision increases significantly compared to excision with other operation. The operation time and blood loss of laparoscopic surgery are less than laparotomy. However, there is not significant difference in recurrence rate. The recurrence time is 10.96±4.15 months.
Conclusion:1.Key points of preoperative diagnosis:clinical symptoms are abdominal dull pain, infertility or no symptoms. Most of the pelvic pseudocysts occur after operation.According to B-ultrasound, most of the cysts belonged to the type of echo-free, showing dividers with no blood flow. Most of the cysts are in the left of pelvis. CA125 test results are normal.2. The main treatments mainly include imaging-assisted needle aspiration and the laparoscopic or laparotomy. When selecting the surgical method, the age of the patients should be considered. Unilateral salpingo-oophorectomy by laparoscopy is the recommended surgerical method.3. The recurrence rate of surgery was lower than needle aspiration, but the recurrence rate of simple excision was higher than cyst removal with other operations. The operation time and blood loss of laparoscopic surgery were less than laparotomy. However, there is not significant difference in recurrence rate. The recurrence time is 10.96±4.15 months.
本文回顾性分析了北京协和医院自2005年至2008年收治的75例行手术治疗的盆腔假性囊肿患者的病例,旨在探讨盆腔假性囊肿的术前诊断要点,评价手术治疗盆腔假性囊肿的效果,同时对患者进行随访了解术后复发率。
研究方法：回顾性分析了北京协和医院自2005年至2008年收治的75例盆腔假性囊肿患者的病例,并进行电话随访,以了解治疗后的情况。所得全部数据均输入SPSS16软件进行统计分析。
结果：75例盆腔假性囊肿患者,平均年龄在38.28±7.08岁,其中32%无临床症状,41.3%有下腹隐痛不适,26.7%不育。37.3%既往无任何手术操作史,66.7%有下腹部手术史。腹部彩超92%提示无回声,提示混合回声仅占8%,其中61.3%提示有分隔合并无血流,52%的包块位于左侧,包块平均直径为7.8±2.825厘米。所有患者CA125检查结果均小于200U／ml。术前妇科查体70.7%的包块活动差,无压痛者占77.3%。术前诊断率为29.3%。治疗上单纯囊肿切除术复发率高于囊肿剔除+其他术式；腹腔镜手术的手术时间、失血量明显少于开腹手术；腹腔镜手术与开腹手术术后复发率无明显的差异；术后平均复发时间10.96±4.15月。
结论：1、术前诊断要点：盆腔假性囊肿患者多数既往有盆腹部手术史；临床表现不典型,可表现为下腹部隐痛不适、不育或无症状；术前查体提示囊性包块,活动差;B超检查若提示盆腔左侧无回声、有分隔无血流,直径较大的包块对诊断有重要意义；CA125<200U/ml。2、治疗手段：以B超辅助下的穿刺抽吸治疗为主,以腹腔镜或开腹手术为辅。手术治疗建议依据患者年龄合理选择术式,腹腔镜下患侧附件切除术为推荐术式。3、预后：手术治疗盆腔假性囊肿复发率低于穿刺治疗；手术治疗中单纯囊肿剔除术复发率高于其他术式；腹腔镜手术时间、失血量明显少于开腹手术,但两者复发率无明显差别；不育患者术后受孕率低；术后平均复发时间10.96±4.15月。
Objective:To investigate the clinical characteristics and the auxiliary examination characteristics of pelvic pseudocyst.Evaluation of surgical treatment and the recurrence rate of pelvic pseudocyst.
Methods:Utilize the software of SPSS 16.0 to perform the regression analysis.The samples are 75 patients who had already been confirmed by pathology.Telephone follow-up was made to know their prognosis.
Results:Average age of these 75 samples is 38.28±7.08 years.32% of them had no clinical symptoms.41.3% of them had low abdominal pain.26.7% of them were infertile. 37.3% of them had no history of any surgical procedure.66.7% of them had surgical history. According to abdominal ultrasonography,92% of them showed no echo while 8% indicated mixed echo.61.3% of cysts with no echo had separate merger with no blood flow.52% of the masses are in the left side and the average diameter of the masses is 7.8±2.825 centimeter.
