卵巢成熟畸胎瘤695例临床分析

 

龚晓明# 冷金花 郎景和 黄荣丽 刘珠凤 孙大为 朱兰[1]

 

（中国医学科学院 中国协和医科大学 北京协和医院妇产科，北京 100730）

 

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摘要 目的 分析695例成熟畸胎瘤病例的临床特点。方法 选取北京协和医院1990年1月～2000年12月间住院的卵巢成熟畸胎瘤患者，共695例，建立数据库后对其临床特点进行分析。结果腹腔镜手术近年来的比例逐渐提高，相对开腹手术而言，在缩短平均住院日、减少术中出血量、缩短手术时间上均较开腹手术具有优势。肿瘤以单侧为多见，占85.8％，右侧略高于左侧（45.2％和40.6％）。手术中对另一侧卵巢的情况进行分析，发现在459例肉眼未发现异常表现者行剖探术，仅有1例（0.22％）有阳性发现。并发症以扭转最为常见（占7.5％），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，当肿瘤最大径在6cm以下时，发生扭转的机率小于4.4％，而在8cm以上时，扭转的发生的机率在10％以上。破裂、感染、恶性变均为罕见的并发症。结论 在卵巢成熟畸胎瘤的处理上腹腔镜手术优于开腹手术。如术中肉眼见对侧卵巢无异常时，可以考虑不行剖探术。肿瘤最大径大于8cm时，发生扭转的机率将大为增加。

 

关键词 卵巢成熟畸胎瘤 腹腔镜 并发症

 

中图号 R71

 

 

 

Clinical Aspect of Mature Ovarian Teratoma: Result of 695 Cases. GONG Xiaoming, LENG Jinhua, LANG Jinghe, et al. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China, 100730. Email: obgyn@sina.com

 

Objective Evaluate the clinical aspect of mature ovarian teratoma. Method Retrospective study of 695 patients operated in Peking Union Medical College Hospital between 1990 and 2000. Results Laparoscopy surgery has gradually become more and more popular during the last decade. Compared with laparotomy, it has shorter hospitalization day, less blood loss during surgery, shorter operation time, while it has comparative relapse rate and post-operative pregnancy rate. Most (85.8%) ovarian teratoma was unilateral. Right side tumors were a little more than left side’s. ( 45.2% versus 40.6%. ) Routine contralateral wedge resection was done in 608 cases. 459 of these had normal inspection and palpatation. Only one (0.22%) was pathologically confirmed bilateraly tumor. Torsion is the major complication (7.5%). Average tumor size of torsion was 10.2±4.5cm. Probability of torsion is increased as the tumor enlarged. The rate is less than 4.4% when the tumor size is less than 6 cm and greater than 10% if size greater than 8cm. Rupture, infection and malignant transformation are less happened. Conclusion Laparoscopy is superior to laparotomy in the treatment of mature ovarian teratoma. If the contralateral ovarian is within normal configuration, contralateral wedge resection is not necessary. When the tumor grows than 8 cm in diameter, it will have more chance to twist.

 

【Key Word】 Mature Ovarian Teratoma； Laparoscopy；Complication

 

Acta Acad Med Sin, 2004,26(6)