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中华诊断学电子杂志 ›› 2023, Vol. 11 ›› Issue (02) : 128 -132. doi: 10.3877/cma.j.issn.2095-655X.2023.02.012

妇产疾病诊治

卵巢重度水肿的诊断学特征分析
柳发勇1, 杨阳2, 张功学2,(), 邱珊3, 齐峰2, 常欢1   
  1. 1. 441200 枣阳市第一人民医院妇科
    2. 441200 枣阳市第一人民医院病理科
    3. 441200 枣阳市第一人民医院手术室
  • 收稿日期:2022-05-26 出版日期:2023-05-04
  • 通信作者: 张功学
  • 基金资助:
    襄阳市科技向医疗卫生领域科技计划项目(2022YL49A); 枣阳市科学技术和经济信息化局卫生项目(202107)

Diagnostic characteristics of massive ovarian edema

Fayong Liu1, Yang Yang2, Gongxue Zhang2,(), Shan Qiu3, Feng Qi2, Huan Chang1   

  1. 1. Department of Gynecology, the First People′s Hospital of Zaoyang, Zaoyang 441200, China
    2. Department of Pathology, the First People′s Hospital of Zaoyang, Zaoyang 441200, China
    3. Operating Room, the First People′s Hospital of Zaoyang, Zaoyang 441200, China
  • Received:2022-05-26 Published:2023-05-04
  • Corresponding author: Gongxue Zhang
引用本文:

柳发勇, 杨阳, 张功学, 邱珊, 齐峰, 常欢. 卵巢重度水肿的诊断学特征分析[J]. 中华诊断学电子杂志, 2023, 11(02): 128-132.

Fayong Liu, Yang Yang, Gongxue Zhang, Shan Qiu, Feng Qi, Huan Chang. Diagnostic characteristics of massive ovarian edema[J]. Chinese Journal of Diagnostics(Electronic Edition), 2023, 11(02): 128-132.

目的

探讨卵巢重度水肿的诊断学特征。

方法

回顾性分析2017年1月至2022年1月枣阳市第一人民医院妇科收治的经病理确诊的4例卵巢重度水肿患者的临床资料,并进行文献复习。

结果

4例患者年龄16~28岁,均有不同程度下腹盆腔痛;妇科超声提示附件区或盆腔低回声包块;3例患者妇科肿瘤标记物检查正常;2例行生殖激素检测,1例诊断为多囊卵巢综合征;4例患者行腹腔镜/剖腹探查术,术中见包块为卵巢增大、肿胀伴扭转,颜色呈瓷白色、淡红色、暗红色不等,卵巢质地坚韧有弹性,切面可见水肿液或血性液体渗出,术中快速冰冻病理检查提示良性病变,术后常规病理检查见不同发育阶段卵泡,水肿区血管、淋巴管显露。

结论

卵巢重度水肿患者年轻,绝大部分与卵巢扭转相关,结合病史、术前检查,快速冰冻病理检查指导手术方式意义重大。

Objective

To investigate the diagnostic features of massive ovarian edema(MOE).

Methods

The clinical data of 4 patients with MOE were retrospectively analyzed, which were diagnosed by pathological diagnosis in the First People′s Hospital of Zaoyang from January 2017 to January 2022. The corresponding literatures were reviewed, simultaneously.

Results

Four patients, 16 to 28 years old, had varying degrees of lower abdominal pelvic pain. All patients underwent ultrasound examination, and gynecological ultrasound showed hypoechoic mass in the annex area or lower abdominal pelvic cavity. Gynecological tumor markers were normal in 3 cases. Two cases underwent reproductive hormone testing, and 1 case was diagnosed with polycystic ovary syndrome. Four patients underwent laparoscopy or laparotomy procedure. The mass was seen as enlarged and swollen ovary with torsion during operation, and the color was porcelain white, pale red, or dark red, the ovary was tough and elastic, and edema fluid or bloody fluid exudation could be seen on the section. Benign lesions were found through intraoperative frozen section examination. Follicles at different developmental stages were found in the postoperative routine pathological examination, and blood vessels and lymphatic vessels were exposed in the edema area.

Conclusions

The patients with MOE are young and related to ovarian torsion. Combination of the medical history, preoperative examination, and intraoperative frozen section examination plays an important role in guiding the surgical procedure.

表1 4例MOE患者临床资料
序号 年龄(岁) 临床表现 超声检查 干预时间及手术方式
1 16 下腹隐痛1月余,无发热 子宫后方见一85 mm×48 mm稍低回声团块,边界清,未见异常血流信号,右下腹见5 mm液性暗区。见图1 症状出现1月后复查包块不消,腹腔镜探查,右侧附件区包块增大,呈瓷白色,表面皱缩、质硬,右侧附件以输卵管间质部、卵巢固有韧带为蒂旋转3圈。术中切除少许卵巢组织快速病检提示良性。行右附件切除术
2 18 右下腹剧痛2 d,无发热 右附件区包块68 mm×56 mm稍低回声团块,边界清,见少许血流信号,腹腔见15 mm液性暗区 入院后行急诊剖腹探查术,右侧附件以输卵管间质部、卵巢固有韧带为蒂旋转2周,切开卵巢皮质,见卵巢内混杂暗红色血凝块,质硬,见囊肿囊壁。行卵巢部分切除术+出血病灶清除术
3 21 右下腹剧痛2 d,无发热。多毛、痤疮体征 右附件区包块65 mm×58 mm稍低回声团块,边界清,见少许血流信号,直肠子宫陷凹见15 mm液性暗区 入院腹痛稍缓解,3 d后剖腹探查术,术中见:左侧卵巢稍增大,表面光滑质韧;右侧附件区包块增大,表面光滑,呈瓷白色充血,质韧,右侧附件以输卵管间质部、卵巢固有韧带为蒂旋转2圈,切开卵巢皮、髓质,见卵巢内混杂暗红色出血灶,未见囊肿囊壁,切面渗出多。行卵巢楔形切除术
4 28 下腹剧痛2 d,孕20 w,无发热 盆腔右侧巨大包块97 mm×165 mm×189 mm稍低回声团块,边界清,未见异常血流信号,腹腔见25 mm液性暗区 入院2 d后完善检查行剖腹探查术,术中见:腹腔暗红色积液800 ml;右侧盆腔巨大包块暗褐色、质韧,表面光滑,娩出瘤体探查为右侧卵巢(22 mm×18 mm×11 mm),以卵巢固有韧带、输卵管间质部为蒂旋转2圈。行右附件切除术
图1 病例1 MOE患者附件包块超声图像注:子宫后方见一85 mm×48 mm稍低回声团块,边界清,未见异常血流信号,可见卵泡样回声(箭头所示)
图2 MOE患者卵巢大体检查图像注:a图为病例1腹腔镜术后标本,外观呈瓷白色,质地质硬;b图为病例2术中标本,外观呈瓷白色,表面皱缩;c图为病例3术中剖视标本,外观肿胀,切面水肿液渗出;d图为病例4术中剖视标本,卵巢增大、肿胀,切面质地均匀,见血性液体渗出
图3 MOE患者卵巢病理学检查图像注:a图可见不同发育阶段卵泡(箭头所示)(HE ×40);b图水肿区可见血管、淋巴管显露(箭头所示)(HE ×100)
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