中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2014年
6期
451-454
,共4页
王永学%潘凌亚%黄惠芳%沈铿%吴鸣%郎景和
王永學%潘凌亞%黃惠芳%瀋鏗%吳鳴%郎景和
왕영학%반릉아%황혜방%침갱%오명%랑경화
卵巢甲状腺肿%畸胎瘤%肿瘤治疗方案
卵巢甲狀腺腫%畸胎瘤%腫瘤治療方案
란소갑상선종%기태류%종류치료방안
Struma ovarii%Teratoma%Antineoplastic protocols
目的 探讨卵巢甲状腺肿的临床特点、治疗及预后.方法 回顾性分析中国医学科学院北京协和医院1990年1月至2012年1月间收治的68例卵巢甲状腺肿患者的临床资料.结果 (1)一般情况:68例患者的中位年龄42岁(17 ～81岁);其中良性卵巢甲状腺肿64例(94％),恶性卵巢甲状腺肿4例(6％).(2)临床表现:32例(47％)患者为健康体检时超声检查发现盆腔包块就诊,28例(41％)患者以腹痛就诊,8例(12％)患者自行扪及下腹包块就诊.54例患者术前有血清CA125检查,仅8例(15％)异常.所有患者均行术前超声检查,其中51例(75％)为多房囊性包块,14例(21％)为囊实性包块,3例(4％)为实性包块.肿瘤的平均直径为(8±3)cm.4例(6％)患者术中可见腹水.68例患者中,67例患者病变位于单侧卵巢,仅1例为双侧.术前患者均无甲状腺功能亢进(甲亢)的临床表现,术后有19例患者行甲状腺功能检查,结果均正常.(3)治疗:所有患者均接受手术治疗.64例良性卵巢甲状腺肿患者中,25例行囊肿剔除术,15例行单侧附件切除术,2例行双侧附件切除术,22例行子宫全切除+单侧或双侧附件切除术.4例恶性卵巢甲状腺肿患者中,3例行保留生育功能手术,其中1例行保留生育功能的分期手术、2例行患侧附件切除术,1例行子宫全切除+双侧附件切除术,2例患者术后接受化疗.(4)预后:良性卵巢甲状腺肿患者的中位随访时间为5.4年(6个月～21年),均无复发.4例恶性甲状腺肿患者的中位随访时间为11.5年(9～ 20年),有3例复发,复发时间分别为术后2、7、16年.复发后均接受再次手术治疗,其中2例患者接受甲状腺切除术联合131I治疗;到随访结束时,4例患者均存活.结论 卵巢甲状腺肿是少见的卵巢单胚层畸胎瘤.囊肿剔除或附件切除可能是良性卵巢甲状腺肿适宜的治疗方法,而恶性卵巢甲状腺肿发病率低,缺乏标准的治疗方案.因恶性卵巢甲状腺肿有远期复发风险,需要严密随访.
目的 探討卵巢甲狀腺腫的臨床特點、治療及預後.方法 迴顧性分析中國醫學科學院北京協和醫院1990年1月至2012年1月間收治的68例卵巢甲狀腺腫患者的臨床資料.結果 (1)一般情況:68例患者的中位年齡42歲(17 ～81歲);其中良性卵巢甲狀腺腫64例(94％),噁性卵巢甲狀腺腫4例(6％).(2)臨床錶現:32例(47％)患者為健康體檢時超聲檢查髮現盆腔包塊就診,28例(41％)患者以腹痛就診,8例(12％)患者自行捫及下腹包塊就診.54例患者術前有血清CA125檢查,僅8例(15％)異常.所有患者均行術前超聲檢查,其中51例(75％)為多房囊性包塊,14例(21％)為囊實性包塊,3例(4％)為實性包塊.腫瘤的平均直徑為(8±3)cm.4例(6％)患者術中可見腹水.68例患者中,67例患者病變位于單側卵巢,僅1例為雙側.術前患者均無甲狀腺功能亢進(甲亢)的臨床錶現,術後有19例患者行甲狀腺功能檢查,結果均正常.(3)治療:所有患者均接受手術治療.64例良性卵巢甲狀腺腫患者中,25例行囊腫剔除術,15例行單側附件切除術,2例行雙側附件切除術,22例行子宮全切除+單側或雙側附件切除術.4例噁性卵巢甲狀腺腫患者中,3例行保留生育功能手術,其中1例行保留生育功能的分期手術、2例行患側附件切除術,1例行子宮全切除+雙側附件切除術,2例患者術後接受化療.(4)預後:良性卵巢甲狀腺腫患者的中位隨訪時間為5.4年(6箇月～21年),均無複髮.4例噁性甲狀腺腫患者的中位隨訪時間為11.5年(9～ 20年),有3例複髮,複髮時間分彆為術後2、7、16年.複髮後均接受再次手術治療,其中2例患者接受甲狀腺切除術聯閤131I治療;到隨訪結束時,4例患者均存活.結論 卵巢甲狀腺腫是少見的卵巢單胚層畸胎瘤.囊腫剔除或附件切除可能是良性卵巢甲狀腺腫適宜的治療方法,而噁性卵巢甲狀腺腫髮病率低,缺乏標準的治療方案.因噁性卵巢甲狀腺腫有遠期複髮風險,需要嚴密隨訪.
