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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2023, Vol. 19 ›› Issue (06) : 696 -702. doi: 10.3877/cma.j.issn.1673-5250.2023.06.011

论著

卵巢子宫内膜异位囊肿发生恶变并发盆腔脓肿1例并文献复习
魏丽坤1, 张旭红1, 罗营1, 薛凤霞1, 王颖梅1, 宋学茹1, 田丽娜1, 张艳芳1, 王艳霞1, 田文艳1,†()   
  1. 1. 天津医科大学总医院妇产科，天津市女性生殖健康与优生重点实验室，天津　300052
  • 收稿日期:2023-11-01 修回日期:2023-11-17 出版日期:2023-12-01
  • 通信作者: 田文艳

Malignant transformation of ovarian endometrioma and pelvic abscesses: a case report and literature review

Likun Wei1, Xuhong Zhang1, Ying Luo1, Fengxia Xue1, Yingmei Wang1, Xueru Song1, Lina Tian1, Yanfang Zhang1, Yanxia Wang1, Wenyan Tian1,†()   

  1. 1. Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin 300052, China
  • Received:2023-11-01 Revised:2023-11-17 Published:2023-12-01
  • Corresponding author: Wenyan Tian
  • Supported by:
    National Natural Science Foundation of China(82171629); Tianjin Key Medical Discipline (Specialty) Construction Project(TJYXZDXK-031A)
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魏丽坤, 张旭红, 罗营, 薛凤霞, 王颖梅, 宋学茹, 田丽娜, 张艳芳, 王艳霞, 田文艳. 卵巢子宫内膜异位囊肿发生恶变并发盆腔脓肿1例并文献复习[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(06): 696-702.

Likun Wei, Xuhong Zhang, Ying Luo, Fengxia Xue, Yingmei Wang, Xueru Song, Lina Tian, Yanfang Zhang, Yanxia Wang, Wenyan Tian. Malignant transformation of ovarian endometrioma and pelvic abscesses: a case report and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(06): 696-702.

目的

探讨卵巢子宫内膜异位囊肿(OMA)发生恶变体外受精-胚胎移植(IVF-ET)治疗后孕妇并发盆腔脓肿的临床特征及风险。

方法

选择2017年1月天津医科大学总医院妇产科收治的1例右侧OMA发生恶变并发盆腔脓肿IVF-ET助孕孕妇(患者1)为研究对象。采取回顾性分析法，分析患者1(31岁)的病史、本次诊治过程及预后等。以"卵巢子宫内膜异位囊肿恶变""体外受精-胚胎移植""盆腔脓肿""育龄期"为中文关键词，以"malignant transformation of ovarian endometrioma""in vitro fertilization and embryo transfer""pelvic abscesses""reproductive age"为英文关键词，在中国知网数据库、万方数据知识服务平台及PubMed文献数据库中，检索OMA发生恶变孕妇并发盆腔脓肿相关研究文献。本研究符合天津医科大学总医院伦理委员会制定的伦理学标准(审批文号：IRB2023-WZ-156)，患者1对诊断及治疗均知情同意。

结果

①对患者1采取全子宫切除术＋双附件切除术＋大网膜切除术＋盆腔及腹主动脉旁淋巴结清扫术后，被诊断为右侧OMA恶变(子宫内膜样腺癌ⅡB期)、盆腔脓肿。患者1术后并发不全性肠梗阻、中度贫血、低蛋白血症及药物性肝损伤等并发症，经治疗于术后7周出院。对患者1术后采取多西他赛＋卡铂方案化疗6个周期，目前随访6.5年右侧卵巢子宫内膜样腺癌无复发。②按照本研究制定的文献检索策略进行文献检索结果显示，未检索到关于育龄期女性OMA恶变并发盆腔脓肿相关研究的文献报道。

结论

临床医师应警惕育龄期女性OMA恶变可能，对OMA应早诊断，以避免患者进入IVF-ET周期后，发生OMA恶变并发盆腔脓肿。对OMA患者应积极预防IVF-ET助孕后盆腔脓肿风险。多学科团队协作在该病患者的诊疗中具有积极作用。

关键词: 子宫内膜异位症, 卵巢子宫内膜异位囊肿, 育龄期, 盆腔脓肿, 体外受精, 胚胎移植, 多学科团队, 女性
Objective

To explore the clinical characteristics and risks of ovarian endometrioma (OMA) malignancy complicated with pelvic abscess in pregnant women after in vitro fertilization-embryo transfer (IVF-ET) treatment.

