良性疾病子宫切除术后再发盆腔包块临床特征分析  

Analysis of clinical features of recurrent pelvic masses after hysterectomy for benign diseases

作　　者：王晓霞[1] 李燕婷[1] 武美丽[1] 史宏晖[2] 朱兰[2] 冷金花[2] 刘晶 孙礼[1] 李芸芝[1] WANG Xiaoxia;LI Yarning;WU Meili;SHI Honghui;ZHU Lan;LENG Jinhua;LIU Jing;SUN Li;LI Yunzhi(Department of Gynecology,Gansu Provincial Maternity and Child-care Hospital,Gansu Lanzhou 730000,China;Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing100730,China)

机构地区：[1]甘肃省妇幼保健院妇科,甘肃兰州730000 [2]中国医学科学院北京协和医院妇产科,北京100730

出　　处：《中国妇幼健康研究》2022年第1期124-129,共6页Chinese Journal of Woman and Child Health Research

基　　金：甘肃省卫生行业科研计划资助项目(GSWSKY2018-30);兰州市科技发展计划资助项目(2017-ZD-33)。

摘　　要：目的探讨因良性疾病行全/次全子宫切除术后发生盆腔包块,并再次手术患者的临床病理特点,分析盆腔包块良性、恶性的相关因素,为临床治疗提供参考。方法回顾性分析2012年1月至2016年12月北京协和医院收治的因良性疾病行全/次全子宫切除术后发生盆腔包块,并再次手术患者的临床资料247例。根据末次手术后病理结果将患者资料分为良性组(163例)和恶性组(84例),比较分析术前临床特点。结果在247例资料中,术后病理证实为良性肿瘤163例(65.99%);术后病理证实为恶性肿瘤84例(34.01%)。两组比较,恶性组患者切除子宫的年龄更大(χ^(2)=7.97,P<0.05),因盆腔包块接受末次手术年龄更大(χ^(2)=21.34,P<0.05),发现盆腔包块距前次手术时间更长(χ^(2)=17.67,P<0.05),较少因查体发现盆腔包块(χ^(2)=44.58,P<0.05),以腹胀纳差(χ^(2)=33.60,P<0.05)和排便异常(χ^(2)=14.60,P<0.05)更多,术前影像学提示为混合回声包块更多(χ^(2)=61.41,P<0.05),术前CA125大于正常范围更高(χ^(2)=75.60,P<0.05)。多因素分析显示,子宫切除的年龄(≥44岁)(OR=3.88)、查体发现盆腔包块(OR=0.21)、排便异常(OR=15.65)、影像学检查提示混合性(OR=5.13)及血清CA125异常升高(OR=8.48)均是后续发生盆腔恶性包块的独立危险因素(P<0.05)。结论对于既往因良性疾病全/次全切除子宫、新发盆腔包块的患者,如切除子宫时年龄偏大,末次手术盆腔包块非体检发现,出现排便异常,盆腔包块性质为混合性,同时伴有CA125的升高,需要特别注意恶性肿瘤的可能。Objective To analyze the clinicopathologic characteristics of patients who found pelvic masses again after total or subtotal hysterectomy for benign disease and underwent reoperations, and further to discuss the factors related to the pelvic masses which was benign or malignant, in order to provide references for clinical treatment.Methods The clinical data of patients, who underwent reoperation for pelvic masses subsequently to total or subtotal hysterectomy for benign diseases in Peking Union Medical College Hospital from January 2012 to December 2016,were retrospectively analyzed.According to the pathological results after the last operation, the patients were divided into the benign group(163 cases) and the malignant group(84 cases),and the preoperative clinical characteristics were compared and analyzed.Results Among the 247 patients, 163 cases were benign tumor(65.99%) and 84 cases were malignant tumor(34.01%),which were confirmed by the postoperative pathology.Comparing the two groups, the patient in the malignant group had older age of hysterectomy(χ^(2)=7.97,P<0.05),older age of last hysterectomy for pelvic mass(χ^(2)=21.34,P<0.05),longer time intervals between last hysterectomy and discovery of the pelvic mass(χ^(2)=17.67,P<0.05),less chances of discovering the pelvic masses by physical examination(χ^(2)=44.58,P<0.05),more frequencies of abdominal distensionand poor appetite(χ^(2)=33.60,P<0.05) and abnormal defecation(χ^(2)=14.60,P<0.05).In addition, the patient in the malignant group were with more mixed masses in preoperative imaging(χ^(2)=61.41,P<0.05) and higher level of preoperative CA125 than the normal range(χ^(2)=75.60,P<0.05).Multivariate analysis showed that the age of hysterectomy(≥44 years old)(OR=3.88),discovery of the pelvic masses by physical examination(OR=0.21),abnormal defecation(OR=15.65),mixed masses in imaging examination(OR=5.13) and abnormal elevated CA125 levels(OR=8.48) were the independent risk factors for the subsequent malignant pelvic masses(P<0.05).Conclusion For

关 键 词：子宫切除术 盆腔包块 良性疾病 恶性肿瘤 

分 类 号：R713.4[医药卫生—妇产科学]