摘要
目的 分析子宫切除术后盆腔包块的发生情况以及不同病理类型盆腔包块的临床特点及高危因素.方法 回顾性分析2011年1月至2016年6月因子宫良性病变行子宫切除术,术后发现盆腔包块就诊于北京协和医院并接受再次手术的85例患者的临床病理资料.结果 子宫切除术后74％（63/85）的盆腔包块为良性病变,19％（16/85）为恶性,7％（7％,6/85）为卵巢交界性肿瘤.子宫切除术后盆腔包块最常见的病理类型为卵巢子宫内膜异位囊肿,占24％（20/85）,多发生于子宫切除术后的5年内（16例）;其次是卵巢黏液性囊腺瘤（14％,12/85）,而恶性肿瘤的病理类型以卵巢乳头状浆液性囊腺癌（8％,7/85）居多,且卵巢肿瘤更多发生在子宫切除术后10年及以后（18例）.子宫切除术后卵巢子宫内膜异位囊肿的发生特点主要包括年龄较小[（47±5）岁]、子宫切除术后病理结果为子宫内膜异位症或子宫腺肌病的比例高（65％,13/20）、子宫切除术至发现盆腔包块的时间间隔较短[（3±3）年],而这些与卵巢肿瘤（包括良性、交界性、恶性）比较存在明显差异（P均＜0.01）.既往多次腹部手术史将明显增加子宫切除术后卵巢瘤样病变（包括卵巢子宫内膜异位囊肿及其他瘤样病变）的发生风险（RR=9.410,95％CI为1.099 ～ 80.564,P=0.041）.结论 子宫切除术后盆腔包块的发生与子宫切除术时的组织病理学类型密切相关,尤其是卵巢子宫内膜异位囊肿,并且既往多次腹部手术将明显增加该风险.针对高危因素进行处理可有效预防子宫切除术后盆腔包块的发生.
Objective To explore how to reduce the incidence of pelvic mass after hysterectomy,and to evaluate clinical characteristics and the risks.Methods A retrospective study was carried out in 85 patients who returned for surgery due to a pelvic mass after prior hysterectomy for benign disease at Peking Union Medical College Hospital from January 2011 to June 2016.Results The majority of pelvic masses arising after hysterectomy and requiring surgery were benign （74%,63/85）,while 19% （16/85） were malignant and 7% （6/85） were borderline.The most common type was ovarian endometrioma （24%,20/85） which usually occurs within the 5 years （16 cases）,however,ovarian tumors （18 cases） were more likely to occur ≥10 years after hysterectomy.Characteristics associated with significantly increased likelihood of ovarian endometrioma were mainly ascribed to younger age [（47±5） years old],prior presence of endometriosis or adenomyosis （65%,13/20） and shorter time to pelvic mass onset [（3 ±3） years],as opposed to ovarian tumors （all P〈0.01）.Additionally,higher number of prior abdominal surgeries significantly intensified the risk （RR=9.410,95% CI：1.099-80.564,P=0.041）.Conclusions The occurrence of pelvic mass after hysterectomy is tightly related to prior histologic findings,and particularly for ovarian endometrioma.Higher number of prior abdominal surgery will exacerbated the risk.It is effective to prevent the pelvic mass in women after hysterectomy if treat patients for the purpose of the risk factors.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2017年第8期526-532,共7页
Chinese Journal of Obstetrics and Gynecology