Methods

A retrospective analysis was conducted on a case of a 31-year-old pregnant woman with malignant transformation of right OMA complicated with pelvic abscess after IVF-ET assisted reproduction (patient 1) admitted to the Obstetrics and Gynecology Department of Tianjin Medical University General Hospital in January 2017. The medical history, diagnosis and treatment process, and prognosis of patient 1 were analyzed. The relevant research literature on OMA malignancy complicated with pelvic abscess in pregnant women was retrieved using the keywords " malignant transformation of ovarian endometrioma" " in vitro fertilization and embryo transfer" " pelvic abscesses" and " reproductive age", in both Chinese and English in the CNKI, Wanfang Data Knowledge Service Platform, and PubMed database. This study complied with the ethical standards formulated by the Ethics Committee of Tianjin Medical University General Hospital (Approval No. IRB2023-WZ-156). Informed censent was obtained from patient 1.

Results

① After undergoing total hysterectomy + bilateral salpingo-oophorectomy + omentectomy + pelvic and para-aortic lymph node dissection, Patient 1 was diagnosed with malignant transformation of right OMA (endometrioid adenocarcinoma stage ⅡB) and pelvic abscess. Patient 1 developed complications such as incomplete intestinal obstruction, moderate anemia, hypoalbuminemia, and drug-induced liver injury after surgery, and was discharged from the hospital after 7 weeks of treatment. Patient 1 received six cycles of chemotherapy with docetaxel + carboplatin after surgery, and follow-up for 6.5 years showed no recurrence of right ovarian endometrioid adenocarcinoma. ② According to the literature retrieval strategy developed in this study, no literature reports were found on the study of OMA malignancy complicated with pelvic abscess in women of reproductive age.

Conclusions

Clinicians should be alert to the possibility of OMA malignancy in women of reproductive age, and early diagnosis of OMA should be made to avoid the occurrence of OMA malignancy complicated with pelvic abscess after patients enter the IVF-ET cycle. Patients with OMA should actively prevent the risk of pelvic abscess after IVF-ET assisted reproduction. Multidisciplinary team collaboration plays an active role in the diagnosis and treatment of these patients.

Key words: Endometriosis, Ovarian endometrioma, Reproductive age, Pelvic abscesses, Fertilization in vitro, Embryo transfer, Multi-disciplinary team, Female
图1　患者1影像学检查结果[图1A：IVF-ET前经阴道超声示右附件区多房囊性包块，大小为5.7 cm×7.1 cm×6.3 cm；图1B：盆腔MRI结果显示宫旁右侧多房囊性包块(红色箭头所示)]　 图2　患者1盆腔病灶照片图[图2A：右侧卵巢肿物(6.0 cm×6.0 cm×6.0 cm)，与子宫紧密黏连(红色箭头所示)；图2B：右侧卵巢切面为多房分隔，其内为黄色脓性恶臭液体，右侧卵巢内可见部分区域呈实性，组织糟脆，并发出血及坏死]　 图3　患者1右侧卵巢内实性区域组织病理学检查结果(右侧卵巢子宫内膜异位囊肿恶变，呈高分化子宫内膜样癌)(HE染色，低倍) 注：患者1为右侧卵巢子宫内膜异位囊肿恶变并发盆腔脓肿，31岁，女性，G1P1。IVF-ET为体外受精-胚胎移植，HE为苏木精-伊红
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