Clinical characteristics analysis of 13 cases of pregnancy complicated with borderline ovarian tumors
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摘要: 目的 探讨妊娠合并卵巢交界性肿瘤（borderline ovarytumours，BOTs）的临床特点，分析手术疗效。方法 收集2004年5月至2018年5月大连市妇幼保健院诊治的13例妊娠合并BOTs患者的临床资料。患者平均年龄（30.7±4.71）岁，平均孕次1.8次（1~4次），平均产次0次（0~1次），行卵巢囊肿剔除术6例，患侧附件切除术7例，总结妊娠合并BOTs的临床、影像学及病理特征，并分析手术治疗效果。结果 13例患者中10例无明显临床症状，2例下腹痛、1例恶心呕吐，患者超声9例提示卵巢肿物内为液暗区伴光点、光带或光团，无明显特异性表现。12例患者剖宫产术同时行保留生育功能的手术治疗，1例患者孕晚期行患侧附件切除术，后经阴道自然分娩；13例新生儿Apgar评分均10分。结论 妊娠合并BOTs的患者无明显临床症状及影像学表现，术前易诊断不全或漏诊，应根据患者年龄、有无生育要求、是否保留胎儿、妊娠时期、肿瘤期别、病理组织类型等选择合适的治疗方式以确保母婴安全。Abstract: Objective To explore the clinical characteristics of pregnancy combined with borderline ovarian tumors (borderline ovary tumours, BOTs), and analyze the surgical efficacy.Methods Clinical data were collected from 13 patients with borderline ovarian tumors from Dalian Maternal and Child Health Hospital from May 2004 to May 2018.The mean age of the 13 patients was (30.7±4.71) years-old, average pregnancy was 1.8 (1-4), average birth was 0 (0-1), Six of the 13 patients had oophorocystectomy and seven had adnexectomy, summary the clinical, imaging and pathological characteristics of pregnancy with BOTs, and the surgical treatment effect was analyzed.Results Ten of the 13 patients had no significant clinical symptoms, two with abdominal pain and one with nausea and vomiting.Nine patient's ultrasound suggested that the dark area with light spots, light bands or optical masses in the ovarian mass, with no obvious specific imaging manifestations. Twelve patients retained reproductive function during cesarean section, 1 patient underwent annexectomy in the late pregnancy and underwent natural transvaginal delivery, the apgar scores of 13 cases were all 10 points.Conclusion Patients with borderline ovarian tumor during pregnancy had no significant clinical symptoms and imaging findings, are prone to incomplete diagnosis or missed diagnosis before surgery, which should arouse clinical precaution. Appropriate treatment methods should be selected according to the patient's age, fertility requirements, fetus preservation requirements, pregnancy phase, tumor stage, and pathological tumor type to ensure the safety of the mothers and infants.
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Keywords:
- pregnancy /
- borderline ovarian tumors /
- clinical features /
- diagnosis /
- surgical treatment
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表 1 13例妊娠合并卵巢交界性肿瘤患者临床资料
Table 1. Clinical data of 13 pregnant patients with borderline ovarian tumors
编号 年龄/岁 发现孕周 发现方式 肿瘤大小/cm 肿瘤标记物 肿瘤手术/终止妊娠孕周 术中所见 肿瘤术式(分期)/终止妊娠方式 腹水检查/术中冰冻 术后病理 随访/月 1 34 39 超声 13 39+2 无腹水、肿瘤表面光滑、内无乳头 左卵巢肿瘤核除术(未分期)/剖宫产术 -/- 局部S-BOT 60 2 29 11+3 超声 左13；
右26AFP 208.5 IU/mL
CA125 22.76 U/mL37 无腹水、肿瘤表面光滑、内无乳头 双卵巢肿瘤核除术(未分期)/剖宫产术 -/局部M-BOT 右局部M-BOT; 左良性 失访 3 32 39 术中探查 5 39 无腹水、肿瘤表面光滑、内无乳头 右卵巢肿瘤核除术(未分期)/剖宫产术 -/- S-BOT 60 4 35 39+3 超声 10 39+4 无腹水、肿瘤表面光滑、内无乳头 右卵巢肿瘤核除术(未分期)/剖宫产术 -/- 局部M-BOT 60 5 25 36+5 超声 8 37 无腹水、肿瘤表面光滑、内壁菜花状 左卵巢肿瘤核除术(未分期)/剖宫产术 -/局部S-BOT 局部S-BOT 60 6 32 5+6 超声 4 CA125 25.27 U/mL 39+1 无腹水、肿瘤表面光滑、内壁有乳头 左附件切除术(全面探查、未分期)/剖宫产术 -/S-BOT S-BOT 60 7 27 孕前 超声 14 39 无腹水、肿瘤表面光滑、内壁有乳头 右侧附件切除术(未分期)/剖宫产术 -/局部M-BOT 局部M-BOT 60 8 31 8+2 超声 8 CA125 20.89 U/mL
CEA 0.797 ng/mL
AFP 136 IU/mL38+4 无腹水、肿瘤表面光滑、内壁有乳头 左侧附件切除术(非规范分期手术)/剖宫产术 -/S-BOT S-BOT 60 9 25 34+4 超声 8 34+4 右卵巢蒂扭转、坏死、囊内凝血块 右侧附件切除术(未分期)/剖宫产术 -/- S-BOT 失访 10 27 孕前 超声 18 CA125 20.36 U/mL
CEA 0.461 ng/mL
AFP 240.7 IU/mL36+3 大量黏稠腹水、肿瘤表面光滑、内壁无乳头、多房 右侧附件切除术(全面探查、未分期)/剖宫产术 大量炎细胞及少许成团的上皮细胞, 考虑为肿瘤细胞/局部M-BOT 局部M-BOT 59 11 35 39+3 术中探查 5 39+3 无腹水、肿瘤表面光滑、内壁有乳头 右侧附件切除术(未分期)/剖宫产术 -/S-BOT S-BOT 55 12 41 39 术中探查 4 39 无腹水、肿瘤表面光滑、内无乳头 右侧卵巢肿瘤核除术(未分期)/剖宫产术 -/- S-BOT 47 13 27 5+2 超声 23 CA125 21.49 U/mL
CEA 29.45 ng/mL
AFP 215.8 IU/mL29+6/36+1 血性腹水、巨大肿瘤表面光滑、多房、无乳头 右侧附件切除术(孕期未分期)/阴道自然分娩 -/M-BOT M-BOT 42 
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