摘要
目的:探讨卵巢交界性肿瘤(BOT)的临床特征、保留生育功能的手术方案及预后。方法:回顾性分析四川省人民医院2005年1月至2019年12月收治的61例行保留生育功能手术的BOT患者的临床资料。结果:患者平均年龄27.66岁,67.21%的患者(41例)无明显临床症状;术前癌抗原125(CA_(125))升高者占74.14%(43/58),糖链抗原19-9(CA_(19-9))升高者占38.18%(21/56),人附睾蛋白4(HE4)升高者占8.70%(2/23)。国际妇产科联盟(FIGO)分期ⅠA期27例,ⅠB期8例,ⅠC期18例,ⅡB期2例,Ⅲ期6例。病理类型交界性浆液性卵巢肿瘤(S-BOT)32例,交界性黏液性卵巢肿瘤(M-BOT)27例,交界性浆黏液性卵巢肿瘤2例。M-BOT患者CA_(19-9)阳性率高于S-BOT者(60%vs 17.86%,P<0.05)。随访58例,9例复发,复发率15.52%。单因素分析显示复发与FIGO分期、肿瘤累及卵巢范围、卵巢手术方式有关(P<0.05),但多因素分析显示以上因素均不是肿瘤复发的独立危险因素。25例患者术后尝试妊娠,17例成功妊娠并足月分娩,1例正在妊娠;卵巢囊肿剥除组患者妊娠率高于单侧附件切除组(87.50%vs 64.71%),但差异无统计学意义(P>0.05)。结论:BOT患者缺乏特异性临床症状及肿瘤标志物,诊断时多为早期,年轻有生育要求患者可行保留生育功能手术。手术方式首选附件切除术,早期BOT患者不推荐同时行分期手术。保留生育功能手术者术后复发风险可接受,复发后可再次行保留生育功能手术。
Objective:To investigate the clinical features,fertility-sparing surgery and prognosis of borderline ovarian tumors(BOT).Methods:The clinical data of 61 patients with BOT who underwent fertility-sparing surgery in Sichuan Provincial People′s Hospital from January 2005 to December 2019 were analyzed retrospectively.Results:The average age of the patients was 27.66 years old.41 patients(67.21%)had no obvious clinical symptoms.The level of carbohydrate antigen 125(CA125),carbohydrate antigen 199(CA199)and human epididymis protein 4(HE4)was increased in 74.14%(43/58),38.18%(21/56)and 8.60%(2/23)of the patients respectively.27 patients were diagnosed at stageⅠA,8 at stageⅠB,18 at stageⅠC,2 at stageⅡB,and 6 at stageⅢ.32 cases were serous borderline ovarian tumors(S-BOT),27 cases were mucinous borderline ovarian tumors(M-BOT),and 2 cases were serous-mucinous borderline ovarian tumors.The positive rate of CA199 in patients with M-BOT was higher than that of S-BOT(60%vs 17.86%,P<0.05).58 cases were followed up,9 cases recurred,the recurrence rate was 15.52%.Univariate analysis showed that recurrence was correlated with FIGO staging,the extent of ovarian involvement and surgical procedure of ovary(P<0.05),but multivariate analysis showed that none of the above factors were independent risk factors.25 patients tried pregnancy after operation,17 patients had successful pregnancy and gave birth at term,and one patient was pregnant.The pregnancy rate of patients with ovarian cystectomy was higher than that with unilateral salpingo-oophorectomy(87.5%vs 64.71%,P>0.05),however,the difference was not statistically significant.Conclusions:Though patients with BOT lack specific clinical symptoms and tumor markers,most of them are diagnosed at the early stage.Fertility-sparing surgery is feasible for young patients with fertility requirements.Salpingo-oophorectomy is the first choice,and staging surgery is not recommended for patients with early BOT.Patients with fertility-sparing surgery have a higher pregnancy rate and
作者
李宁蔚
廖治
周飞
梅劼
LI Ningwei;LIAO Zhi;ZHOU Fei(Department of Obstetrics and Gynecology,Sichuan Provincial People's Hospital,Chengdu Sichuan 610072,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2021年第7期545-550,共6页
Journal of Practical Obstetrics and Gynecology
关键词
卵巢交界性肿瘤
临床特征
保留生育功能手术
预后
妊娠结局
Ovarian borderline tumor
Clinical features
Fertility-sparing surgery
Prognosis
Pregnancy outcome
