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【医学PPT课件】卵巢成熟畸胎瘤695例报道

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医学PPT课件 卵巢成熟畸胎瘤695例 卵巢成熟畸胎瘤
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单击此处编辑母版标题样式 单击此处编辑母版副标题样式 **1 卵巢成熟畸胎瘤695例报道 •北京协和医院妇产科 •龚晓明 冷金花 郎景和 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 病例来源及方法 •我院1990年~2000年间住院的卵巢成熟 畸胎瘤病例695例。 •建立病例的数据库,并对其进行统计分 析。 2卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 结果分析 •患者的一般资料 •病史分析 •辅助检查分析 •手术情况分析 •肿瘤的情况 3卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 占卵巢良性肿瘤的比例 4卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 畸胎瘤年龄分布图 平均年龄为32.4±10.2(4岁~76岁),最高峰年龄出现在26岁。20~40岁之间的病例占总 数的72.3%。绝经后占总例数的4.2% 5卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 孕产次分析 •平均孕次1.5次(0~8次) •产次0.6次(0~7次) 6卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 病 史 7卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 合并妊娠情况 •合并妊娠者73例(10.3%)。 •其中43例为早孕或其它异常妊娠行流产时无意发现。 •16例有生育要求: –2例在孕期未行处理,在剖宫产同时行畸胎瘤剔除术 –3例在阴道分娩后行畸胎瘤剔除术; –11例均在孕12~25周之间行开腹畸胎瘤剔除术,4例术后 失访,其余7例均足月顺娩。 •14例患者在分娩前未诊断,在剖宫产术中发现。 –13无症状 –1例孕期有下腹部疼痛,误诊为坐骨神经痛。 8卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 辅助检查的结果--X线 •695例中有335例(48.2%)患者行X线检查 。 •阳性率63.3%,阳性者中 –有软组织影19.8% –以钙化(不包括骨影)为表现的有67.9% –有骨影的有18.6% 9卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 辅助检查的结果--B超 •508例(74.2%)术前进行了超声检查。 •超声的表现中以混合回声的包块最为常 见,占82.3%。 •B超声检查中67.7%在术前即能诊断或提 示为畸胎瘤。 10卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 肿瘤标记物阳性率 标记物检查例数阳性例数阳性率% αFP 8111.2 βhCG 65 11.5 CA125 14328 *19.6% *其中有1例合并巧囊,5例合并子宫肌瘤。最高者可达188u/ml 。 11卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹腔镜手术vs开腹手术 •近10年中腹腔镜手术(45.4%)和开腹 手术(54.4%)各约占一半 •但是腹腔镜手术所占的比率逐年升高 12卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 开腹手术、腹腔镜手术所占的比例 13卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 平均住院日的变化 14卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹腔镜手术与开腹手术的比较 开腹手术术腹腔镜镜手术术P值值 平均住院日(天)11.5±5.77.6±3.8 0.05 正常3.8 X光片是 否阳性 是1.40.05 否 6.1 X光片上 见钙化影 是7. 30.05 否2.6 合并妊娠 是6.80.05 否7.6 28卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 扭转相关因素的分析 (2) 项目值扭转发生率P值 位置 左6.4 0.05 右6.9 单侧/双侧 单侧6.50.030 双侧 13.4 X光片上 见钙化影 是7. 30.05 否2.6 病理检查 见骨质 是13.90.015 否6.4 29卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 复发性畸胎瘤 •共36例,占全部695例的5.2%。 •观察术后复发时间平均为8.1年(1.5~ 21年)。 30卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 随访的复发率 31卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 复发率和手术方式的关系 •开腹手术(6.0%)与腹腔镜手术相当( 4.8%)(P0.05) •单侧的肿瘤:一侧肿瘤剔除术( 2.2% ),与一侧卵巢切除术(5.0%)相当( P0.05) •术中对侧卵巢肉眼未见异常:未行剖探 者术后22例无一例复发,行对侧剖探术 的复发率为2.1%(P0.05) 32卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 复发和肿瘤其它因素的关系 •位置:双侧肿瘤(25.8%)单侧肿瘤(1.7%) •房数:多房肿瘤(13.7%)单房肿瘤(2.7%) •肿瘤成份:含骨质(20.0%)不含骨质(4.1%) 33卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 术后妊娠情况 •开腹手术不孕发生率(3.2%)低于腹腔 镜不孕症发生率(21.7%),但P0.05 。 •对侧卵巢肉眼未见异常时,是否行剖探 术,术后两者妊娠率无统计学差别。 34卵巢成熟畸胎瘤695例临床分析 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 **35 讨 论 • Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹腔镜手术在畸胎瘤处理中的地位 随着腹腔镜技术的日益发展,腹腔镜已经 成为处理卵巢成熟畸胎瘤的主要方法。从我们 的病例总结中可以看出,腹腔镜手术无论是在 缩短住院日,缩短手术时间,减少手术出血量 上均要优于开腹手术;而在手术并发症上无明 显差别。 除此以外,腹腔镜还具有患者痛苦小,术 后恢复快的特点。 36卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 腹腔镜术后妊娠率低 •腹腔镜组术后不孕的发生率要较开腹手 术高(21.7%和3.7%),尽管由于受例 数的限制,两者无明显的统计学差异, 但是有必要对这一个问题作进一步的研 究。如果确实证实有影响,估计可能是 与腹腔镜术中电刀的使用对卵巢的功能 产生一定影响的结果。 37卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 对侧剖探是否必要? 从我们的病例总结看,在术中如对 侧卵巢肉眼未发现异常而行剖探术,阳 性率仅为0.22%,而是否剖探术后复发 率和妊娠率无差别。在剖探对侧时对卵 巢所造成的损伤(电刀的效应以及卵巢 部分切除)是否会对患者今后卵巢功能 造成影响未知的情况下,没有必要为了 这一罕见的情况行剖探术。 38卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 并发症的问题 •扭转是主要的并发症(7.5%) •扭转与肿瘤大小有明确的关系,当肿瘤 最大径在8cm以上时,扭转的发生率超 过10%。 •小于6cm时,扭转概率小于4.4% •二次手术的时机? 39卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 结 论 •腹腔镜手术在处理卵巢成熟畸胎瘤上要 明显优于开腹手术。 •对于手术中对侧卵巢肉眼未见异常者, 以后是否可以考虑不再行常规剖探术。 •诊断明确的无症状的畸胎瘤,6cm以下 者发生扭转的概率小于5%,可以考虑延 期手术。 40卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 41卵巢成熟畸胎瘤695例临床分析 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 42卵巢成熟畸胎瘤695例临床分析
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