超声在妊娠合并卵巢肿瘤患者的诊断价值

冯敏芝; 伍诗媚; 李建聪

doi:10.12122/j.issn.1674-4500.2019.04.04

超声在妊娠合并卵巢肿瘤患者的诊断价值

doi: 10.12122/j.issn.1674-4500.2019.04.04

1.
中山市黄圃人民医院超声科，广东中山 528429
2.
中山市博爱医院超声科，广东中山 528400

详细信息

作者简介:
冯敏芝，主治医师，E-mail：1085788483@qq.com

通讯作者:
李建聪，副主任医师，E-mail：1875239998@qq.com

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- 被引次数: 0
出版历程
- 收稿日期: 2019-09-11
- 刊出日期: 2019-12-01

Diagnotic and surveillant value of ultrasound in ovarian tumors during pregnancy

1.
Department of Ultrasound, Zhongshan Huangpu Hospital, Zhongshan 528429, China
2.
Department of Ultrasound, Bo-ai Hospital of Zhongshan, Zhongshan 528400, China

摘要

摘要: 目的探讨超声检查在妊娠合并卵巢肿瘤患者的诊断价值。方法回顾性分析2016年1月~2018年12月就诊的48例妊娠患者临床及超声检查资料，年龄20~41岁（30.5±4.7岁），所有患者均在妊娠期超声检查发现并经手术病理证实卵巢肿瘤，总结超声检查在妊娠期卵巢肿瘤诊治的价值。结果48例妊娠合并卵巢肿瘤患者，经超声发现病灶共51例，其中成熟性畸胎瘤28例，粘液性、浆液性囊腺瘤分别为8例、10例，黄体囊肿并出血2例，浆-粘液性肿瘤并内膜样囊肿、单纯性囊肿、甲状腺肿各1例，超声检查可显示各类型病灶特征。肿瘤直径2.2~12.1 cm（5.5±2.1 cm），超声上提示恶性病变3例，提示妊娠合并卵巢肿瘤并发肿瘤蒂扭转或黄体囊肿出血7例。因患者意愿终止妊娠并肿瘤切除3例，因妊娠急腹症、可疑恶变、肿瘤体积较大等采用腹腔镜手术切除卵巢肿瘤共12例，采用期待疗法33例，在剖宫产分娩时进行卵巢肿瘤切除，大部分患者取得良好的妊娠结局。结论超声检查可测量妊娠合并卵巢肿瘤的病灶大小、判断良恶性、鉴别组织学来源、有无合并症、并对妊娠过程中卵巢肿瘤进行动态监测，为临床决策提供关键证据。
- 妊娠 /
- 卵巢肿瘤 /
- 超声检查
Abstract: ObjectiveTo explore diagnostic and surveillant value of ultrasound in ovarian tumors during pregnancy.MethodsClinical and ultrasound data of 48 patients with pathologically proven ovarian tumors during pregnancy were retrospectively reviewed. The patients aged from 21 to 41 years old (30.5±4.7 years old) had undertaken ultrasound examinations during pregnancy between January 2016 to December 2018. The diagnostic and surveillant value of sonographic examinations were summarized.ResultsFifty-one tumors were detected by sonographic examinations in 48 patients. These lesions included 27 mature teratomas, 8 mucinous cystadenomas, 10 serous cystadenomas, 2 hemorrhagic corpus luteum cysts, 1 serous - mucinous tumor with endometrioid cyst, 1 simple cyst, and 1 struma ovarii. The ultrasound examinations would well document the imaging characteristics of these tumors. On sonography, the diametre of tumors ranged from 2.2 cm to 12.1 cm (5.5±2.1 cm). Based on sonographic features, 3 cases were probably malignant, and 7 cases were probably torsion of ovarian tumor or hemorrhagic corpus luteum cysts. Among 48 patients, 3 patients underwent pregnancy termination precession only by their personal willingness, and the resection of ovarian tumors were performed, and 12 patients underwent tumor resection through laparoscopic surgery before delivery due to abdominal pain, probably malignant, or large volumes of tumors. The other 33 patients underwent expectant treatment, and ovarian tumors were resected while cesarean delivery. The majority of patients achieved a satisfying pregnancy outcome. ConclusionUltrasound examinations could measure the lesions’ diametre, detect malignant lesions, differentiate the tumors, reveal the complications, and surveil the tumors during pregnancy, which provide pivotal evidence for clinical decision.
- pregnancy /
- ovarian tumor /
- ultrasounds

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图 1 右侧卵巢等回声包块

女，32岁，停经8周，发现右侧附件包块；超声检查发现右侧卵巢见等回声包块，大小约39 mm×30 mm，边界清晰，内回声欠均匀，CDFI示包块内条状血流信号，RI 0.34；注意宫腔内可见胚芽；因怀疑肿块为恶性病变，4周后进行手术切除，病理结果为右侧卵巢交界浆液性囊腺瘤.

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图 2 良性肿瘤特殊，病灶体积稳定

女，27岁，孕24周发现右侧附件包块. A：右侧宫旁见一囊性包块，大小约35 mm×32 mm，边界清淅，透声好，后方回声增强. CDFI内未见血流信号；B：孕36周时复查，包块未见明显增大. 因肿块较小，且无明显恶性征象，采用期待疗法；孕38周剖宫产分娩时行手术切除包块，病理证实为右侧卵巢囊性畸胎瘤.

