妊娠合并卵巢囊肿的诊疗策略

妊娠合并卵巢囊肿的诊疗策略

陈思诗 丁景新▲

复旦大学附属妇产科医院妇科，上海 200000

[摘要] 卵巢囊肿是妇科的常见疾病之一，但妊娠期间确诊合并卵巢囊肿的情况相对少见，它的发病率约为0.15%～5.7%。因缺乏充足的临床治疗经验，且目前尚无国际公认的临床指南，关于妊娠合并卵巢囊肿的治疗仍存在较多争议。虽然它的诊疗思路大致与非孕期卵巢囊肿患者相似，但因结合了妊娠这一特点而体现出其特殊性。针对妊娠合并卵巢肿块，应根据临床症状、B 超、MRI 等影像学检查及实验室检查全面评估于孕期进行手术干预的必要性，对于考虑良性的、直径＜6cm 且无症状的卵巢囊肿患者应鼓励定期随访，而针对需孕期手术的患者，建议将手术推迟至孕中期进行，以避免较高的流产风险。与经腹手术比较，孕期行腹腔镜手术被认为同样安全有效，并且单孔腹腔镜的应用为孕期手术进腹途径提供了更多选择。目前仍没有适用于妊娠合并卵巢肿块的诊疗指南，建议尽快制定相关指南，以实现疾病的规范化诊治。

[关键词] 妊娠合并卵巢囊肿；诊断；治疗；孕期手术；单孔腹腔镜

[中图分类号] R737.31 [文献标识码] A [文章编号] 2095-0616（2019）11-30-06

Diagnosis and treatment strategy for pregnancy with ovarian cyst

CHEN Sishi DING Jingxin

Gynaecology Department,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200000,China

[Abstract] Ovarian cyst is one of the common gynecological diseases,but the diagnosis of ovarian cyst during pregnancy is relatively rare,its incidence is about 0.15%-5.7%.Due to the lack of sufficient clinical experience and internationally recognized clinical guidelines,there is still much controversy about the treatment of pregnancy with ovarian cysts.Although the diagnosis and treatment of ovarian cyst is similar to the non-pregnant women,but its particularity is reflected by pregnancy.According to clinical symptoms,B-mode ultrasonography,MRI and laboratory examination,the necessity of surgical intervention during pregnancy should be comprehensively evaluated.Regular follow-up should be encouraged for patients with benign, the diameter less than 6 cm and asymptomatic ovarian cyst.For patients who need pregnancy operation,it is recommended that the operation should be postponed to the second trimester to avoid a higher risk of paroscopic surgery during pregnancy is considered to be as safe and effective as transabdominal surgery,moreover,the application of single-port laparoscopy provides more options for abdominal approach.At present,there are no guidelines for the diagnosis and treatment of ovarian cyst in pregnancy.The relevant guidelines should be formulated as soon as possible in order to achieve standardized diagnosis and treatment of diseases.

[Key words] Pregnancy with ovarian cyst;Diagnosis;Treatment;Pregnancy operation;Single-port laparoscopy

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通讯作者

卵巢肿块是妇科的常见疾病之一，但妊娠期间合并卵巢肿块的情况相对少见。随着产检B 超的普及和生育年龄的增加，妊娠合并卵巢肿块的发病率和检出率都在不断上升，将近1%的孕妇在孕期被诊断为合并卵巢肿块[1]，且其中良性囊肿占95%～99%。关于妊娠合并卵巢囊肿的总体发病率，不同报道差异较大，约为0.15%～5.7%[2]。因缺乏充足的临床治疗经验，且目前尚无国际公认的临床指南，关于妊娠合并卵巢囊肿的治疗仍存在较多争议。尽管它的诊疗思路与非孕期有相似之处，但仍需考虑妊娠这一特殊状态对诊疗带来的影响。妊

娠合并卵巢囊肿的患者中有65% ~ 80%无明显临床症状

[3]

。大部分患者在孕早期或孕中期行产检

B 超时意外发现肿块。也有部分患者因腹痛等症状就诊。美国妇产科医师学会（ACOG，American college of obstetricians and gynecologists）已于2016年推出了针对附件肿块的最新诊疗指南，但目前仍没有适用于妊娠合并卵巢肿块的诊疗指南。1 病理类型

妊娠早期发现的卵巢来源肿块主要为功能性囊肿，如黄体囊肿、滤泡囊肿等。功能性囊肿常于孕14～16周后自行消退。故孕16周后最常见的