CA125 test results of all patients were less than 200U/ml. Gynecological checkup before surgery showed that 70.7% of the masses are inactive and 77.3% of them are no tenderness. Preoperative diagnosis rate was 29.3%. The recurrence rate of cyst excision increases significantly compared to excision with other operation. The operation time and blood loss of laparoscopic surgery are less than laparotomy. However, there is not significant difference in recurrence rate. The recurrence time is 10.96±4.15 months.
Conclusion:1.Key points of preoperative diagnosis:clinical symptoms are abdominal dull pain, infertility or no symptoms. Most of the pelvic pseudocysts occur after operation.According to B-ultrasound, most of the cysts belonged to the type of echo-free, showing dividers with no blood flow. Most of the cysts are in the left of pelvis. CA125 test results are normal.2. The main treatments mainly include imaging-assisted needle aspiration and the laparoscopic or laparotomy. When selecting the surgical method, the age of the patients should be considered. Unilateral salpingo-oophorectomy by laparoscopy is the recommended surgerical method.3. The recurrence rate of surgery was lower than needle aspiration, but the recurrence rate of simple excision was higher than cyst removal with other operations. The operation time and blood loss of laparoscopic surgery were less than laparotomy. However, there is not significant difference in recurrence rate. The recurrence time is 10.96±4.15 months.
引文
[1]Kurachi H, Imagin of peritoneal pseudocysts:value of MR imaging compared with ultrasound and CT [J]. AJR,1993,160(3):589-591.
[2]Slanety Pz,Hahr PF,Hall DA,et al.The freguency and significance of adrenexal lesions incidentally revealed by CT [J]. AJR,1997,168(3):647-648.
[3]丁慧青,舒静,妇科术后盆腔包裹性积液治疗方法的探讨,现代实用医学,2005,17(1)：87
[4]棠才,经阴道超声诊断学,北京科学出版社,1999,145
[5]Ching-Chou Tsai,Chung-Chang Shen,Ultrasound-Guided Transvaginal Cyst Aspiration for theManagement of Pelvic Pseudocyst:A Preliminary Experience [J].Chang Gung Med J,2002,25:751-7.
[6]关若丽,饶丽平,孙大为,经阴道超声引导穿刺治疗盆腔包裹性积液32例分析,北京医学,2006,28(1)
[7]王静文,腹腔镜手术诊治盆腔假性囊肿38例临床分析,中国实用妇科与产科杂志,2004,20(7)：412-413
[8]易村健,王晓雯27例术后盆腔假性囊肿的临床分析,华中医学杂志,2004,28(5)
[9]吴国英,盆腔假性囊肿15例诊治分析,中国妇幼保健,2007,22(29)：4094-4095
[10]朱巍立,盆腔包裹性积液42例分析,浙江医学,2007,29(8).857-858.
[11]郑斐,邵丽风,盆腔包裹性积液的诊断和处理,浙江医学,2001,23(7).409-410.
[12]马良坤,冷金花,郎景和,子宫切除术后盆腔囊肿,中国医刊.2003,38(6).44-46.
[13]钱国昌,育龄期妇女盆腔假性囊肿的临床及CT表现,放射学实践,2001,16(3).188-189.
[14]刘彦,实用妇科腹腔镜手术学,第1版,北京科学技术文献出版社,2004：7
[15]薛晓红林金芳腹腔镜在盆腔炎诊断和治疗中的价值,中国实用妇科与产科杂志,2004,20(9)
[1]Kurachi H, Imagin of peritoneal pseudocysts:value of MR imaging compared with ultrasound and CT [J] AJR,1993,160(3):589-591.
[2]Slanety Pz,Hahr PF,Hall DA,et al,The freguency and significance of adrenexal lesions incidentally revealed by CT [J], AJR,1997,168(3):647-648.
[3]吴国英,盆腔假性囊肿15例诊治分析,中国妇幼保健,2007,22(29)：4094-4095
[4]王静文,腹腔镜手术诊治盆腔假性囊肿38例临床分析,中国实用妇科与产科杂志,2004,20(7)：412-413
[5]郑斐,盆腔包裹性积液的诊断和处理(附96例分析),浙江医学,2001,23(7)：409-410
[6]丁慧青,舒静,妇科术后盆腔包裹性积液治疗方法的探讨,现代实用医学,2005,17(1)：87
[7]棠才,经阴道超声诊断学,北京科学出版社,1999,145
[8]Phillips RKS,Dudley HAF,The effect of tetracycline lavage and trauma on visceral and parietal peritoneal ultrastructure and adhesion formation[J],Br J Surg,1984, 71:537-9.
