CAJ | 학술논문

目的探讨卵巢良性肿瘤合并胸、腹水(Meigs综合征)的临床特点及其诊治策略并结合文献进行复习。方法回顾性分析2011年4月至2013年8月于四川大学华西第二医院收治的14例 Meigs 综合征患者的临床病理资料,电话随访其预后情况,并进行相关文献复习。对本组患者腹水量和肿块直径、血浆CA125值进行相关性分析。本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准。结果本组患者年龄为20~79岁,平均为(54.4±13.7)岁。其中,合并盆、腹部包块者为9例；腹痛、腹胀者为3例；咳嗽、气促者为2例。术前血清CA125值升高者为4例,伴发胸水者为2例。对其进行卵巢肿瘤剥除术者为2例,进行患侧附件切除术者为7例,进行双侧附件切除术者为2例,进行全子宫切除术+双附件切除术者3例。术后组织病理学检查结果显示卵巢纤维瘤为7例,卵巢纤维-卵泡膜瘤为5例,乳头状囊腺瘤为2例。腹水量深度与肿块直径呈正相关关系(r=0.535,P=0.048),与血浆 CA125值无明显关系(r=0.319,P=0.266),肿块直径与血浆 CA125值呈正相关关系(r=0.625,P=0.027)。结论 Meigs综合征临床少见,易被误诊为结核、肝炎与胸、腹腔恶性肿瘤等,组织病理学检查是确诊该病的关键,其治疗以手术切除肿瘤为主,术后预后好。Meigs综合征患者腹水量与肿瘤直径呈正相关关系,推测腹水产生可能与肿瘤压迫脉管导致漏出液增加有关。
목적탐토란소량성종류합병흉、복수(Meigs종합정)적림상특점급기진치책략병결합문헌진행복습。방법회고성분석2011년4월지2013년8월우사천대학화서제이의원수치적14례 Meigs 종합정환자적림상병리자료,전화수방기예후정황,병진행상관문헌복습。대본조환자복수량화종괴직경、혈장CA125치진행상관성분석。본연구준순적정서부합본원인체시험위원회소제정적윤리학표준,득도해위원회비준。결과본조환자년령위20~79세,평균위(54.4±13.7)세。기중,합병분、복부포괴자위9례；복통、복창자위3례；해수、기촉자위2례。술전혈청CA125치승고자위4례,반발흉수자위2례。대기진행란소종류박제술자위2례,진행환측부건절제술자위7례,진행쌍측부건절제술자위2례,진행전자궁절제술+쌍부건절제술자3례。술후조직병이학검사결과현시란소섬유류위7례,란소섬유-란포막류위5례,유두상낭선류위2례。복수량심도여종괴직경정정상관관계(r=0.535,P=0.048),여혈장 CA125치무명현관계(r=0.319,P=0.266),종괴직경여혈장 CA125치정정상관관계(r=0.625,P=0.027)。결론 Meigs종합정림상소견,역피오진위결핵、간염여흉、복강악성종류등,조직병이학검사시학진해병적관건,기치료이수술절제종류위주,술후예후호。Meigs종합정환자복수량여종류직경정정상관관계,추측복수산생가능여종류압박맥관도치루출액증가유관。
Objective To study the clinical characteristics and treatment strategies of the ovarian benign tumor with ascites or pleural effusion (Meigs syndrome),and combined with literatures reviewed. Methods Retrospective analyses were conducted on 14 cases with Meigs syndrome in West China Second University Hospital of Sichuan University from April 2011 to August 2013.Prognosis was conducted by telephone,and literatures were reviewed.SPSS 17.0 software was used to make correlation analysis between the amount of ascites,tumors diameters and serum CA125 expressions.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital,Sichuan University. Informed consent was obtained from all participants. Results The 14 patients with Meigs′syndrome were from 20 to 79 years old and the mean age was (54.4±13.7)years old.Among them,there were 9 patients combined with pelvis and abdominal mass,3 patients with abdominal pain and distension,2 patients with cough and short breath.Besides,there were 4 patients with serum CA125 levels increased and 2 patients with pleural effusion before surgery.Among them,2 patients received ovarian tumor resection,7 patients received unilateral adnexectomy and 2 patients received bilateral adnexectomy and 3 patients with hysterectomy plus bilateral adnexectomy.Postoperative histopathology result showed that there were 7 cases with fibroma of ovary,5 cases with fibrothecoma and 2 cases with papillary cystadenoma.There was positive correlation between ascites volumes and tumors diameters (r=0. 535,P=0.048),while there was no correlation between ascites volumes and values of serum CA125 (r=0. 319,P=0.266),and there was positive correlation between tumors diameters and values of serum CA125 (r= 0 .6 2 5 ,P = 0 .0 2 7 ).Conclusions Meigs syndrome is a rare clinical disease and is apt to be misdiagnosed as tuberculosis,hepatitis or chest and abdominal malignant tumor,definite diagnosis is only made through histopathology,and tumor resection leads to favorable prognosis.The ascites volumes of Meigs syndrome positively correlates with tumors diameters, supporting the hypothesis of tumor compression.