卵巢成熟性囊性畸胎瘤237例临床分析
摘要
目的:分析了237例成熟性囊性畸胎瘤病例的临床特点。方法:回顾性的分析了新疆医科大学第一附属医院妇科自2002年12月至2007年6月手术治疗并经病理证实为卵巢成熟性囊性畸胎瘤的患者,共计237例,建立数据库后对其临床特点进行分析。结果:①卵巢成熟畸胎瘤占卵巢良性肿瘤的31.0%,平均年龄29.6±11.7岁,2O一40岁之间的病例占总数的61.6%。45.9%患者无任何自觉症状,69.2%的患者是在妇科查体时发现的。术前检查中,术前B超检查提示的以混合性包块的表现居多(65.8%)。肿瘤标记物CA125升高者占16.4%,而AFP阳性者罕见。②腹腔镜手术相对开腹手术而言,在缩短平均住院天数、减少木中出血量、缩短手术时间均较开腹手术具有优势。③肿瘤单侧为多见,占88.6%,右侧略高于左侧(53.2%和35.4%)。肿瘤平均最大径在6.9±3.7cm,单房多见占78.5%。手术中对另一侧卵巢剖探进行分析,发现在108侧肉眼未发现异常表现者行剖探术,仅有5例(0.22%)有阳性发现,肿瘤的组成成份仍以毛发、油脂、骨质为常见。④并发症以扭转最为常见(7.2%)。发生扭转的肿瘤平均最大径在10.2±4.5cm,较未发生扭转者大。扭转的概率随肿瘤的增大而增加.在6cm以上时,扭转的发生的机率在10%以上。腹腔镜手术中瘤体破裂57例,两组病人的一般情况无明显差异(P值>0.05),两组瘤体的大小、位置也无明显差异,但瘤体破裂组周围粘连比例明显高于未破裂组(P值<0.05),且行囊肿剥除术时更易发生破裂(P值<0.05)。瘤体破裂组的手术时间明显长于未破裂组的手术时间(P值<0.05),未破裂组的术者手术经验明显比破裂组的丰富(P值<0.05),两组病人在术中出血量、术后一般情况以及预后方面也无明显差异(P值>0.05)。⑤本组中复发性肿瘤10例,6年内的累积复发率为5.8%;复发率与手术方式、囊肿的位置及处理方式无关(P值>0.05):CA125为阳性的、多房的、含有骨质成份的肿瘤,其复发率相对较高(P值<0.05)。结论:①在卵巢成熟畸胎瘤的处理腹腔镜手术要优于开腹手术;②如术中肉眼见对侧卵巢无异常时,可以考虑不行剖探术;③当肿瘤最大径大于6cm时.发生扭转的机率将大为增加;④腹腔镜手术治疗卵巢良性畸胎瘤过程中瘤体破裂主要发生在囊肿剥除过程中,且与瘤体周围的粘连有关,如发生破裂,经过及时正确的处理对患者的预后无明显的影响;⑤肿瘤复发与保守手术的方式关系不大,但是CA125阳性的、多房的、含有骨质成份的肿瘤,其复发率相对较高。
Objective:Evaluate the clinical aspect of mature ovarian teratome.Method: Retrospective study of 237 patients in who received surgery for cystic teratoma at Xinjiang Medical University Hospital from December,2002 to June,2007. Result: Teratoma occupy 31.0% of the ovarian diseases. Mean age is 29.6±11.7, 61.6%cases are between 20 and 40. 45.9% patients were asymptomatic. Pre-operation Ultrasound found 60.7% had mixed mass. Elevated CA125 level were found in 16.4% cases, while AFP were rarely elevated. Compared with laparotomy, Laparoscopy has shorter hospitalization day, less blood Loose during surgery, short operation time. Most ovarian teratoma was unilateral(88.6%), Right side tumors were a little more than left side . (53.2% versus35.4%).The Mean tumor diameter was 6.9±3.7cm, Monolocular tumor occupied 78. 5% . Routine contra lateral wedge resection was done in 108 cases ,only 5 be found. Hair and grease are the main component of tumor. Torsion is the major complication(7.2%).Mean tumor size of torsion was 10.2±4.5cm, Probability of torsion is increased as the tumor enlarged, the rate is greater than 10% if size larger than 6cm. 57 cases suffered from intra—operative leakage. The tumor size and location were not associated with intra—operative leakage.Tumor surface adhesion ratio of leakage group was higher than that of no leakage group(P<0.05).The operation time of leakage group was longer than that of no lealkage group(P<0.05).There Was no difference of prognosis between the two groups either(P>0.05). 6 years after operation, the total relapse rate was 5.8%. Conclusion: 1.Laparoscopy is superior than laparotomy in the treatment of ovarian teratoma;2.If the cotralaterral ovarian is with normal configuration , cotralaterral wedge resection is not necessary;3.When the tumor grows than 6cm,it will have more chance to torsion;4.Tumor surface adhesion is an important cause. When rupture occurs,timely cleanness can decrease post-surgery complications and won’t affect the prognosis of patients.5.Repapse rate related to the Elevated CA125 level, multiocular tumor with done composition is easily to relapse.
Objective:Evaluate the clinical aspect of mature ovarian teratome.Method: Retrospective study of 237 patients in who received surgery for cystic teratoma at Xinjiang Medical University Hospital from December,2002 to June,2007. Result: Teratoma occupy 31.0% of the ovarian diseases. Mean age is 29.6±11.7, 61.6%cases are between 20 and 40. 45.9% patients were asymptomatic. Pre-operation Ultrasound found 60.7% had mixed mass. Elevated CA125 level were found in 16.4% cases, while AFP were rarely elevated. Compared with laparotomy, Laparoscopy has shorter hospitalization day, less blood Loose during surgery, short operation time. Most ovarian teratoma was unilateral(88.6%), Right side tumors were a little more than left side . (53.2% versus35.4%).The Mean tumor diameter was 6.9±3.7cm, Monolocular tumor occupied 78. 5% . Routine contra lateral wedge resection was done in 108 cases ,only 5 be found. Hair and grease are the main component of tumor. Torsion is the major complication(7.2%).Mean tumor size of torsion was 10.2±4.5cm, Probability of torsion is increased as the tumor enlarged, the rate is greater than 10% if size larger than 6cm. 57 cases suffered from intra—operative leakage. The tumor size and location were not associated with intra—operative leakage.Tumor surface adhesion ratio of leakage group was higher than that of no leakage group(P<0.05).The operation time of leakage group was longer than that of no lealkage group(P<0.05).There Was no difference of prognosis between the two groups either(P>0.05). 6 years after operation, the total relapse rate was 5.8%. Conclusion: 1.Laparoscopy is superior than laparotomy in the treatment of ovarian teratoma;2.If the cotralaterral ovarian is with normal configuration , cotralaterral wedge resection is not necessary;3.When the tumor grows than 6cm,it will have more chance to torsion;4.Tumor surface adhesion is an important cause. When rupture occurs,timely cleanness can decrease post-surgery complications and won’t affect the prognosis of patients.5.Repapse rate related to the Elevated CA125 level, multiocular tumor with done composition is easily to relapse.
引文
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