【作者】 刘莉；

【导师】 岳瑛；

【作者基本信息】 吉林大学 ， 临床医学， 2009， 硕士

【摘要】 青春期为儿童期向性成熟期发展的过渡时期,女性的卵巢在此期开始发育并逐渐成熟。在此期间卵巢细胞生长活跃,容易发生变异,形成一个相对发病高峰。青春期卵巢肿瘤虽发病率较成人低,但恶性率高,且其临床表现、病理类型及其治疗原则均与成年女性存在不同,故青春期卵巢肿瘤的诊治越来越受到临床医生的重视。本文通过对近10年吉林大学第一医院妇产科收治住院的128例青春期(10~19岁)卵巢肿瘤患者的临床资料做回顾性分析,探讨其临床表现、诊断、病理类型、治疗及随访等方面的情况。为临床工作提出以下几方面建议:对月经初潮后1~2年内和16岁月经未来潮的女性进行一次包括盆腔器官的全面普查;各科医生要重视青春期女性的主诉、月经情况和盆腹腔症状体征,减少误诊误治;推行超声图像评分及血流指数综合评价系统;重视术前、治疗和随访中相关血清肿瘤标志物的检查,CA125检查应作为卵巢肿瘤的常规检查项目;应根据综合情况评估冰冻切片结果;重视腹水情况及腹水脱落细胞检查;保留生育功能的治疗方案是处理青春期良性卵巢肿瘤和早期恶性肿瘤的可行手段;良性肿瘤应尽可能应用腹腔镜手术,减少创伤以利于患者恢复;联合化疗是重要的治疗手段,应及时按疗程应用;应加强对恶性肿瘤患者的长期随访工作。更多还原

【Abstract】 Objective: To study the clinical characteristics of incidence, diagnosis, treatment and therapy of adolescent ovarian tumors.Methods: Make a retrospective study of 128 cases aged from 10 to 19 with ovarian tumors in our department between January 1999 and December 2008.Results: The rate of adolescent ovarian tumors in contemporaneous ovarian tumors is 5.3%. There are 114 cases of benign tumors , 2 cases of borderline tumors and 12 cases of malignancy tumors(5.6% in contemporaneous malignancy ovarian tumors). The MOGCT rats 58.3%(7/12). Germ cell tumors occupied 47 cases (36.7%), tumour-like lesion 40 cases (31.3%), epithelial tumors 37cases (28.9%) and sex cord stromal tumors 3 cases (2.3%), lipid-like cell tumor 1 case (0.8%) respectively. Abdominalgia, abdominal distention, menoxenia and the mass in the pelvic and lower abdominal cavity were the most common symptoms. The rate of misdiagnosis of adolescent ovarian tumors was 29.7%.The ultrasound check has high accuracy rate in diagnosis of tumors. The highest rate is cystic teratoma 77.5% (31/40), next is rhexis of tumor 61.1% (11/18) and torsion of pedicle 58.6% (17/29). The sonographic features is useful to judge if the tumor is benign or malignancy. The check rate of tumor markers in serum is 10.9%. Only 7 cases took the check of the cast-off cells in ascites. The frozen section was taken in 20.3% of patients,and the accurate rate to the final result was 76.9%. The error rate of the nature of the tumors was 15.4%. The fertility-sparing therapy was warranted in the benign and early malignant cases. The torsion always resulted in the loss of unilateral ovarian and Fallopian tube. The laparoscope was taken 28 cases (24.6%), it made the time in hospital declined. Chemotheray was used in 6 cases of all 12 malignant cases,and the course of treatment were not canonical.Conclusions: We suggest that girls should obtain a complete examination including the pelvic organ who are in 1-2 years after menarche or 16 years old premenarche.clinical doctors should pay attention to the chief complaint, menses and the symptoms and sign associated with pelvic and abdominal organ, and try to reduce the misdiagnosis and incorrect treatment.The ultrasound check has high accuracy rate in diagnosis of tumors.The making scheme and blood flow system should be carry out. Must pay attention to the check of tumor markers in serum ,for its’effort in pre-operation, treating and follow-up procedure.And we suggest CA125 should be the routine item. The error rate of the frozen section in the nature of the tumors is high. We should evaluate it synthetically. Check of the cast-off cells in ascites also calls to be pay attention to. The fertility-sparing therapy was warranted in the benign and early malignant cases.The laparoscope should be taken in more benign tumors for its good. Chemotheray is important to be pay close attention to. And the follow-up job must be strengthen.更多还原