转移性卵巢肿瘤的临床分析及文献回顾  

Clinical analysis and literature review of secondary tumors of the ovary

作　　者：杨玲玲[1,2] 万冬梅[1] 王美 李萌 李拟东[1] 王广涵 梁华茂 Yang Lingling;Wan Dongmei;Wang Mei(Department of Obstetrics and Gynecology,Peking University Third Hospital,National Clinical Research Center for Obstetrics and Gynecology(Peking University Third Hospital),Beijing 100191;Department of Gynecology,Women and Children's Hospital,School of Medicine,Xiamen University,Xiamen 361000;Department of Obstetrics and Gynecology,Beijing Hospital of Traditional Chinese Medicine Shunyi Hospital,Beijing 101300)

机构地区：[1]北京大学第三医院妇产科,国家妇产疾病临床医学研究中心,北京100191 [2]厦门大学附属妇女儿童医院妇科,厦门361000 [3]北京中医医院顺义医院妇产科,北京101300

出　　处：《现代妇产科进展》2025年第4期269-273,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:分析转移性卵巢肿瘤(STOs)的临床特点及治疗。方法:回顾分析2000年1月1日至2024年9月31日在北京大学第三医院妇科住院的STOs患者的临床和病理资料。结果:共纳入89例STOs患者,年龄19~84(50.1±15.4)岁。主要临床表现为腹痛(30例)、腹胀(44例),37例合并腹水。原发肿瘤包括非生殖系统来源80例(89.9%),生殖道来源9例(10.1%)。非生殖系统来源以消化道来源为主(64/80,80.0%),包括胃癌、结直肠癌、阑尾癌、消化道恶性肿瘤(未分类)、胆胰腺癌等。其他非妇科来源包括乳腺癌、未知原发来源、腹膜假性黏液瘤等。生殖道来源STOs中,包括子宫内膜癌7例和宫颈癌2例。16例患者既往有恶性肿瘤病史,原发肿瘤已切除(胃癌5例,乳腺癌4例,结肠癌4例,子宫内膜癌2例,阑尾癌1例),原发肿瘤手术后距发现卵巢转移的中位时间为3.6(0.5,20.2)年。辅助检查中诊断STOs的敏感度:CT 36.8%(21/57),MRI 26.9%(14/52),正电子发射计算机断层显像(PET-CT)58.0%(18/31),三者相比差异有统计学意义(P=0.018)。对于诊断消化系统来源STOs,胃肠镜的敏感性为74.2%(23/31),大便潜血试验为27.5%(11/40),差异有统计学意义(P<0.001)。CEA对于鉴别胃肠道来源的STOs具有一定价值(P=0.031)。所有患者中,24例(27.0%)在术前确诊STOs,转至相应科室治疗;65例(73.0%)患者行妇科手术,21.5%(14/65)患者行卵巢癌肿瘤细胞减灭术。术中冰冻病理的准确率为47.7%。结论:需加强对STOs的术前识别,PET-CT和胃肠镜等辅助检查有助于减少误诊。Objective:To analyze the clinical characteristics and treatment of secondary tumors of the ovary(STOs).Methods:The clinical and pathological data of patients with STOs admitted in the Department of Gynecology of Peking University Third Hospital from January 1,2000 to September 31,2024 were retrospectively analyzed.Results:A total of 89 patients aged 19~84(50.1±15.4)years were included.The main clinical manifestations were abdominal pain(30 cases),abdominal distension(44 cases),and ascites(37 cases).The primary tumors included 80 cases(89.9%)of non-reproductive system origin and 9 cases(10.1%)of reproductive tract origin.The main non-reproductive sources were digestive tract(64/80,80.0%),including gastric cancer,colorectal cancer,appendix cancer,gastrointestinal malignance(not classified),biliary pancreatic cancer,etc.Other non-gynecological sources included breast cancer,unknown primary source,peritoneal pseudomyxoma,etc.STOs of reproductive tract origin included 7 cases of endometrial cancer and 2 cases of cervical cancer.16 patients had once suffered from cancers(5 gastric cancer,4 breast cancer,4 colon cancer,2 endometrial cancer,and 1 appendix cancer),and the median time from the surgery of primary cancer to the discovery of ovarian metastases was 3.6(0.5,20.2)years.In the auxiliary examination,the sensitivity of diagnosing STOs was 36.8%(21/57)with CT,26.9%(14/52)with MRI,58.0%(18/31)with positron emission computed tomography(PET-CT),and the difference was statistically significant(P=0.018).The sensitivity of diagnosing digestive tract origin STOs was 74.2%(23/31)with gastroenteroscopy and 27.5%(11/40)with fecal occult blood test,and the difference was statistically significant(P<0.001).CEA was found to be of diagnostic significance in identifying digestive tract origin STOs(P=0.031).Twenty-four patients(27.0%)were diagnosed with STOs before operation and transferred to corresponding departments for treatment.Sixty-five patients(73.0%)received gynecological surgery,including 21.5%(14/65)with debulking surge

关 键 词：转移性 卵巢肿瘤 诊断 治疗 

分 类 号：R737.33[医药卫生—肿瘤]