목적 탐토란소갑상선종적림상특점、치료급예후.방법 회고성분석중국의학과학원북경협화의원1990년1월지2012년1월간수치적68례란소갑상선종환자적림상자료.결과 (1)일반정황:68례환자적중위년령42세(17 ～81세);기중량성란소갑상선종64례(94％),악성란소갑상선종4례(6％).(2)림상표현:32례(47％)환자위건강체검시초성검사발현분강포괴취진,28례(41％)환자이복통취진,8례(12％)환자자행문급하복포괴취진.54례환자술전유혈청CA125검사,부8례(15％)이상.소유환자균행술전초성검사,기중51례(75％)위다방낭성포괴,14례(21％)위낭실성포괴,3례(4％)위실성포괴.종류적평균직경위(8±3)cm.4례(6％)환자술중가견복수.68례환자중,67례환자병변위우단측란소,부1례위쌍측.술전환자균무갑상선공능항진(갑항)적림상표현,술후유19례환자행갑상선공능검사,결과균정상.(3)치료:소유환자균접수수술치료.64례량성란소갑상선종환자중,25례행낭종척제술,15례행단측부건절제술,2례행쌍측부건절제술,22례행자궁전절제+단측혹쌍측부건절제술.4례악성란소갑상선종환자중,3례행보류생육공능수술,기중1례행보류생육공능적분기수술、2례행환측부건절제술,1례행자궁전절제+쌍측부건절제술,2례환자술후접수화료.(4)예후:량성란소갑상선종환자적중위수방시간위5.4년(6개월～21년),균무복발.4례악성갑상선종환자적중위수방시간위11.5년(9～ 20년),유3례복발,복발시간분별위술후2、7、16년.복발후균접수재차수술치료,기중2례환자접수갑상선절제술연합131I치료;도수방결속시,4례환자균존활.결론 란소갑상선종시소견적란소단배층기태류.낭종척제혹부건절제가능시량성란소갑상선종괄의적치료방법,이악성란소갑상선종발병솔저,결핍표준적치료방안.인악성란소갑상선종유원기복발풍험,수요엄밀수방.
Objective To study the clinical features,treatment and prognosis of struma ovarii.Methods From January 1990 to January 2012,a total of 68 patients were diagnosed struma ovarii at the Department of Obstetrics and Gynecology,Peking Union Medical College Hospital.Clinical data of these patients were studied retrospectively.Results (1) Characteristics of patients:the median age of patients was 42 years old (17-81 years).Of those patients,64 cases (94％) were diagnosed begin struma ovarii and 4(6％) were malignant struma ovarii.(2) Clinical feature:32(47％,32/68) patients were identified with pelvic mass by ultrasonic test,28 cases(41％) had clinical abdominal pain,8(12％) touched a mass from abdominal wall.Preoperative CA125 were tested in 54 patients,but only 8 cases(15％) had moderate elevation.All patients receive ultrasound examination,and 51 cases (75％) were mulitcystic lesions with many septi,3(4％) solid lesions and 14(21％) solid-cystic tumors.The mean diameter of tumors was(8 ± 3) cm.Ascites was present in 4 (6％,4/68)patients.Sixty-seven patients had unilateral lesions,and 1 patient had bilateral lesions.No patient had hyperthyroidism presentation.Nineteen cases underwent thyroid function test after operation,and the results were normal.(3) Treatment:all patients underwent surgical treatment.Among patients with begin struma ovarii,25 cases underwent cystectomy,15 cases unilateral,2 bilateral salpingo-oophorectomy,22 cases hysterectomy + unilateral or bilateral salpingo-oophorectomy.Four malignant struma ovarii,1 patient underwent fertility-sparing staging surgery,2 patients unilateral salpingo-oophorectomy,1 case hysterectomy + bilateral salpingo-oophorectomy.Two patients received chemotherapy after surgery.(4) Prognosis:all patients were followed up in Peking Union Medical College Hospital.The median follow-up time of benign struma ovarii was 5.4 years (6 months-21 years) and there were no recurrence.The median follow-up time of malignant struma ovarii was 11.5 years (9-20 years).Three cases had long-term recurrence at 2,7 and 16 years respectively after surgery.They were received surgical treatment after recurrence and all were alive.Two cases were given by thyroidectomy and 131I treatment.Conclusions Struma ovarii is a rare ovarian monodermal teratoma.Tumorectomy or salpingo-oophorectomy is the appropriate therapeutic treatment for benign struma ovarii.The incidence of malignant struma ovarii is low,and there are no standard treatments.Because of higher long-term recurrence rate,these patients need close follow-up.
