| Objective:To summarize and analyze the clinical characteristics, diagnosis, treatment and relapse of borderline ovarian tumors, analyze the value of frozen section in diagnosis of BOT, analyze the omental implantation rate, explore the significance of omentectomy, provide a basis for intraoperative decision-making.Methods:This study collected 92 patients who diagnosis of borderline ovarian tumors in Qilu Hospital of Shandong University Department of Obstetrics and Gynecology from 2007 January to 2014 December.Statistically analysis the clinical manifestation, surgery, follow up the recurrence, menstruation and pregnancy after fertility preserving surgery.Statistical analysis was performed by using SPSS 20 software. P<0.05 shows statistically significant.Results:1. The clinical characteristics:The mean age was 37.21±14.17.34%(25/74) patients had abdominal pain and distension of the the 74 initial treatment patients.24% (18/74) patients had no syptom just found pelvic mass when they had physical examination. The histological type:Serous borderline tumor in 55 cases (59.8%), mucinous borderline tumors in 35 cases (38%), other types of borderline tumors in 2 cases, all of them are endometriod borderline tumors (3.2%). According to the 2013 FIGO staging,73 patients were stage Ⅰ (79.5%),9 patients were stage Ⅱ (9.8%),10 patients were stage Ⅲ (10.7%).2. Serum CA-125 and ultrasound:92 cases underwent surgical treatment.84 patients had detection of serum CA-125,59 cases (64.1%) had positive result. The mean level is 132.14±240.84 U/ml± 74 cases were examined by ultrasound,66.2%(49/74) were considered as cystic solid mass,33.8%(25/74) were considered as a cystic mass. 24.3%(18/74) patients detected papillary structure,44.6%(33/74) with blood flow signal.3. Frozen section (FS):For total type, SBOT and MBOT, the coincidence rate between FS and paraffin section (PS) was 89.13%,94.5%,71.43%. The pathological type is the only factor who affect coincidence rate between FS and PS; SBOT compared with MBOT, the coincidence rate is high (94.5%VS 71.43%), the difference was statistically significant (P=0.043).Age, tumor diameter, the level of CA-125 and whether double side tumor or not which does not affect the coincidence rate.4. Omentectomy:58 cases of patients with different degree of omentum resection,9 cases (15.5%) had omental implants. Of which 7 (12.5%), cases underwent omental biopsy, and found no omental implant.17 (31.5%) patients underwent partial omentum resection,3 cases had omental implants,34 (63%) patients with under colon omentectomy,6 cases were found with omental implants.A comparison between macroscopic and microscopic evaluation of omentum had a high coincidenc (P=0.001). Ovarian surface implants were related to omental implants (P=0.002), and the age, tumor size, tumor pathological type, the degree of omentum resection were not the factors associated with omentum implants.5. Follow up:43 of 58 patients who underwent fertility preserving surgery, with complete follow-up (74.1%) for 3-84 months, median follow-up time 18 months.11 cases of patients with pregnancy plan, a total number of 6 pregnancies,1 cases of tubal pregnancy, live birth in 3 cases,2 cases are under pregnant, the total pregnancy rate was 55%. The pregnancy rate of laparoscopic group and laparotomy group were 50%(3/6)and 60%(3/5), the mean time for pregnancy after surgery were 11 ±4.72 and 16 ±4.35 months, the mean time of menstrual recovery were 2.06±1.05 and 2.53 ±9.54 months. The pregnancy outcome comparison between the two groups had no statistical difference. Tumor free survival rate was 100%.2 patients developed with recurrence, the recurrence rate was 4.6%.Conclusion:1.The coincidence rate between FS and PS of MBOT is lower than SBOT, pathologists and surgeons need to be vigilant.2.Omental implants appear in stage ⅡB-Ⅲ patients, patients in stage I who had macroscopic normal omentum may ignore omentectomy. |
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