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目的探讨不孕症患者合并卵巢肿瘤的临床特点、诊断、手术处理及妊娠结局。方法回顾性分析1999年1月1日—2004年12月31日在浙江大学医学院附属妇产科医院生殖内分泌科因不孕症住院手术后经病理检查证实的110例卵巢肿瘤患者的临床资料。按病理检查结果分为卵巢上皮性肿瘤组(上皮性肿瘤组)、畸胎瘤组和其他组,分别为49、42、19例。结果上皮性肿瘤组、畸胎瘤组和其他组的术前确诊率分别为29%、81%和63%,前组明显低于后两组(P<0.01)。110例患者中,97例为直径<5 cm 的卵巢小肿瘤患者;97例完成腹腔镜下卵巢肿瘤剔除手术,11例行开腹手术,2例腹腔镜检查后转开腹手术;上皮性肿瘤组合并盆腔致密粘连的发生率为61%,明显高于畸胎瘤组的26%(P<0.01)。有随访结果的102例患者中,共45例妊娠,妊娠率44%,其中18例自然受孕,21例体外受精妊娠,6例人工授精妊娠。结论 (1)不孕症合并卵巢肿瘤以直径<5 cm 的小肿瘤为主,术前诊断率低,腹腔镜检查可明确诊断。(2)卵巢上皮性肿瘤合并慢性盆腔炎发生率较高,术中应认清解剖关系,完整剔除肿瘤,同时尽量保护卵巢功能。(3)不孕症合并卵巢肿瘤患者在手术和辅助生育治疗后可获得良好的妊娠结局。
Objective To investigate the clinical features, diagnosis, surgical treatment and pregnancy outcome of patients with infertility complicated with ovarian tumors. Methods The clinical data of 110 patients with ovarian tumors confirmed by pathological examination after hospitalization for infertility due to infertility were retrospectively analyzed from January 1, 1999 to December 31, 2004 in the Affiliated Obstetrics and Gynecology Hospital of Zhejiang University Medical College . According to the results of pathological examination, the patients were divided into ovarian epithelial tumor group (epithelial tumor group), teratoma group and other groups, 49, 42 and 19 cases respectively. Results The preoperative diagnosis rates of epithelial tumor, teratoma group and others were 29%, 81% and 63% respectively, which were significantly lower than those of the latter two groups (P <0.01). Of the 110 patients, 97 were ovarian small tumors <5 cm in diameter, 97 underwent laparoscopic ovarian tumor resection, 11 underwent laparotomy, and 2 underwent open laparoscopic surgery. Epithelial neoplasms The combined incidence of pelvic dense adhesions was 61%, significantly higher than the teratoma group, 26% (P <0.01). There were 102 patients with follow-up results, a total of 45 cases of pregnancy, the pregnancy rate was 44%, of which 18 cases of natural pregnancy, 21 cases of in vitro fertilization pregnancy, 6 cases of artificial insemination pregnancy. Conclusions (1) Infertility with ovarian tumors is mainly composed of small tumors <5 cm in diameter. The preoperative diagnosis rate is low, and laparoscopy can confirm the diagnosis. (2) Epithelial ovarian cancer with a higher incidence of chronic pelvic inflammatory disease, intraoperative anatomy should recognize the relationship between the complete removal of the tumor, while protecting ovarian function. (3) Infertility patients with ovarian cancer can get good pregnancy outcomes after surgery and assisted reproductive therapy.