Management of adnexal masses in pregnancy: analysis of 27 cases and review of the literature

Yıl 2008, Cilt: 39 Sayı: 2, 55 - 61, 01.03.2008

Samet Topuz Ahmet Cem İyibozkurt Süleyman Engin Akhan Sinan Berkman Ergin Bengisu

Öz

The incidence of adnexal masses in pregnancy is approximately 1%. Most of them are corpus luteum and benign physiological cysts seen in first trimester. 90% of these cysts are resolved spontaneously in the second trimester. The rate of complication such as torsion and rupture in persisted cysts is about 25%. The risk of malignancy is between 2-5%. It is reasonable to perform surgery in cysts with high risk of malignancy or in cysts susceptible to complication, other masses can be treated conservatively. Suitable time for surgery is between 16th and 18th weeks of gestation. The traditional method of management of adnexal masses in pregnancy is laparatomy but in certain conditions laparoscopy can be performed. Most of the ovarian cancers detected inpregnacy are germ cell tumors and these can be operated conservatively. In this paper management of adnexal masses in pregnancy, difficulties in diagnosis, treatment methods and timing were mentioned. Besides that, 27 adnexal masses diagnosed during pregnancy in our clinic were analyzed under the view of the literature. i

Anahtar Kelimeler

Pregnancy, Pregnancy Complications, Adnexal Diseases, Prevalence, Diagnosis, Therapy

Gebelikte adneksiyel kitleye yaklaşım: 27 olgunun analizi ve literatürün gözden geçirilmesi

Öz

Gebelikte adneksiyel kitle görülme sıklığı %1 civarındadır. Bunların çoğu ilk trimesterde görülen korpus luteum ve fizyolojikfolükül kistleridir. Yüzde doksanı gebeliğin 2. trimesterinde kaybolurlar. Persiste eden kistlerde torsiyon, rüptür gibi komplikasyon çıkarma olasılığı % 25 civarındadır. Malignite görülme olasılığı ise %2-5 arasındadır. Komplikasyon çıkaracağı düşünülen veya malignite riski yüksek kitlelere cerrahi yapmak mantıklı gözükmektedir, diğer kitleler konzervatif izlenebilir. Elekti/ cerrahi için uygun hafta gebeliğin 16-18 haftalarıdır. Gebelik ve adneksiyel kitleye cerrahi yaklaşımda geleneksel yöntem laparatomidir. Ancak laparoskopik girişim belli kurallara uyulursa, uygun bir yöntem olabilir. Gebelikte görülen over kanserlerinin çoğu germ hücreli tümörlerdir bu olgularda konzervatif cerrahi uygulanabilir. Bu yazıda gebelikte görülen adneksiyel kitleye yaklaşım tanıda karşılaşılan güçlükler, tedavi yöntemi ve zamanlamasından bahsedilmiş, ayrıca kliniğimizde gebelikte saptadığımız 27 adneksiyel kitlenin analizi literatür eşliğinde yapılmıştır.

Anahtar Kelimeler

Gebelik, Gebelik komplikasyonları, Adneksa hastalıkları, Yaygınlık, Tanı, Tedavi

Kaynakça

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