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参考文献(22)

[1]	Fruscio R, Ceppi L, Codacci-Pisanelli G, et al. Managing ovarian tumors during pregnancy[M]//Azim A, Hamdy H. Managing Cancer during Pregnancy. Berlin: Springer, 2016: 149-58.
[2]	Mascilini F, Moruzzi C, Giansiracusa C, et al. Imaging in gynecological disease. 10: clinical and ultrasound characteristics of decidualized endometriomas surgically removed during pregnancy[J]. Ultrasound Obstet Gynecol, 2014, 44(3): 354-60. doi: 10.1002/uog.13323
[3]	周晓美, 苏亦平. 妊娠合并卵巢肿物的临床分析[J]. 医学研究生学报, 2018, 31(2): 178-80.
[4]	Canavan TP. Sonographic Tips for evaluation of adnexal masses in pregnancy[J]. Clin Obstet Gynecol, 2017, 60(3): 575-85. doi: 10.1097/GRF.0000000000000302
[5]	丘春东. 妊娠中期行腹腔镜手术治疗妊娠合并卵巢肿瘤的可行性分析[J]. 实用妇科内分泌杂志: 电子版, 2018, 5(20): 139-45.
[6]	袁江静, 王玉东. 妊娠期卵巢肿瘤的相关处理[J]. 中国计划生育和妇产科, 2019, 11(02): 21-5.
[7]	Van Calster B, Wynants L, Kaijser J, et al. The independent effect of tumor size in predicting ovarian malignancy[J]. Eur J Obstet Gynecol Reprod Biol, 2012, 162(2): 237-8. doi: 10.1016/j.ejogrb.2012.02.023
[8]	Rao B, Sindhoora KS, Shameem V, et al. Clinical study of ovarian tumors in pregnancy: observation vs.surgery[J]. Int J Innov Res Developmt, 2014, 3(9): 52-5.
[9]	Mukhopadhyay A, Shinde A, Naik R. Ovarian cysts and cancer in pregnancy[J]. Best Pract Res Clin Obstet Gynaecol, 2016, 33(5): 58-72.
[10]	American CO. ACOG practice bulletin.management of adnexal masses[J]. Obstet Gynecol, 2007, 110(1): 201-14. doi: 10.1097/01.AOG.0000263913.92942.40
[11]	和平, 吴青青, 孙丽娟, 等. 对比观察ADNEX模型, 简单规则风险估计模型及恶性风险指数诊断卵巢良恶性肿瘤[J]. 中国医学影像技术, 2019, 35(01): 104-7.
[12]	Mascilini F, Savelli L, Scifo MC, et al. Ovarian masses with papillary projections diagnosed and removed during pregnancy: ultrasound features and histological diagnosis[J]. Ultrasound Obstet Gynecol, 2017, 50(1): 116-23. doi: 10.1002/uog.17216
[13]	Husz V, Bus D, Vajda G. Extremely large epithelial ovarian cancer associated with pregnancy: a case report[J]. Molecul Clin Oncol, 2018, 8(1): 103-6.
[14]	Fruscio R, de Haan J, Van Calsteren K, et al. Ovarian cancer in pregnancy[J]. Best Pract Res Clin Obstet Gynaecol, 2017, 41(5): 108-17.
[15]	余贵媛, 李秋霞, 张蕾, 等. 425例妊娠合并卵巢肿瘤患者的诊治分析[J]. 国际妇产科学杂志, 2018, 45(2): 231-5. doi: 10.3969/j.issn.1674-1870.2018.02.027
[16]	Oprescu ND, Ionescu CA, Drăgan I, et al. Adnexal masses in pregnancy: perinatal impact[J]. Rom J Morphol Embryol, 2018, 59(1): 153-8.
[17]	Yuk JS, Shin JY, Park WI, et al. Association between pregnancy and adnexal torsion: a population-based, matched case-control study[J]. Medicine (Baltimore), 2016, 95(24): e3861-72. doi: 10.1097/MD.0000000000003861
[18]	张琴, 盛文伟, 吕述彦. 超声在妊娠合并附件扭转诊断中的价值[J]. 中国临床医学影像杂志, 2015, 26(9): 678-80.
[19]	Bonde AA, Korngold EK, Foster BR, et al. Radiological appearances of corpus luteum cysts and their imaging mimics[J]. Abdom Radiol (New York), 2016, 41(11): 2270-82. doi: 10.1007/s00261-016-0780-1
[20]	Goh W, Bohrer J, Zalud I. Management of the adnexal mass in pregnancy[J]. Curr Opin Obstet Gynecol, 2014, 26(2): 49-53. doi: 10.1097/GCO.0000000000000048
[21]	Kole MB, Frishman GN, Werner EF. Minimally invasive management of ovarian cysts during pregnancy using ethanol sclerosis[J]. J Minim Invasive Gynecol, 2016, 23(3): 450-2. doi: 10.1016/j.jmig.2015.12.018
[22]	韦瑶, 苏娜, 桂阳, 等. 妊娠合并卵巢肿瘤超声诊断分析[J]. 中华医学超声杂志: 电子版, 2014, 11(9): 743-8.