张菲菲　　崔春燕　　张传厚　　杨延冬

[关键词] 孕晚期;妊娠;卵巢肿瘤;扭转

[中图分类号] R714.25          [文献标识码] C          [文章编号] 1673-9701（2021）21-0148-03

A case report of late gestation combined with ovarian tumor torsion

ZHANG Feifei   CUI Chunyan   ZHANG Chuanhou   YANG Yandong

Department of Obstetrics and Gynecology， Affiliated Hospital of Binzhou Medical University， Binzhou   256600， China

[Abstract] Most of the ovarian tumors during pregnancy occur in early gestation， and the incidence gradually decreases with the increasing of gestational age. Torsion is a common complication of ovarian tumor， which refers to the anatomical displacement of the ovary， ovarian tumor， fallopian tube along with the infundibulopelvic ligament. Ovarian tumor torsion during pregnancy mostly occurs in early pregnancy， and rarely occurs in late pregnancy. Due to the atypical clinical symptoms， the diagnosis mainly depends on clinical experience and comprehensive evaluation， which is prone to misdiagnosis and missed diagnosis. Treatment of ovarian tumors during pregnancy should be based on the gestational age， the size of the tumor， clinical manifestations， and the risk of surgical intervention， etc. Emergency surgery is required at any gestational age due to acute abdominal pain caused by torsion or rupture。This paper reports a case of a pregnant woman，who was admitted to the hospital at 36+2 weeks of gestation due to lower abdominal pain. Considering the possibility of ovarian tumor torsion in late gestation， emergency surgery was performed. The patient recovered well after surgery， and the neonate grew well.

[Key words] Late gestation; Gestation; Ovarian tumor; Torsion

卵巢肿瘤是常见的女性生殖系统肿瘤，可发生于包括育龄期在内的任何年龄段女性。随着辅助生殖技术的应用及超声检查技术的进步，妊娠合并卵巢肿瘤的发生率较前增加，其中大部分为生理性卵巢囊肿和良性肿瘤，良性肿瘤以成熟性囊性畸胎瘤及浆液性囊腺瘤居多。妊娠期卵巢肿瘤的并发症主要包括扭转、破裂、产道梗阻和恶变，其中扭转最为常见。一半以上的扭转发生于妊娠早期，随着孕龄增加，卵巢肿瘤扭转的风险降低，扭转发生于妊娠晚期者较为少见。因临床症状不典型，其诊断主要依赖于临床经验及综合评估，易发生误诊及漏诊。妊娠期卵巢肿瘤的治疗方案应根据诊断时的孕龄、肿瘤大小及性质、临床表现、手术干预的风险等综合制订，由于扭转、破裂引起的急性腹痛，在任何孕龄都需紧急手术。本文报道1例晚期妊娠合并卵巢肿瘤扭转患者，因可疑早产临产入院，入院彩超未提示卵巢肿瘤，经仔细查体，结合早孕期超声检查结果，提出可疑诊断，及时进行手术，避免了卵巢坏死。

1病例资料

患者30岁，孕2产1，末次月经2020年4月22日，自然受孕，孕36+2周因下腹痛3 h急诊入院，不能直立行走，家属搀扶就诊，拟诊早产临产。自述自晨起持续性下腹剧痛，无间歇，无阴道流血流液。查体：生命体征平稳。腹软，未触及明显宫缩。宫高：30 cm，腹围：95 cm，头先露，胎心：150次/min，宫口未开，宫颈管长1.5 cm，居中，质中，先露-3。……