[9]Granberg S,Crona N,Enk L,Hammarberg K,Wikland M, Ultrasound-guided puncture of cystic tumors in the lower pelvis of young women[J],J Clin Ultrasound,1989, 17:107-11.
[10]Granberg S,Norstr A,Wikland M,Tumors in lower pelvis as imaged by vaginal sonography[J], Gyn Oncology,1990,37:224-9.
[11]De Crespigny LC, Robinson HP, Davoren RA. The simple ovarian cyst:aspirate or operate [J], Br J Obs Gyn,1989,96:1035-39.
[12]Ching-Chou Tsai,Chung-Chang Shen,Ultrasound-Guided Transvaginal Cyst Aspiration for theManagement of Pelvic Pseudocyst:A Preliminary Experience [J] Chang Gung Med J,2002,25:751-7
[13]Timor-Tritsch IE,Peisner DB,Monteagudo A.Puncture procedures utilizing transvaginal ultrasonic guidance [J],Ultrasound Obs Gyn,1991,144-50.
[14]Hurwitz A,Yagel S,Zion I, Zakut D, Palti Z, Adoni A. The management of persistent clear pelvic cysts diagnosed by ultrasongraphy [J]. Obs Gyn,1988,72:320-2.
[15]关若丽,饶丽平,孙大为,经阴道超声引导穿刺治疗盆腔包裹性积液32例分析,北京医学,2006,28(1)
[16]Dellenbach P,Muller P.infections utero annexielles aigues[J].Encycl Med Chir Paris Gynecol,1972,470(11):1410-1413
[17]郎景和,妇科腹腔镜的现状及展望,妇科手术笔记,第2版,北京,中国科学技术出版社,2004,1
[18]刘彦,实用妇科腹腔镜手术学,第1版,北京,科学技术文献出版社,2004,7
[19]Ahrenhole DH,Simmons RL.Fibrin in Peritonitis:I beneficial and adverse effects of fibrin in experiment [J],coli peritonitis Surgery,1980,88(1);41-44
[20]薛晓红,林金芳,腹腔镜在盆腔炎诊断和治疗中的价值,中国实用妇科与产科杂志,2004,20(9)
[21]车荣华,易村健,14例盆腔假性囊肿临床分析,湖北省卫生职工医学院学报,2003,16(3)
[22]易村健,王晓雯,27例术后盆腔假性囊肿的临床分析,华中医学杂志,2004,28(5)
[23]顾美皎,术后粘连与盆腔疼痛.实用妇科与产科杂志,1998,14(6)：287
[2]Slanety Pz,Hahr PF,Hall DA,et al.The freguency and significance of adrenexal lesions incidentally revealed by CT [J]. AJR,1997,168(3):647-648.
[3]丁慧青,舒静,妇科术后盆腔包裹性积液治疗方法的探讨,现代实用医学,2005,17(1)：87
[4]棠才,经阴道超声诊断学,北京科学出版社,1999,145
[5]Ching-Chou Tsai,Chung-Chang Shen,Ultrasound-Guided Transvaginal Cyst Aspiration for theManagement of Pelvic Pseudocyst:A Preliminary Experience [J].Chang Gung Med J,2002,25:751-7.
[6]关若丽,饶丽平,孙大为,经阴道超声引导穿刺治疗盆腔包裹性积液32例分析,北京医学,2006,28(1)
[7]王静文,腹腔镜手术诊治盆腔假性囊肿38例临床分析,中国实用妇科与产科杂志,2004,20(7)：412-413
[8]易村健,王晓雯27例术后盆腔假性囊肿的临床分析,华中医学杂志,2004,28(5)
[9]吴国英,盆腔假性囊肿15例诊治分析,中国妇幼保健,2007,22(29)：4094-4095
[10]朱巍立,盆腔包裹性积液42例分析,浙江医学,2007,29(8).857-858.
[11]郑斐,邵丽风,盆腔包裹性积液的诊断和处理,浙江医学,2001,23(7).409-410.
