1295例盆腔混合性肿块术前良恶性评估的多因素分析与个体化腹腔镜手术的研究  

Preoperative Multivariate Analysis on Pelvic Mixed Masses and Individualized Laparoscopic Management:Report of 1295 Cases

作　　者：王岳萍[1,2] 喇端端[1,2] 沈立翡[1,2] 龙雯晴[1,2] 

机构地区：[1]上海交通大学医学院附属瑞金医院妇产科 [2]上海交通大学附属瑞金医院腔镜中心,上海200025

出　　处：《中国微创外科杂志》2011年第10期867-870,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨盆腔混合性肿块术前评估良恶性的相关因素以及个体化的腹腔镜手术方法。方法回顾性分析2006年1月～2010年10月1295例经过超声和妇科检查诊断为盆腔混合性肿块行腹腔镜手术治疗者的临床资料。结果 1232例(95.1%)经腹腔镜病理诊断为良性肿瘤,其中681例(52.6%)行囊肿剔除术,372例(28.7%)行附件切除术,179例(13.8%)行输卵管切除、整形、盆腔粘连松解术。63例(4.9%)术中冰冻病理为恶性或交界性肿瘤,其中3例行腹腔镜下卵巢癌根治术,16例中转开腹行根治、肿瘤细胞减灭手术,20例行患侧附件切除术,8例行肿瘤剔除术(其中6例在术后石蜡病理明确后行二次手术切除患侧附件并行化疗),16例仅行活检术(其中8例在新辅助化疗后行开腹肿瘤细胞减灭术)。患者术前出现腹部不适,超声发现肿瘤直径>6 cm、附壁乳头状突起、盆腔积液以及伴有肿瘤指标CA125、CEA升高者患恶性肿瘤的比例高于良性。这些单因素行Logistic回归分析,肿瘤直径>6 cm、附壁乳头状突起、盆腔积液、CA125升高提示肿块恶性可能大。结论盆腔混合性肿块95%以上为良性肿瘤。术前认真评估肿块性质行个体化腹腔镜手术是诊治盆腔混合性肿块安全有效的方法。Objective To explore the prognostic factors of mixed masses in the pelvis and individualized treatment by laparoscopy. Methods A total of 1295 patients with mixed pelvic masses were treated with laparoscopy from January 2006 to October 2010 at our hospital.Results In the 1295 patients,1232 were pathologically confirmed with benign tumors,681 of them（52.6%） underwent laparoscopic resection of pelvic cysts,372（28.7%） recieved laparoscopic adnexetomy,and 179（13.8%） underwent laparoscopic salpingectomy or tuboplasty.Malignant or borderline tumors were diagnosed by frozen sections in 63 cases（4.9%）,in which laparoscopic radical operation was performed on 3 patients;16 patients were converted to open surgery for radical resection and cytoreductive surgery;20 patients received adnexetomy at the affected side;8 underwent resection of the tumor（6 of them received a second operation for adnexetomy at the affected side combined with chemotherapy when postoperative pathological results confirmed malignancy）;and 16 patients received biopsy only（8 of them underwent laparotomy for cytoreductive surgery after neoadjuvant chemotherapy）.The patients who had abdominal symptoms before operation,tumor size 6 cm by ultrasonography,parietal papillary process,pelvic hydrops,or increased levels of CA125 and CEA,showed higher rate of malignancy.We performed Logistic regression on these factors,and found that tumor diameter 6 cm,parietal papillary process,pelvic hydrops,and increased level of CA125 indicated malignancy. Conclusions More than 95% of pelvic masses are benign lesions.Preoperative evaluation and individualized laparoscopic surgery are effective surgical methods for mixed pelvic masses.

关 键 词：腹腔镜 卵巢肿瘤 混合性肿块 

分 类 号：R737.31[医药卫生—肿瘤]