[12]马良坤,冷金花,郎景和,子宫切除术后盆腔囊肿,中国医刊.2003,38(6).44-46.
[13]钱国昌,育龄期妇女盆腔假性囊肿的临床及CT表现,放射学实践,2001,16(3).188-189.
[14]刘彦,实用妇科腹腔镜手术学,第1版,北京科学技术文献出版社,2004：7
[15]薛晓红林金芳腹腔镜在盆腔炎诊断和治疗中的价值,中国实用妇科与产科杂志,2004,20(9)
[1]Kurachi H, Imagin of peritoneal pseudocysts:value of MR imaging compared with ultrasound and CT [J] AJR,1993,160(3):589-591.
[2]Slanety Pz,Hahr PF,Hall DA,et al,The freguency and significance of adrenexal lesions incidentally revealed by CT [J], AJR,1997,168(3):647-648.
[3]吴国英,盆腔假性囊肿15例诊治分析,中国妇幼保健,2007,22(29)：4094-4095
[4]王静文,腹腔镜手术诊治盆腔假性囊肿38例临床分析,中国实用妇科与产科杂志,2004,20(7)：412-413
[5]郑斐,盆腔包裹性积液的诊断和处理(附96例分析),浙江医学,2001,23(7)：409-410
[6]丁慧青,舒静,妇科术后盆腔包裹性积液治疗方法的探讨,现代实用医学,2005,17(1)：87
[7]棠才,经阴道超声诊断学,北京科学出版社,1999,145
[8]Phillips RKS,Dudley HAF,The effect of tetracycline lavage and trauma on visceral and parietal peritoneal ultrastructure and adhesion formation[J],Br J Surg,1984, 71:537-9.
[9]Granberg S,Crona N,Enk L,Hammarberg K,Wikland M, Ultrasound-guided puncture of cystic tumors in the lower pelvis of young women[J],J Clin Ultrasound,1989, 17:107-11.
[10]Granberg S,Norstr A,Wikland M,Tumors in lower pelvis as imaged by vaginal sonography[J], Gyn Oncology,1990,37:224-9.
[11]De Crespigny LC, Robinson HP, Davoren RA. The simple ovarian cyst:aspirate or operate [J], Br J Obs Gyn,1989,96:1035-39.
[12]Ching-Chou Tsai,Chung-Chang Shen,Ultrasound-Guided Transvaginal Cyst Aspiration for theManagement of Pelvic Pseudocyst:A Preliminary Experience [J] Chang Gung Med J,2002,25:751-7
[13]Timor-Tritsch IE,Peisner DB,Monteagudo A.Puncture procedures utilizing transvaginal ultrasonic guidance [J],Ultrasound Obs Gyn,1991,144-50.
[14]Hurwitz A,Yagel S,Zion I, Zakut D, Palti Z, Adoni A. The management of persistent clear pelvic cysts diagnosed by ultrasongraphy [J]. Obs Gyn,1988,72:320-2.
[15]关若丽,饶丽平,孙大为,经阴道超声引导穿刺治疗盆腔包裹性积液32例分析,北京医学,2006,28(1)
[16]Dellenbach P,Muller P.infections utero annexielles aigues[J].Encycl Med Chir Paris Gynecol,1972,470(11):1410-1413
[17]郎景和,妇科腹腔镜的现状及展望,妇科手术笔记,第2版,北京,中国科学技术出版社,2004,1
[18]刘彦,实用妇科腹腔镜手术学,第1版,北京,科学技术文献出版社,2004,7
[19]Ahrenhole DH,Simmons RL.Fibrin in Peritonitis:I beneficial and adverse effects of fibrin in experiment [J],coli peritonitis Surgery,1980,88(1);41-44
[20]薛晓红,林金芳,腹腔镜在盆腔炎诊断和治疗中的价值,中国实用妇科与产科杂志,2004,20(9)
[21]车荣华,易村健,14例盆腔假性囊肿临床分析,湖北省卫生职工医学院学报,2003,16(3)
[22]易村健,王晓雯,27例术后盆腔假性囊肿的临床分析,华中医学杂志,2004,28(5)
[23]顾美皎,术后粘连与盆腔疼痛.实用妇科与产科杂志,1998,14(6)：287